Privacy Policy
Theranostix Inc.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU AND HEALTH CARE PROVIDERS CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Pledge Regarding Patient Health Information
We understand that health information pertaining to each patient whose health information is provided to us for testing (each a “Patient” and collectively, the “Patients”) is personal and we are committed to protecting the privacy of such information. We are committed to protecting the confidentiality of Patients’ laboratory test results and other patient protected health information (PHI) that we collect or create as part of our diagnostic testing activities.
How We May Use and Disclose Health Information
The following categories describe different ways that we may use and disclose health information. For each category of uses or disclosures we will explain what we mean, and in some cases, give examples. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose information will fall within one of the categories. Information may be disclosed in writing, orally, by facsimile, or electronically.
• For Treatment. We will use and disclose Patient health information to provide, coordinate, or manage Patient health care and any related services. We may disclose Patient information to doctors, nurses, technicians and other personnel who are involved in the Patient’s care. For example, we may disclose Patient health information to physicians who may be treating the Patient or consulting with respect to the Patient’s care. In some cases, we may also disclose Patient health information to an outside treatment provider for purposes of the treatment activities of the other provider.
• For Payment. We may use and disclose Patient health information so that we can bill and collect payment for the tests we perform on behalf of the Patient. For example, we may provide health information to a Patient’s insurance company relating to tests we perform on behalf of the Patient so that they will pay us or reimburse the Patient. We may also tell a Patient’s insurance company about a test we are going to perform to obtain prior approval or to determine whether such Patient’s insurance company will cover the test.
• For Health Care Operations. We may use and disclose Patient health information for operational purposes. For example, Patient health information may be disclosed to members of our medical staff, risk or quality improvement personnel, and others to:
• evaluate the performance of our staff;
• learn how to improve our services; or
• determine how to continually improve the quality and effectiveness of the tests we provide.
• Business Associates. We may contract with certain business associates to perform operational tasks on our behalf. An example of a business associate would be a third party that we contract with to provide billing and collection services on our behalf. In connection with the services to be provided by a business associate, we may disclose Patient health information to the business associate so that such business associate is able to perform the tasks that we have contracted with them to provide. However, we require that each of our business associates appropriately protects and safeguards any health information received from us.
• Research. Under certain circumstances, we may use and disclose Patient health information for research purposes. For example, we may release Patient health information to researchers preparing to conduct a research project who need to know how many patients have a specific health problem. We may use Patient health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of Patient health information has approved the research.
• As Required By Law. We will disclose Patient health information when required to do so by applicable law.
• Health Oversight Activities. We may disclose Patient health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
• Lawsuits and Disputes. If a Patient is involved in a lawsuit or a dispute, we may disclose health information about the Patient in response to a court or administrative order. We may also disclose Patient health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell the Patient about the request or to obtain an order protecting the information requested.
• Law Enforcement. We may release Patient health information if asked to do so by a law enforcement official:
in response to a court order, subpoena, warrant, summons or similar process;
• to identify or locate a suspect, fugitive, material witness, or missing person;
• about the victim of a crime, under certain limited circumstances, if we are unable to obtain the person’s agreement;
• about a death we believe may be the result of criminal conduct;
• about criminal conduct at our practice; or
• in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
• Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
• National Security and Intelligence Activities. We may release health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
• Protective Services for the President and Others. We may disclose health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
• Department of Health and Human Services. We may disclose health information when required by the Secretary of the United States Department of Health and Human Services for purposes of an investigation or determination regarding our compliance with the federal privacy rule.
OTHER DISCLOSURES AND USES OF HEALTH INFORMATION
Other uses and disclosures of Patient health information not covered by this Notice or the laws that apply to us will be made only with written permission from the Patient. If a Patient provides us permission to use or disclose health information, the Patient may revoke that permission, at any time, by providing us written notice of such revocation. If a Patient revokes his or her permission, we will no longer use or disclose health information about the Patient for the reasons covered by the Patient’s written authorization. Patient understands that we are unable to take back any disclosures we have already made with Patient’s permission, and that we are required to retain our records of the tests we have conducted on Patient’s behalf.
Patient RIGHTS REGARDING HEALTH INFORMATION
Patient has the following rights regarding health information we maintain about Patient:
• Right to Inspect and Copy. Patient has the right to access, inspect and/or obtain a copy of Patient’s health information that is maintained by or for us.
To access, inspect and/or obtain a copy of Patient’s health information, Patient must complete and submit to us a written request for his or her health information. If Patient requests a copy of Patient’s health information, we may charge a fee that will not exceed (i) a retrieval fee of $15 and a copying fee of $.25 per page (which copying fee shall not apply to the first ten (10) pages copied), and (ii) actual postage costs, as applicable.
We may deny a Patient’s request to access, inspect and/or copy Patient’s health information in certain very limited circumstances. If we deny a Patient’s request, Patient may request that the denial be reviewed. Another licensed medical care professional chosen by us will review Patient’s request and the denial. The person conducting the review will not be the person who denied the Patient’s request. We will comply with the outcome of the review.
• Right to Amend. If a Patient feels that health information we maintain about him or her is incorrect or incomplete, the Patient may ask us to amend the information. Patient has the right to request an amendment for as long as the information is maintained by or for us.
To request an amendment, Patient must complete and submit to us a written request for amendment which includes the reason that supports the Patient’s request for the amendment.
We may deny a Patient’s request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny a Patient’s request if the Patient asks us to amend information that:
• was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• is not part of the health information kept by or for us;
• is not part of the information which Patient would be permitted to inspect and copy pursuant to the federal privacy rule; or
• is accurate and complete.
• Right to an Accounting of Disclosures. Patient has the right to request an accounting of disclosures made by us of Patient’s health information outside of treatment, payment, and operational purposes (and without an authorization) during the six (6) year period immediately prior to such request (excluding any time period prior to April 14, 2003).
To request an accounting of disclosures, Patient must complete and submit to us a written request for an accounting. The first accounting of disclosures Patient receives from us in a twelve (12) month period will be free. For additional accountings Patient requests from us within the same twelve (12) month period, we may charge Patient for the costs of providing the accounting. We will notify Patient of the cost involved and Patient may choose to withdraw or modify his or her request at that time before any costs are incurred.
• Right to Request Restrictions. Patient has the right to request a restriction or limitation on the health information we use or disclose about Patient for treatment, payment or health care operations. Patient also has the right to request a limit on the health information we disclose about Patient to someone who is involved in Patient’s care or the payment for Patient’s care, like a family member or friend. For example, Patient could ask that we not use or disclose information about a test we performed on behalf of Patient. However, we are not required to agree to Patient’s request. If we do agree, we will comply with Patient’s request unless a use or disclosure is required by applicable law.
To request restrictions, Patient must make his or her request in writing to our President at 5770 Decatur Boulevard, Suite A, Indianapolis, Indiana 46241. In the Patient’s request, the Patient must tell us (i) what information Patient wants to limit; (ii) whether Patient wants to limit our use, disclosure or both; and (iii) to whom Patient want the limits to apply.
• Right to Request Confidential Communications. Patient has the right to request that we communicate with Patient about medical matters in a certain way or at a certain location. For example, Patient can ask that we only contact Patient at work or by mail.
To request confidential communications, Patient must make his or her request in writing to our President at 5770 Decatur Boulevard, Suite A, Indianapolis, Indiana 46241. We will not ask Patient the reason for his or her request. We will accommodate all reasonable requests. Patient’s request must specify how or where Patient wishes to be contacted.
• Right to a Paper Copy of This Notice. Patient has the right to a paper copy of this Notice. Patient may ask us to give Patient a copy of this Notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice, and to make the revised or changed Notice effective for health information we already have about Patient as well as any information we receive in the future. We will post a copy of the current Notice at 5770 Decatur Boulevard, Suite A, Indianapolis, Indiana 46241.
COMPLAINTS
If Patient believes Patient’s privacy rights have been violated, Patient may file a complaint with our practice or with the Secretary of the United States Department of Health and Human Services. All complaints must be submitted in writing.
Patient will not be penalized or retaliated against for filing a complaint with either us or the Secretary of the United States Department of Health and Human Services.
CONTACT PERSON
The contact person for Theranostix Inc. for all issues regarding Patient privacy and Patient rights under the federal privacy standards is our President. Information regarding matters covered by this Notice of Privacy Practices can be requested by contacting us at 5770 Decatur Boulevard, Suite A, Indianapolis, Indiana 46241.
EFFECTIVE DATE
This Notice is effective April 30, 2010.
