Effective Date: 01/21/2019
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (‘Notice”) is effective 01/21/2019.
CQuentia is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to maintain the privacy of health information about you and to provide you with this Notice of our legal duties and Privacy Practices.
CQuentia understands the importance of privacy and is committed to maintaining the confidentiality of your health information. We make a record of your health information, such as the clinical laboratory test results we produce, and we may obtain records related to your medical care from others. We use these records to provide or enable other healthcare providers to provide quality medical care, to obtain payment for services provided, and for administrative and operational purposes. When we use or disclose your health information, we are required to abide by the terms of this Notice and to comply with HIPAA.
You have the following rights with respect to your protected health information:
- Obtain a paper copy of the CQuentia Notice of Privacy Practices upon request. You may request a new copy at any time by contacting the Compliance Department at firstname.lastname@example.org or by calling us at (817) 882-6900 ext. 322.
- Request a restriction on certain uses and disclosures of your information. You have the right to request a restriction on your protected health information (“PHI”). You have the right to request that we limit: 1) how we use and disclose your PHI for treatment, payment and healthcare operations activities; or 2) our disclosure of PHI to individuals involved in your care or payment for your care. CQuentia will consider your request but is not required to agree to it unless the requested restriction involves a disclosure that is not required by law to a health plan for payment or healthcare operations purposes and not for treatment, and you have paid for the service in full out of pocket. If we agree to a restriction on other types of disclosures, we will state the agreed restrictions in writing and will abide by them, except in emergency situations when the disclosure is for purposes of treatment. To request restrictions, you must send a written request to CQuentia’s Chief Compliance Officer at email@example.com.
- Inspect and obtain a copy of your information. You have the right to access and copy PHI about you contained in your medical and billing records for as long as CQuentia maintains the information. To read or copy your PHI, you must send a written request to theChief Compliance Officer at firstname.lastname@example.org. If you request a copy of the information, we may charge you a reasonable fee for the costs of the copying, mailing or other supplies that are necessary for the electronic transfer of your information. If we maintain an electronic health record containing your health information, you have the right to request that we send a copy of your health information in electronic format to you or a third party that you identify. We may deny your request to read and copy in certain limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed by filing a request for review with the CQuentia’s Chief Compliance Officer at email@example.com.
- Amend your information. If you feel that the PHI we have about you is incomplete or incorrect, you may request that we amend the information. You may request an amendment for as long as we maintain your health information. To request an amendment, you must send a written request to CQuentia’s Chief Compliance Officer at firstname.lastname@example.org, you must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision withthe Chief Compliance Officer and we may prepare a rebuttal to your statement, which we will provide to you.
- Receive an accounting of disclosures of your information. You have the right to receive an accounting of certain disclosures we have made of your PHI after the effective date of this Notice. The accounting will exclude disclosures we have made directly to you, disclosures to friends or family members involved in your care, disclosures made pursuant to a valid authorization, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations. To request an accounting, you must submit your request in writing to CQuentia’s Chief Compliance Officer. Your request must specify the time period for which you are seeking an accounting, but it may not be longer than 6 years or the time period permitted by law. The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
- Request communications of your information by alternative means or at alternative locations. To request confidential communication of your PHI, you must submit your request in writing to CQuentia’s Chief Compliance Officer at email@example.com. Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests.
The following categories describe different ways that we may use and disclose your protected health information.
- For Treatment: CQuentia may use or disclose PHI for treatment purposes, including disclosure to physicians, nurses, medical students, pharmacies and other healthcare professionals who provide you with healthcare services and/or are involved in the coordination of your care, such as providing physicians with laboratory test results.
- For Payment: CQuentia may use or disclose PHI to bill and collect payment for laboratory services. For example, a bill may be sent to you or a third-party payor. The information on or accompanying the bill may include information that identifies you.
- For Healthcare Operations : CQuentia may use or disclose PHI for healthcare operation purposes. Members of our staff may use your information and others like it to assess the quality of laboratory testing, accuracy of results and outcomes. This information will then be used in an effort to continually improve the quality and effectiveness of services provided.
- Business Associates: There are some services provided at CQuentia through contracts with business associates. CQuentia may disclose PHI to those business associates to perform certain business functions. To protect your information, CQuentia requires all business associates to appropriately safeguard PHI. Business associates are also directly responsible for compliance with federal security standards and certain provisions of the federal privacy law, to further ensure the protection of PHI.
- Individuals Involved in Your Care or Payment for Your Care: CQuentia may disclose PHI to a person who is involved in your care or helps pay for your care, such as a family member, friend or any other person you identify. As allowed by federal and state law, we may disclose the PHI of minors to their parents or legal guardians.
- Food and Drug Administration (FDA): We may disclose PHI to the FDA, or persons under the jurisdiction of the FDA for purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity such as food, medicines and supplements to enable product recalls, repairs and replacement.
- Public Health: As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability.
- Law Enforcement: CQuentia may disclose PHI for law enforcement purposes as required by law or in response to a court order.
- As Required by Law: CQuentia must disclose your PHI if required to do so by federal, state or local law.
- Health Oversight Activities: CQuentia may disclose PHI to a health care oversight agency for activities authorized by law. These oversight activities include audits, civil, administrative, or criminal investigations and proceedings/actions, inspections, licensure/disciplinary actions; or other activities necessary for appropriate oversight of healthcare system, government programs, and compliance with civil rights laws.
- Judicial and Administrative Proceedings: If you are involved in a lawsuit or dispute, we may disclose your PHI in the course of a judicial or administrative proceeding, including in response to a court or administrative order, subpoena, discovery request, or other lawful process.
- Research: We may disclose your PHI to researchers whentheir research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
- Coroners, Medical Examiners and Funeral Directors: CQuentia may disclose PHI to a coroner, medical examiner or funeral director for the purpose of identifying a deceased person, determining cause of death or for performing some other duty authorized by law.
- Correctional Institution: CQuentia may disclose the PHI of an inmate or other individual when requested by a correctional institution or law enforcement official for health, safety and security purposes.
- Serious Threat to Health or Safety: CQuentia may disclose PHI if necessary to prevent or lessen a serious and/or imminent threat to health or safety to a person or the public or for law enforcement authorities to identify or apprehend an individual.
- Government Functions: In certain situations, CQuentia may disclose the PHI of military personnel and veterans, including Armed Forces personnel, as required by military command authorities. Additionally, we may disclose PHI to authorized officials for national security purposes, such as protecting the President of the United States, conducting intelligence, counter-intelligence, other national security activities, and when requested by foreign military authorities. Disclosures will be made only in compliance with U.S. law.
- Regulatory Compliance: Federal law makes provision for your medical information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a member of our work force or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
- Victims of Abuse or Neglect: CQuentia may disclose PHI about an individual to a government authority, including social services, if we reasonably believe that an individual is a victim of abuse or neglect.
CQuentia may use your PHI to provide legally-required notices of unauthorized access, acquisition or disclosure of your PHI. CQuentia is required to provide patient notification if it discovers a breach of unsecured PHI unless there is a demonstration based on a risk assessment, that there is a low probability that PHI has been compromised.
We will obtain written authorization before using or disclosing your PHI for purposes other than those listed above or as otherwise permitted or required by law.
We will retain all PHI in accordance with legal requirements.
If you have questions or would like additional information about CQuentia’s Notice of Privacy Practices, or have a compliant about our use or disclosure of your PHI please contact: firstname.lastname@example.org, call us at (817) 882-6900 ext. 322. You file a complaint with the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.
CQuentia reserves the right to make changes to this notice and to our privacy policies from time to time. Changes adopted will apply to any PHI we maintain about you. CQuentia is required to abide by the terms of our notice currently in effect. When changes are made, we will promptly update this notice and post the information on the CQuentia website at www.cquentia.com. Please review the website periodically to ensure that you are aware of such updates.
Note Regarding State Law
For all of the above purposes, when state law is more restrictive than federal law, we are required to follow the more restrictive state law.
Effective Date: 01/21/2019