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.
Our principal goal at MicrobiomeDx is to offer high quality healthcare services that meet your needs. In order to perform these services, we collect, create, use and disclose information about you. We are dedicated to keeping your health information private, in accordance with federal and state law. As required by the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA“), we provide you with this notice of our legal duties with respect to health information. We are required to follow the terms of this notice currently or any revision to it that is in effect. We reserve the right to make changes to this notice as allowed by law. Changes to our privacy practices will apply to all health information we maintain.
If we change this notice, you can access the revised notice using one of these options:
- At any of our physical locations; or
- From our website www.microbiomedx.com
How We May Use and Disclose Your Health Information
We may use your health information and disclose it to appropriate persons, authorities and agencies, as allowed by federal and state law. We may do this without your written permission for the following purposes:
Treatment. We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Billing for Services. We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
Health Care Operations. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Other Ways We May Disclose Your Health Information
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
Help with public health and safety issues. We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Health Care Oversight. We may disclose your health information to authorities and agencies for oversight activities allowed by law, including audits, investigations, inspections, licensing, disciplinary actions, or legal proceedings. These activities are necessary for oversight of the health care system, government programs and civil rights laws.
Response to Legal Proceedings. We may disclose your health information in the course of certain legal proceedings. For example, we may disclose your information in response to a court order.
Death. We may disclose your health information to coroners, medical examiners (for example, to find out the cause of death) and funeral directors so they can carry out their duties.
Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
Research. We can use or share your information for health research.
Workers’ compensation, law enforcement, and other government requests. We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Disclosures Requiring Your Permission
Other uses and disclosures not described in the previous sections of this notice may be made only with your permission. Specifically, we would be required to obtain your permission for the following types of uses and disclosures:
Marketing. We would obtain your permission before using or disclosing your health information for marketing purposes, except if the communication is made face-to-face with you or involves providing you with a promotional gift of nominal value.
Sale of Information. We would obtain your permission before making any disclosure that constitutes a sale of health information.
Psychotherapy Notes. For our entities that provide behavioral health services and maintain psychotherapy notes as defined by the HIPAA privacy rules, we would obtain your permission for most uses and disclosures of psychotherapy notes. Psychotherapy notes are very specific types of notes recorded by a mental health professional documenting or analyzing the contents of conversation during counseling sessions and kept separate from the rest of the medical record.
Withdrawing Your Permission
In circumstances that require your permission, you may withdraw such permission at any time by notifying us in writing. If you withdraw your permission, we will no longer use or disclose your health information for the purposes specified in the authorization, except if we have already taken action based upon your permission.
Your Health Information Rights
As a patient or customer who receives health care services from MicrobiomeDx, you have the right to:
Read and copy your health information. With a few exceptions, you have the right to read and obtain a copy of your health information. We may charge you a reasonable fee if you want a copy of your health information. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision. If you request an electronic copy and the health information you are requesting is maintained electronically, we would provide the copy electronically in the form you request if it is readily producible, or if not, in an agreed upon readable electronic form. You have a right to request, in writing, that we transmit a copy of your health information directly to another individual. To obtain your health information or to obtain your billing information, contact MicrobiomeDx directly at the contact information below.
Request to correct your health information. If you believe there is an error in your health information or something has been left out, you may ask us to correct the information. You must make the request in writing and give the reason why your health information should be changed. If we did not create the information you believe is incorrect, or if we disagree with you and believe your health information is correct, we will deny your request. You may appeal to us in writing if we deny your request. To request a correction to your health information, contact MicrobiomeDx directly at the contact information below.
Request to restrict certain uses and disclosures of your information. You have the right to request in writing that we restrict how your health information is used or disclosed. For most requests, under the law, we are not required to agree to your request. In some cases, we may not be able to agree to your request because we do not have a way to tell everyone who would need to know about the restriction. There are other instances in which we are not required to agree with your request. We will inform you when we cannot find a way to carry out your request. You have the right to request restrictions to the disclosure of your health information to a health plan when the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law. We will agree to these requests if the information to be restricted pertains solely to a health care item or service for which you or another person on your behalf (other than a health plan) has paid out of pocket in full. You may request a restriction by contacting MicrobiomeDx directly.
Receive information at a different place or by different means. You have the right to ask that we send information to you in different ways or at different places. For example, you may wish to receive a test result at an address other than your home address. We will grant reasonable requests.
Receive notification of a breach. We take the privacy and security of your health information seriously and have policies and safeguards in place to protect against unauthorized access, use or disclosure. Following any breach of unsecured health information, we will notify any affected individuals as required by law.
Obtain a paper copy of this notice. Upon your request, you may at any time receive a paper copy of this notice. This notice is available at the registration desks and customer service counters of all our facilities.
File a complaint if you feel your rights are violated:
- You can complain if you feel we have violated your rights by contacting MicrobiomeDx directly at the contact information below.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
Contact for information, questions or concerns
If you have questions or concerns about your privacy rights, MicrobiomeDx’ privacy-related policies or the information contained in this notice, please contact us at firstname.lastname@example.org
This notice is effective on and after September 1, 2013, unless and until it is revised by MicrobiomeDx.