Notice of Privacy Practices
Effective Date: 05/01/2016
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. PLEASE REVIEW IT CAREFULLY.
OUR PLEDGE REGARDING MEDICAL INFORMATION: Staff at Blueprint Diagnostics, LLC create a record of the care and services you receive at Blueprint Diagnostics and use this record to provide you with quality care as well as to comply with legal requirements. Because we understand that information about your health is personal, we are committed to protecting that information, whether it is in written, verbal or electronic format.
This notice, which is required by law, describes our practices with respect to your protected health information. It applies to all records of your care generated by Blueprint Diagnostics. All Blueprint Diagnostics staff and contractors who are authorized to have access to your health information are subject to the provisions of this Notice.
We are required by law to:
• abide by the terms of the Notice that is in effect at a given time.
• protect the privacy of your health information.
• subject to certain exceptions under the law, provide notice of any unauthorized acquisition, access, use or disclosure of your protected health information to the extent it was not otherwise protected.
We will not use or disclose your health information without written authorization, except as described in this Notice. Use or disclosure pursuant to this Notice may include electronic transmittal of your health information.
For each type of use or disclosure, we will explain what we mean and try to give some examples. Not every use or disclosure will be listed. However, all of the ways we are permitted to use and disclose information should fall within one of the following categories:
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION:
For Treatment: While we are providing you with health-care services, we may need to share your health information with other health-care providers or other individuals who are involved in providing health care to you. Examples include doctors, hospitals, nurses, therapists, pharmacists, and labs that are involved in your care. We will work with your referring physician to achieve your health goals.
For Payment: Health information may be sent to a third party payer. The information may include information that identifies your diagnosis, procedure, and/or supplies used.
For Health Care Operations: Blueprint Diagnostics may need to share health information about you in the course of conducting health-care business activities that are related to providing health care to you. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.
Appointment Reminders and Treatment Alternatives: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest.
Business Associates: There are some services provided at Blueprint Diagnostics through contracts with business associates such as medical transcription and computer software services. We require business associates to protect your health information.
Individual Involved in Your Care or Payment for Your Care: Unless you notify us that you object, we may release health information about you to a friend or family member who is involved in your medical care or payment for your medical care. This may include your condition.
Disaster Relief Efforts: We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location if such a situation arises.
Research: Under certain circumstances, we may use and disclose medical information about you for research purposes.
To Avert a Serious Threat to Health or Safety: As required by law, and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to anyone’s health or safety.
Military, Veteran, National Security, or Incarceration/Law Enforcement Custody: We may be required to release your health information to the military or for national security or intelligence activities or if you are in the custody of law enforcement officials.
Public Health Activities: As required by law, we may report your health information to public health or legal authorities to help prevent or control disease, injury or disability.
Health Oversight Activities: We may be required to release health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in health care, or for governmental benefit programs.
Activities Related to Death: We may be required to release health information to coroners, medical examiners, and funeral directors so they can carry out their duties related to your death.
As Required or Allowed By Law: Sometimes we must report some of your health information to legal officials or authorities such as law enforcement officials, court officials or governmental agencies or attorneys.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION: Although your medical record is the physical property of Blueprint Diagnostics, the information belongs to you. You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care as provided by law. Usually, this includes medical records, but does not include psychotherapy notes. If you wish to inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department at firstname.lastname@example.org. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.
NOTICE: We may dispose of your medical record on or after the 7th anniversary of the date which the patient was last treated. For minors, we may dispose of records on or after the date of the patient’s 20th birthday or on or after the 7th anniversary of the date on which the patient was last treated, whichever date is later.
Right to Request an Amendment: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to Blueprint Diagnostics’ Medical Records Department at email@example.com. We will notify you if we are unable to grant your request to amend the record.
Right to Obtain an Accounting of Disclosures: You have the right to obtain an accounting of disclosures made of your protected health information as provided by law. Requests for such accounting can be made to the Blueprint Diagnostics Medical Records department at firstname.lastname@example.org.
Right to Request Restrictions: You have the right to request a restriction on the medical information we use or disclose about you for treatment, payment or health care operations and as to disclosures permitted to persons including family members who are involved in your care or the payment for your care as provided by law. However, we are not required by law to agree to a requested restriction and will notify you if we are unable to agree to the requested restriction. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the Blueprint Diagnostics Privacy Officer.
Right to Request Confidential Information: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate all reasonable requests and will not ask you the reason for your request.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Privacy Notice. You may also obtain a copy of this notice at our website, www.blueprint-diagnostics.com.
Right to Revoke Authorization: If you have provided us with authorization to use or disclosure medical information about you, you have a right to revoke that authorization in writing except to the extent that action has already been taken in reliance on your authorization.
CHANGES TO THIS NOTICE: We reserve the right to change our practices and to make the revised or changed provisions effective for all protected health information we maintain. You may request a copy of the current notice by writing to the Blueprint Diagnostics Privacy Officer, or by requesting a copy from us. The revised notice will also be posted on the Blueprint Diagnostics web page. The effective date of the notice will be on the top left hand corner of the first page.
QUESTIONS: If you have any questions and would like additional information, you may contact the Blueprint Diagnostics Privacy Officer at 1-800-969-9551 or by email at email@example.com.
COMPLAINT: If you believe your privacy rights have been violated, you can file a complaint with Blueprint Diagnostics or with the Secretary of the Department of Health and Human Services. Complaints may be submitted in writing to the:
Blueprint Diagnostics, LLC
You will not be penalized in any manner for filing a complaint.