Notice
of Privacy Practices
AviaraDx, Inc. Notice of Privacy Practices
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.
Background
AviaraDx, Inc. (“AviaraDx”) is a provider of
laboratory testing services. In providing testing services,
AviaraDx receives,
creates and discloses personal health information. This information
is private and confidential. There are policies and procedures
in place to protect the information against unlawful use
and disclosure. This notice describes information we collect,
how
we use that information, and when and to whom we may disclose
it.
Protected Health Information and Our Obligations
Protected health information or “PHI” (also called “personal
health information”), is current, past or future
information created or received by AviaraDx from physicians,
patients,
healthplans, or other sources about patients for whom testing
is ordered from AviaraDx. It may indicate the physical
condition of a patient, the provision of health care to
that patient,
or payment for the provision of health care to that patient.
The term PHI does not generally include publicly available
information, or information available or reported in a
summarized format.
Certain laws require AviaraDx to maintain the privacy
of PHI and to make available this notice of our legal
duties
and privacy
practices with respect to PHI. When we use or disclose
PHI, we are required to abide by the terms of this
notice (or
other notice in effect at the time of the use or disclosure).
Information Collected and Created by AviaraDx
AviaraDx collects the information that is minimally
necessary to provide testing services and to obtain
payment for
these services. This may include name, address, telephone
number,
social security number, date of birth, medical history,
diagnosis, treatment, provider identification and
treatment information,
financial responsibility and payment information.
AviaraDx creates, through its testing services, information
to be used by a physician in the diagnosis of disease
or condition or in the treatment of a disease or
condition.
Protection of PHI
Access to PHI is restricted to only those employees
of AviaraDx who need it in order to provide services
to
clients and patients.
We maintain physical, technical and procedural
safeguards to protect PHI against unauthorized
use and disclosure.
We have
a Privacy Officer who is responsible for developing,
educating AviaraDx personnel about, and overseeing
the implementation
and enforcement of policies and procedures designed
to safeguard PHI against inappropriate use and
disclosure consistent with
the applicable law.
Standard Uses and Disclosures of PHI
In the course of providing laboratory services,
AviaraDx uses PHI internally and discloses
it to health care
providers (doctors
requesting services, laboratory personnel involved
in ordering services and other caregivers),
insurers, third
party administrators,
plan sponsors and other payors (employers,
health care provider organizations and others who may
be responsible
for paying
for or administering your health benefits);
vendors, consultants, government authorities; and their
respective agents. They
are required by law to keep PHI confidential.
Some examples of
what we do with the information we collect
and the reasons it might be disclosed to third parties
are
described
below.
We may use or disclose PHI with or without
your consent to provide health care services.
Examples
of these
uses and
disclosures include:
- Treatment - the fulfillment
of requests by physicians to perform laboratory testing
services is considered
the provision
of treatment
- Payment - AviaraDx uses and
discloses PHI to obtain reimbursement for testing services.
Examples of
these payment activities
include: billing, collections
activities, determination of eligibility and obtaining
authorization for services. We may use or disclose PHI
in
connection with
payment activities with or without
your consent.
- Health care operations - AviaraDx uses and
discloses PHI for our health care operations, which include
internal
administration
and
planning
and various
activities that improve the quality and cost effectiveness
of the services provided.
Other Activities Permitted or Required by Law
We may use or disclose PHI for other important activities
permitted or required by law, with or without your
authorization. These
include:
Requesting Other Disclosures
It is possible to request that we disclose
PHI to people in ways not described above.
To authorize
us to disclose
your
personal
health information
to
a person or organization or for reasons other
than
those described in the section
above,
see the contact information at the bottom
of this page. If you make a special authorization
and later
change
your mind
about
this, you
may
send a letter
to us to let us know that you would like
to
revoke the special authorization. In
any communication with us, please provide
your name, address, patient identification number
or Social
Security number,
and a telephone
number where we can reach
you in case we need to contact you about
your
request.
Your Rights with Respect to PHI
-
You have a right to ask us in writing to
restrict use or disclosure of your PHI
related to your
treatment, related
to your payment
or related to routine
health
care operations. In addition, you may request
PHI disclosure
restrictions to family members, other relatives
or close friends involved in
your care. We
are not required to agree to such a restriction,
but if we do agree, we will honor
our agreement except in case of an emergency.
Any restriction we agree to is not effective
to prevent
uses or disclosures
of PHI
required by
the Secretary
of the Department of Health and Human Services
to investigate or determine
our compliance with federal privacy regulations
adopted under the Health Insurance
Portability and Accountability Act of 1996
or for certain activities permitted or
required by law (see
Section
V above).
- You may request, in writing, to
receive confidential communications containing
your PHI from
us in ways or at locations that
are outside our usual process.
We will make every effort to accommodate
reasonable requests.
- You have a right
to review and obtain a copy of existing PHI contained
in medical
and
billing records about
you maintained
by AviaraDx.
You must make
your request
in writing and this right is limited
to existing records that are maintained,
collected, used
or disseminated by AviaraDx.
This right
does not apply
to results of clinical testing - this
information is
specifically excluded by
law; or
to information we compile in reasonable
anticipation of, or for use in, civil,
criminal
or administrative actions or proceedings.
We may charge a fee for any copies
you request.
- You have a right to request that we
amend the records described above
for as long
as we maintain
them.
You must make the
request in writing
and give
us
a reason for the amendment. We may
deny your request if: (i) we determine
that
we did
not create the record,
unless
the
originator of the PHI
is no longer
available
to act on the requested amendment;
or (ii) if we believe that the
existing records are accurate and
complete. Note that an amendment may take
several forms; for
example we may add an explanatory
statement to a record rather than changing it.
- You
have a right to receive an accounting of disclosures
made by AviaraDx to
any third party
in the six years
prior to the
date
on which the
accounting is requested. This right
does not apply to certain disclosures,
including,
but not
limited to, disclosures made for
the purposes of treatment, payment
or health
care operations;
disclosures
made
to you or to others
involved in your care;
disclosures made with your authorization;
disclosures
made for national security or intelligence
purposes or to correctional
institutions or law enforcement
purposes; or disclosures made prior
to April 14, 2003. You must
make
any request
for an
accounting in writing and we may
charge a fee to fill more than
one request
in any given year.
Distribution and Updates of This
Notice
This notice is published on the
AviaraDx web site at www.AviaraDx.com/PrivacyPolicy
and
is made available
in printed form upon request.
Effective Date and Duration of
This Notice
This notice describes the privacy
policy of AviaraDx effective
March 8, 2007.
We may change
the terms
of this notice at
any time. If we
change this notice,
we may make the new notice
terms effective for all PHI
that we
maintain, including
any information
created
or
received
prior
to issuing the
new notice. If we
change this notice, we will
post the new notice on our
Internet
site at
www.AviaraDx.com.
Communication with AviaraDx
As a convenience, AviaraDx
may make available email
addresses by which
you can communicate
with us regarding
billing
issues. Please
be advised
that
email is
not a secure means of communication,
therefore AviaraDx cannot
guarantee the security of
any information
that you send to
us prior to our
receipt of it.
This fact may also restrict
our
use of email in communicating
any response
to
you
- we will make every attempt
to use alternate means of
communicating anything that
may be considered sensitive
information.
Copy of Notice, Questions
or Complaints
If you would like a paper
copy of this notice,
have questions
about
it, or
believe its terms
or any AviaraDx
privacy
or confidentiality policy
has been
violated
with respect to information
about you, please let
us know immediately
by contacting
us
at 760-579-0500 and
request
the Compliance
Office. Please include
your name, address, and
a telephone
number
where we can contact
you, and a
brief description
of the complaint. If
you prefer, you may lodge an
anonymous
complaint.
Compliance Office
11025 Roselle Stree
Suite 200
San Diego, CA 92121
You also may contact
the Secretary of the
Department
of Health
and Human Services
at:
The U.S. Department of
Health and Human Services
200 Independence Avenue,
S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
Please provide as much
information as possible
so that the complaint
can be
properly investigated.
AviaraDx
will not retaliate
against
a person who files
a complaint
with us or with the
Secretary of the Department of
Health and Human Services.
AviaraDx, Inc. Notice
of Privacy Practices
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