Our Uses and Disclosures
We may use and share your information as we:
- Provide laboratory services to you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Comply with the law
- Respond to organ/tissue donation requests
- Work with medical examiner or funeral director
- Respond to lawsuits and legal actions
- Address workers’ compensation, law enforcement, and other government needs
You have the right to:
- Get a copy of your paper or electronic laboratory record
- Correct your paper or electronic laboratory record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information if we:
- Market our services and sell your information
- Raise funds
OUR USES AND DISCLOSURES
We typically use or share your health information in the following ways.
For your treatment
We can use your health information to provide laboratory services to you and share it with other professionals who are treating you.
Run our organization
We can use and share your health information to run our laboratory, improve our services to you, and contact you when necessary.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Other Ways We Use 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:
- Helping with product recalls
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
We may use or disclose health information for research purposes when permitted by law, such as when an Institutional Review Board or privacy board has reviewed the research proposal and our plans to ensure the privacy of your health information, and such board has determined that your authorization is not required. We may also use or disclose health information about deceased patients to researchers if certain requirements are met. We may use and disclose a limited data set containing some of your health information for research purposes. However, we will only disclose a limited data set if we enter into a data use agreement with the recipient.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
Although unlikely, we can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
Although unlikely, 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
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
When it comes to your health information, you have certain rights:
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your laboratory record and other health information we have about you. Ask us how to do this by contacting the Juno Privacy Officer.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this by contacting the Juno Privacy Officer.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask the Juno Privacy Officer for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting the Juno Privacy Officer.
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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share.
You have the right and the choice to tell us to share information with your family, friends, or others involved in your care. We have a special authorization form available below for this purpose.
We will never:
- Share information with any person or company except as required or permitted by law or with your written authorization
- Share your information in a disaster relief situation
- Share your information for marketing purposes without your written authorization
- Share your information to raise funds without your written authorization
- Sell your information without your written authorization
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
CHANGES TO THE TERMS OF THIS NOTICE
We can change the terms of this notice, and the changes will apply to all healthinformation we have about you. The new notice will be available upon request, in our offices, and on our web site.
The Juno Diagnostics Privacy Officer is Paul Oeth and may be contacted at firstname.lastname@example.org.
ACKNOWLEDGMENT OF RECEIPT OF HIPAA NOTICE OF PRIVACY PRACTICES
Patient/Legal Representative Acknowledgment
______ I have received an electronic or paper copy, and reviewed, the Juno Diagnostics Notice of Privacy Practices.
AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION
I, __________________, hereby authorize (Name of person or facility which has information) to release the following information:
( Name and title or facility name to receive health information )
( Street address, city, state, ZIP code ) ( Telephone number )
For the following purposes:
This authorization is in effect until ______________ (date or event), when it expires.
I understand that by signing this authorization:
- I authorize the use or disclosure of my individually identifiable health information as described above for the purpose listed.
- I have the right to withdraw permission for the release of my information. If I sign this authorization to use or disclose information, I can revoke that authorization at any time.The revocation must be made in writing and will not affect information that has already been used or disclosed.
- I have the right to receive a copy of this authorization.
- I am signing this authorization voluntarily and treatment, payment, or my eligibility for benefits will not be affected if I do not sign this authorization.
- I further understand that a person to whom records and information are disclosed pursuant to this authorization may not further use or disclose the medical information unless another authorization is obtained from me or unless such disclosure is specifically required or permitted by law.
Signed by Patient: _______________________________________ Date: _________________
Or Signed by Personal Representative: ______________________ Date: _________________
On Behalf of (Name of Patient): ____________________________ Date: _________________
PERSONAL REPRESENTATIVE INFORMATION
WHAT LEGAL AUTHORITY DO YOU HAVE TO MAKE MEDICAL DECISIONS FOR THE:
[ ] PARENT
[ ] GUARDIAN
[ ] MEDICAL POWER OF ATTORNEY
[ ] CONSERVATOR
[ ] EXECUTOR OF WILL
[ ] OTHER