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.
America Clinical Laboratories is committed to protecting the privacy of your PHI.
This includes laboratory test orders and test results as well as invoices for the
healthcare services we provide.
you have any questions about this Notice or our privacy practices, please
contact us at (877) 803.1010 Option 2, or send an email to us at firstname.lastname@example.org, or write to us at the
Mid America Clinical Laboratories
Attention: Privacy Officer
PO Box 19163
Indianapolis, IN 46219
America Clinical Laboratories is required by law to maintain the privacy of
your PHI. We are also required to provide you with this Notice upon request. It
describes our legal duties, privacy practices and your patient rights as
determined by the Health Insurance Portability and Accountability Act (HIPAA)
of 1996. We follow the terms of this Notice. This Notice does not apply to
non-diagnostic services that we perform such as certain drugs of abuse testing
services and clinical trials testing services.
How We May Use or Disclose Your
your PHI for treatment, payment, or healthcare operations purposes and for
other purposes permitted or required by law. Not every use or disclosure is
listed in this Notice, but all of our uses or disclosures of your health
information will fall into one of the categories listed below.
We need your written authorization to use or disclose your health information
for any purpose not covered by one of the categories below. Any authorization you provide may be revoked
at any time. If you revoke your authorization, we will no
longer use or disclose your health information for the reasons stated in your
authorization except to the extent we have already taken action based on your authorization.
The law permits us to use or disclose your health information for the following
America Clinical Laboratories provides laboratory testing for physicians and
other healthcare professionals and we use your information in our testing process. We disclose your health information to
authorized healthcare professionals who order tests or need access to your test
results for treatment purposes. Examples
of other treatment related purposes for which we may use or disclose your health
information include disclosure to a pathologist to help interpret your test
results or use your information to contact you to obtain another specimen, if
use your PHI as part of our billing process and may send it to insurance
companies or other appropriate parties, including to you, to obtain payment for
our services. If you are insured under another person’s health insurance policy
(for example, parent, spouse, domestic partner or a former spouse), we may also
send invoices to the subscriber whose policy covers your health services.
use or disclose your PHI for activities necessary to support our healthcare
operations, such as performing quality checks on our testing, internal audits,
or developing reference ranges for our tests.
We may provide
your PHI to other companies or individuals to assist us in providing specific
services to us. These other entities, known as "business associates,"
are required to maintain the privacy and security of PHI. Our business
associates must only use your health information for the services they perform on
our behalf. For example, we may provide information to companies that assist us
with billing of our services. We may also use an outside collection agency to
obtain payment when necessary.
Required by Law
certain circumstances, federal or state laws may require that we provide your
health information to organizations such as:
Food and Drug Administration
Security and Intelligence Organizations
and Tissue Donation Organizations
Medical Examiners and Funeral Directors
Enforcement Activities and Legal Proceedings
use or disclose your PHI if necessary, to prevent or lessen a serious threat to
your health and safety or that of another person. We may also provide PHI to
law enforcement officials, for example, in response to a warrant, investigative
demand or similar legal process, or for officials to identify or locate a
suspect, fugitive, material witness, or missing person. We may also disclose PHI
to appropriate agencies if we reasonably believe an individual to be a victim
of abuse, neglect or domestic violence.
We may disclose your PHI as required to comply with a court or administrative
order. Finally, we may provide your PHI in response to a subpoena, discovery
request or other legal process in the course of a judicial or administrative
proceeding, but only if efforts have been made to tell you about the request or
to obtain an order of protection for the requested information.
Mid America Clinical Laboratories may
disclose health information for research purposes when an Institutional Review
Board or privacy board has reviewed the research proposal and established
protocols to ensure the privacy of your PHI and determined that the researcher
does not need to obtain your authorization prior to using your PHI for research
purposes. We may also disclose
information about decedents to researchers under certain circumstances.
Regarding State Law
of the above purposes, when state law is more restrictive than federal law, we
are required to follow the more restrictive state law.
Your Patient Rights
have the right to receive a copy of your PHI that we have created. However, some
state laws restrict our ability to provide test results directly to you and
require that you obtain test results directly from your treating provider. If your request for a copy of your test
information is denied, you may request that the denial be reviewed.
request changes to your PHI and we will accommodate them if we can. However, we are not required to make the
requested changes. If we deny your written request to change your PHI we will
provide you with a written explanation of the reason for the denial and
additional information regarding further actions that you may take.
have the right to receive a list of certain disclosures of your health
information made by Mid America Clinical Laboratories in the past six years from
the date of your written request. Under the law, this does not include
disclosures made for purposes of treatment, payment, or healthcare operations.
request that we agree to restrictions on certain uses and disclosures of your health
information, but we are not required to agree to your request, with the
following exception. You have the right to ask us to restrict the disclosure of
health information to your health plan for a service we provide to you where
you have directly paid us (out of pocket, in full) for that service, in which
case we must honor your request.
have the right to request that we send your health information by alternative
means or to an alternative address, and we will accommodate reasonable
to Exercise Your Rights
You may write to
us at the address at the beginning of this Notice or send an email to us at Privacy@macl1.com with your specific
request. You may also contact us at (877) 803.1010 option 2 to
request a form to complete to obtain a copy of your test results. Mid America
Clinical Laboratories will consider your request and provide you a response
within a reasonable timeframe.
believe your privacy rights have been violated, you have the right to file a
complaint with us. You also have the right to file a complaint with the
Secretary of the U.S. Department of Health and Human Services, Office for Civil
Rights. Mid America Clinical Laboratories will not retaliate against any
individual for filing a complaint.
To file a complaint with us, send an email to us at Privacy@macl1.com, or write to us at the following
Mid America Clinical Laboratories
Attention: Privacy Officer
PO Box 19163
Indianapolis. IN 46219
reserve the right to amend the terms of this Notice to reflect changes in our
privacy practices, and to make the new terms and practices applicable to all
PHI that we maintain about you, including PHI created or received prior to the
effective date of the Notice revision. Our Notice is displayed on our website
and a copy is available upon request.
November 29, 2012