Notice of Privacy Practices Statement
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.
BAKO'S PRIVACY PRACTICES
Bako Pathology Services (“BAKO”) is committed to protecting the confidentiality of your medical and health information (“Protected Health Information”) as described in this Notice and maintains the privacy of your Protected Health Information as required by law. Protected Health Information is information, including demographic information, that may identify you and that relates to health care services provided to you, the payment of health care services provided to you, or your physical or mental health or condition, in the past, present or future. We have provided this notice to you to describe the way we may use and share your Protected Health Information. This Notice describes our privacy practices relating to Protected Health Information, including how we may use your Protected Health Information within BAKO and how under certain circumstances we may disclose it to others outside BAKO. This Notice also describes the rights you have concerning your own Protected Health Information. Please review it carefully. If you have questions about any part of this Privacy Notice or if you want more information about the privacy practices of BAKO, please contact the Privacy Officer listed at the end of this Notice.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION PERMITTED OR REQUIRED BY LAW
The law permits us to use your Protected Health Information for treating you, billing for services and for health care operations, all of which are explained below. Certain types of Protected Health Information have additional protection under state or federal law. For example, information about genetic testing and mental health treatment or condition may have added protections. For disclosure of those types of information, BAKO is required to get your authorization as described below before disclosing it to others.
Your Protected Health Information may be used and disclosed only for the following purposes:
For Treatment: We may use your Protected Health Information to provide you with medical treatment and other services. We may also disclose your Protected Health Information to others who need information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers, and others involved in your care. For example, we will allow your physician to have access to your laboratory results to assist in your treatment and for follow-up care.
For Payment: We may use and disclose your Protected Health Information to get paid for the medical services and supplies we provide to you. For example, your health plan or health insurance company may ask to see parts of your medical record before they will pay us for your treatment.
To Family Members and Others Involved in Your Care: We may disclose your Protected Health Information, unless prohibited by applicable federal or state law, to a family member, other relative, a close personal friend, or any other person identified by you who is involved in your medical care, or to someone who helps to pay for your care. If you do not want us to disclose your Protected Health Information to family members or others, please contact BAKO’s Privacy Officer, as provided below.
For Research: We may use or disclose your Protected Health Information without your consent or authorization for research projects, such as studying the effectiveness of a treatment you received, if an Institutional Review Board approves a waiver of authorization for disclosure. These research projects must go through a special process that protects the confidentiality of your Protected Health Information.
For Public Health Activities: We may also use and disclose certain Protected Health Information for public health purposes such as preventing or lessening a serious and/or imminent threat to an individual’s or the public’s health or safety. We may also report information to your employer as required under laws addressing work-related illness and injuries or workplace medical surveillance. For instance, a positive communicable disease test result may be reported to the State Health Department. We also may need to report patient problems with medications or medical products to the Food and Drug Administration (FDA).
As Required by Law: Federal, state, or local laws sometimes require us to disclose Protected Health Information. For instance, we are required to report child abuse or neglect and must provide certain information to law enforcement officials in domestic violence cases. We also are required to give information to the State Workers’ Compensation Program for work-related injuries.
To Law Enforcement Officials: We may disclose Protected Health Information to law enforcement officials as required by law or in compliance with a search warrant, subpoena or court order. We also may disclose Protected Health Information to assist law enforcement officials in identifying or locating a person, to prosecute a crime of violence, to report deaths that may have resulted from criminal conduct, and to report criminal conduct at BAKO.
To Correctional Institutions. If you are an inmate of a correctional institution, we may disclose Protected Health Information about you to the correctional institution. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
For Military, Veterans, National Security, and Other Government Purposes: If you are a member of the armed forces, we may release your Protected Health Information as required by military command authorities or to the Department of Veterans Affairs. We may also disclose Protected Health Information to federal officials for intelligence and national security purposes, or for Presidential Protective Services.
For Judicial Proceedings: We may disclose your Protected Health Information if we are ordered to do so by a court or administrative order or if we receive a subpoena or a search warrant.
For Health Oversight Activities: We may disclose Protected Health Information to a government agency that oversees BAKO or its personnel, such as the College of American Pathologists (CAP), the federal agency that oversees Medicaid and Medicare (CMS), and the Food and Drug Administration (FDA), to ensure compliance with state and federal laws.
To Coroners, Medical Examiners, and Funeral Directors: We may disclose Protected Health Information concerning deceased patients to coroners, medical examiners and funeral directors to assist them in carrying out their duties.
For Organ and Tissue Donation: We may disclose Protected Health Information to organizations that facilitate organ, eye or tissue donation or transplantation.
USES AND DISCLOSURES WITH YOUR AUTHORIZATION
BAKO cannot use your Protected Health Information for anything other than the reasons mentioned above, without your signed “Authorization.” An Authorization is a written document signed by you giving us permission to use or disclose your Protected Health Information for the purposes you specifically set forth in the Authorization. You may revoke the Authorization, at any time, by delivering a written statement to the BAKO Privacy Officer identified below. If you revoke your Authorization, BAKO will no longer use or disclose your Protected Health Information as permitted by your Authorization. However, your revocation of Authorization will not reverse the use or disclosure of your Protected Health Information made while your Authorization was in effect.
You have the right to request that BAKO limit its uses and disclosures of Protected Health Information in relation to treatment, payment, health care operations, and health services, or not use or disclose your Protected Health Information for these reasons at all. You also have the right to request BAKO restrict the use or disclosure of your Protected Health Information to family members or personal representatives. Any such request must be made in writing to BAKO’s Privacy Officer listed below and must state the specific restriction requested and to whom that restriction would apply. BAKO is not required to agree to a restriction that you request. However, if it does agree to the requested restriction, it may not violate that restriction except as necessary to allow the provision of emergency medical care to you.
YOUR INDIVIDUAL RIGHTS
Right to Request Your Protected Health Information: In most cases, you have the right to look at or get copies of your Protected Health Information. However, federal laboratory regulations and state law provide that BAKO cannot report test results directly to a patient. You must make the request for such Protected Health Information to your healthcare provider in writing who will then coordinate such disclosure with BAKO. Any Protected Health Information that we have will be forwarded to your healthcare provider upon receipt of your written request to do so, and your provider should then provide you the information.
To request the forwarding of your Protected Health Information to your healthcare provider, write to BAKO’s Privacy Officer as set forth below. We may charge a fee for the costs of copying, mailing or other supplies associated with your request, but we will let you know about the fee in advance.
Right to Request Amendment of Protected Health Information You Believe Is Erroneous or Incomplete: If you examine your Protected Health Information and believe that some of the information is wrong or incomplete, you may ask us to amend your record. We will comply with your request unless we are not the originator of the information or we believe that the information you request to be amended is accurate and complete, the information is not available for inspection or special circumstances apply. To ask us to amend your Protected Health Information, write to BAKO’s Privacy Officer as set forth below.
Right to Receive an Accounting of Disclosures of Your Protected Health Information: You have the right to request a list of certain disclosures we make of your Protected Health Information, for reasons other than disclosures for treatment, payment and health care operations, as described above, disclosures made to you or your personal representatives or pursuant to a written authorization obtained from you, disclosures for national security or intelligence purposes as provided by law and disclosures to correctional institutions or law enforcement officials, as provided by law. If you would like to receive such a list, write to BAKO’s Privacy Officer as set forth below. Your request must state a time period desired for the accounting, which must be within six years prior to the date of your request. We will provide the first list to you free of charge, but we may charge you for any additional lists you request during the same twelve (12) month period. We will tell you in advance what this list will cost, at which time you may withdraw or modify your request.
Right to Request Restrictions on How BAKO Will Use or Disclose Your Protected Health Information for Treatment, Payment, or Health Care Operations: You have the right to request us not to make uses or disclosures of your Protected Health Information to treat you, to seek payment for care, or to operate our laboratories. We will consider your requests carefully, but we are not required to agree to your requested restriction. If you want to request a restriction, submit your request in writing to BAKO’s Privacy Officer and describe your request in detail. BAKO’s Privacy Officer will reply within 30 days of receiving your request.
Right to Request Special Communications: You have the right to ask us to communicate your Protected Health Information by alternative means of communication or at alternative locations. For example, you can ask us not to call your home, but to communicate with you only by mail. To make such a request, write to BAKO’s Privacy Officer.
Right to Receive a Paper Copy of This Notice: If you have received this Notice electronically, you have the right to a paper copy at any time. You may download a paper copy of the notice from our Web site, at www.BakoPathology.com, or you may obtain a paper copy of the notice by calling or writing to BAKO’s Privacy Officer.
CHANGES TO THIS NOTICE
From time to time, we may change our practices concerning how we use or disclose Protected Health Information, or how we will implement patient rights concerning such information. We reserve the right to change this Notice and to make the provisions in our new Notice effective for all Protected Health Information we maintain. If we change these practices, we will publish a revised Notice. You can get a copy of our current Notice at any time by downloading a paper copy of the notice from our Web site, at www.BakoPathology.com, or you may obtain a paper copy of the Notice by calling or writing to BAKO’s Privacy Officer.
QUESTIONS, CONCERNS, OR COMPLAINTS
If you have any questions about this Notice, or have further questions about how BAKO may use and disclose your Protected Health Information, please contact the Privacy Officer as set forth below. We also welcome your feedback regarding any problems or concerns you have with your privacy rights or how BAKO uses or discloses your Protected Health Information. If you have a concern, please contact:
BAKO Privacy Officer
Attn: Nina C. Hobin
6240 Shiloh Road
Alpharetta, GA 30005
If for some reason BAKO cannot resolve your concern or complaint, you may also file a complaint with the Secretary of Health and Human Services. We will not penalize or retaliate against you in any way for filing a complaint.
Effective Date of this Notice: August 24, 2012