Affiliated Medical Service Laboratory, Inc.
Privacy Notice
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.
Affiliated Medical Services, Inc. (“AMS”) is required by law to
maintain the privacy of certain confidential healthcare information, known
as Protected Health Information or PHI, and to provide you with a notice of
our legal duties and privacy practices with respect to your PHI. AMS is also
required to abide by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: AMS
may use PHI for the purposes of treatment,
payment, and healthcare operations, in most
cases without your written permission. Examples
of our use of your PHI:
- For
treatment. This includes such
things as obtaining verbal and
written information about your
medical condition and treatment
from you as well as from others,
such as doctors and nurses who
give orders to allow us to provide
treatment to you. We may give
your PHI to other healthcare
providers involved in your treatment,
and may transfer your PHI via
radio or telephone to the hospital
or dispatch center.
- For
payment. This includes any activities
we must undertake in order to
get reimbursed for the services
we provide to you, including
such things as submitting bills
to insurance companies, making
medical necessity determinations,
and collecting outstanding accounts.
- For
healthcare operations. This
includes quality assurance activities,
licensing, and training programs
to insure that our personnel
meet our standards of care and
follow established policies and
procedures, as well as certain
other management functions.
- Reminders
and information on other services.
We may also contact you to provide
you with a reminder of any scheduled
appointments, or to provide information
about other services we provide,
or services we have provided
to you.
Use
and Disclosure of PHI Without Your Authorization: AMS
is permitted to use PHI without your written authorization,
or opportunity to object, in certain situations, and
unless prohibited by a more stringent state law, including:
- For
the treatment, payment or healthcare operations activities of
another healthcare provider
who treats you;
- For
healthcare and legal compliance
activities;
- To
a family member, other relative,
or close personal friend or other
individual involved in your care
if we obtain your verbal agreement
to do so or if we give you an
opportunity to object to such
a disclosure and you do not raise
an objection, and in certain
other circumstances where we
are unable to obtain your agreement
and believe the disclosure is
in your best interests;
- To
a public health authority in
certain situations as required
by law (such as to report abuse,
neglect, or domestic violence);
- For
health oversight activities including
audits or government investigations,
inspections, disciplinary proceedings,
and other administrative or judicial
actions undertaken by the government
(or their contractors) by law
to oversee the healthcare system;
- For
judicial and administrative proceedings
as required by a court or administrative
order, or in some cases in response
to a subpoena or other legal
process;
- For
law enforcement activities in
limited situations, such as when
responding to a warrant;
- For
military, national defense and
security and other special government
functions;
- To
avert a serious threat to the
health and safety of a person
or the public at large;
- For
workers’ compensation
purposes, and in compliance
with workers’ compensation
laws;
- To
coroners,
medical
examiners,
and
funeral
directors
for
identifying
a
deceased
person, determining cause of death, or carrying on their duties as
authorized by law;
- If
you
are
an
organ
donor,
we
may
release
health
information
to
organizations
that
handle organ procurement or organ, eye or tissue transplantation
or
to
an
organ
donation bank, as necessary to facilitate organ donation and
transplantation;
- For
research
projects,
but
this
will
be
subject
to
strict
oversight
and
approvals;
- We
may
also
use
or
disclose
health
information
about
you
in
a
way
that
does
not personally identify you or reveal who you are.
Any
other
use
or
disclosure
of
PHI,
other
than
those
listed
above
will
only
be
made with your written authorization. You may revoke
your
authorization
at
any time, in writing, except to the extent that we
have
already
used
or
disclosed
medical information in reliance on that authorization.
Patient
Rights: As
a
patient,
you
have
a
number
of
rights
with
respect
to
your
PHI, including:
The
right
to
access,
copy
or
inspect
your
PHI: This
means
you
may
inspect
and
copy most of the medical information about you that
we
maintain.
We
will
normally provide you with access to this information
within
30
days
of
your
request.
We may also charge you a reasonable fee for you to
copy
any
medical
information
that you have the right to access. In limited circumstances,
we
may
deny
you access to your medical information, and you may
appeal
certain
types
of denials. We have forms available to request access
to
your
PHI
and
we
will provide a written response if we deny you access
and
let
you
know
your
appeal rights. You also have the right to receive
confidential
communications
of
your PHI. If you wish to inspect and copy your medical
information,
you
should
contact our privacy officer.
The
right
to
amend
your
PHI: You
have
the
right
to
ask
us
to
amend
written
medical information that we may have about you. We
will
generally
amend
your
information within 60 days of your request and will
notify
you
when
we
have
amended the information. We are permitted by law to
deny
your
request
to
amend your medical information only in certain circumstances,
like
when
we
believe the information you have asked us to amend
is
correct.
If
you
wish
to
request that we amend the medical information that
we
have
about
you,
you
should
contact our privacy officer.
The
right
to
request
an
accounting: You
may
request
an
accounting
from
us
to certain disclosures of your medical information
that
we
have
made
in
the
6 years prior to the date of your request. We are
not
required
to
give
you
an accounting of information we have used or disclosed
for
purposes
of
treatment,
payment,
or healthcare operations, or when we share your health
information
with
our
business associate, like our billing company. We
are
also
not
required
to
give you an accounting of our uses of protected health
information
for
which
you have already given us written authorization.
If you
wish
to
request
an
accounting, contact our privacy officer.
The
right
to
request
that
we
restrict
the
uses
and
disclosures
of
your
PHI: You
have the right to request that we restrict how we use
and
disclose
your
medical
information that we have about you. AMS is not required
to
agree
to
any
restrictions
you request, but any restrictions agreed to by AMS
in
writing
are
binding
on AMS.
Internet,
Electronic
Mail,
and
the
Right
to
Obtain
Copy
of
Paper
Notice
on
Request: If we maintain a Web site, we will
prominently
post
a
copy
of
this
Notice on our Web site. If you allow us, we will
forward you
this
Notice
by
electronic
mail instead of on paper and you may always request
a
paper
copy
of
the
Notice.
Revisions
to
the
Notice: AMS
reserves
the
right
to
change
the
terms
of
this
Notice
at any time and the changes will be effective immediately
and
will
apply
to all protected health information that we maintain.
Any
material
changes
to the Notice will be promptly posted in our facilities
and
posted
to
our
Web site, www.amsreferencelab.com. You can get a
copy
of
the
latest
version
of this Notice by contacting our privacy officer.
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