HIPAA Privacy 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.
This notice will tell you about the ways in which ACM may use and disclose medical information about you. It also describes your rights and certain obligations that ACM has regarding the use and disclosure of medical information. Since ACM is considered an "indirect treatment provider" under regulations, the level of required documentation is less than that experienced by other health care providers.
ACM Medical Laboratory is permitted by the Health Insurance Portability and Accountability Act (HIPAA) to disclose medical information about you for the following purposes:
- Treatment: For example, test results will be released to the person authorized by the State of New York to order laboratory tests and as directed by that provider.
- Payment: For example, Information concerning completed tests will be provided to your insurance company to allow payment for tests. This will include diagnostic information provided by your physician as well as individually indentifiable health information as required by the insurance company (Name, DOB, Policy #, etc.) This disclosure will not include the results of said tests.
- Healthcare Operations: For example, Audit assessments, training/competency.
- Other: Examples include: as required by federal, state, or local law as directed in a subpoena, as requested by the Armed Forces, workers compensation, for law enforcement activities, to coroners, medical examiners and funeral directors.
Any other uses and disclosure will only be made with your written authorization. Said authorization may be revoked.
Individual Rights: You have the right to request restrictions on certain uses and disclosures of protected health information. However, ACM is not required to agree to the requested restriction. Additionally, you have the right to receive an accounting of disclosures of protected health information.
ACM Medical Laboratory Duties: The laboratory is required by law to maintain the privacy of protected health information and to provide you with notice of its legal duties and privacy practices with respect to protected health information. ACM is required to abide by the terms of this notice currently in effect and reserves the right to change the terms of this notice. Any changes in the terms of this notice must be communicated. Revised notices will be identified as such with the date of the revision noted on the notice.
Complaints: If you believe that your privacy rights have been violated by the laboratory you have the right to complain to ACM and to the Secretary of the Health and Human Services. You may file a complaint by writing to the laboratory PRIVACY OFFICER at ACM Medical Laboratory, 160 Elmgrove Park, Rochester, NY 14624 or by calling the main laboratory number at 585.429.2398 and ask to speak with the PRIVACY OFFICER. The laboratory will not retaliate against any complaint. This notice is effective as required by HIPAA on 4/14/2003.