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I. Who We Are
This Notice describes the privacy practices of NorDx and its personnel. It
applies to services furnished to you at all NorDx Patient Service Centers, all
other facilities where phlebotomy service is provided and at all NorDx sites
where laboratory testing is performed. Locations are listed in Section VIII.
II. Our Privacy Obligations
We are required by law to maintain the privacy of your health information (Protected
Health Information or PHI) and to provide you with this Notice of our legal
duties and privacy practices with respect to your Protected Health Information.
When we use or disclose your Protected Health Information, we are required to
abide by the terms of this Notice (or other notice in effect at the time of
the use or disclosure).
III. Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, which we will describe in Section IV below, we must obtain
your written authorization in order to use and/or disclose your PHI. However,
we do not need any type of authorization from you for the following uses and
disclosures:
A. Uses and Disclosures For Treatment, Payment and Health Care Operations
We may use and disclose PHI, but not your Highly Confidential Information
(defined in Section IV.B below), in order to treat you, obtain payment for
services provided to you and conduct our Health Care Operations as detailed
below:
- Treatment We use and disclose your PHI
to provide specimen collection and laboratory testing ordered by your healthcare
provider and other services to you--for example, to diagnose and treat your
injury or illness. We disclose PHI to healthcare providers involved in your
treatment.
- Payment We may use and disclose your
PHI to obtain payment for services that we provide to you-for example, disclosures
to claim and obtain payment from your health insurer, HMO, or other company
that arranges or pays the cost of some or all of your health care (Your
Payor) to verify that Your Payor will pay for health care.
- Health Care Operations We may use and
disclose your PHI for our health care operations, which include internal
administration and planning and various activities that improve the quality
and cost effectiveness of the care that we deliver to you. For example,
we may use PHI to evaluate the quality of our laboratory services and competence
of our personnel. We may disclose PHI internally in order to resolve any
complaints you may have and ensure a high quality of service to you.
- We may also disclose PHI to your other health care providers when such
PHI is required for them to treat you, receive payment for services they
render to you, or conduct certain health care operations, such as quality
assessment and improvement activities, reviewing the quality and competence
of health care professionals, or for health care fraud and abuse detection
or compliance.
B. Disclosures to Relatives and Close Personal Friends We
may disclose your PHI related to payment of your health care to a family member,
other relative, a close personal friend or any other person identified by
you. We would disclose only information that we believe is relevant to the
person’s involvement with payment related to your health care.
C. Public Health Activities We may disclose your PHI for
the following public health activities: (1) to report health information to
public health authorities for the purpose of preventing or controlling disease,
injury or disability; (2) to report information about products and services
under the jurisdiction of the U.S. Food and Drug Administration;
D. Health Oversight Activities We may disclose your PHI
to a health oversight agency that oversees the health care system and is charged
with responsibility for ensuring compliance with the rules of government health
programs such as Medicare or Medicaid.
E. Judicial and Administrative Proceedings We may disclose
your PHI in the course of a judicial or administrative proceeding in response
to a legal order or other lawful process.
F. Law Enforcement Officials We may disclose your PHI to
the police or other law enforcement officials as required or permitted by
law or in compliance with a court order or a grand jury or administrative
subpoena.
G. Organ and Tissue Procurement We may disclose your PHI
to organizations that facilitate organ, eye or tissue procurement, banking
or transplantation.
H. Decedents We may disclose your PHI to a coroner or medical
examiner as authorized by law.
I. Research We may use or disclose your PHI without your
consent or authorization if Maine Medical Center’s Institutional Review
Board approves a waiver of authorization for disclosure.
J. Health or Safety We may use or disclose your PHI to prevent
or lessen a serious and imminent threat to a person’s or the public’s
health or safety
K. Specialized Government Functions We may use and disclose
your PHI to units of the government with special functions, such as the U.S.
military or the U.S. Department of State under certain circumstances.
L. Workers’ Compensation We may disclose your PHI
as authorized by and to the extent necessary to comply with state law relating
to workers' compensation or other similar programs.
M. As required by law We may use and disclose your PHI when
required to do so by any other law not already referred to in the preceding
categories.
IV. Uses and Disclosures Requiring Your Written Authorization
A. Use or Disclosure with Your Authorization For any purpose
other than the ones described above in Section III, we may only use or disclose
your PHI when you grant us your written authorization on our authorization
form. For instance, you will need to execute an authorization form before
we can send your PHI to your life insurance company or to the attorney representing
the other party in litigation in which you are involved.
B. Uses and Disclosures of Your Highly Confidential Information
In addition, federal and state law requires special privacy protections for
certain highly confidential information about you including the subset of
your PHI that is about HIV/AIDS testing, diagnosis or treatment.
V. Your Rights Regarding Your Protected Health Information
A. Complaints If you desire further information about your
privacy rights, are concerned that we have violated your privacy rights or
disagree with a decision that we made about access to your PHI, you may contact
our Privacy Office. You may also file written complaints with the Director,
Office for Civil Rights of the U.S. Department of Health and Human Services.
Upon request, the Privacy Office will provide you with the correct address
for the Director. We will not retaliate against you if you file a complaint
with us or the Director.
B. Right to Request Additional Restrictions You may request
restrictions on our use and disclosure of your PHI (1) for treatment, payment
and health care operations, or (2) to individuals (such as a family member,
other relative, close personal friend or any other person identified by you)
involved with payment related to your care. While we will consider all requests
for additional restrictions carefully, we are not required to agree to a requested
restriction. If you wish to request additional restrictions, please obtain
a request form from our Privacy Office and submit the completed form to the
Privacy Office. We will send you a written response.
C. Right to Receive Confidential Communications You may
request, and we will accommodate, any reasonable written request for you to
receive your PHI by alternative means of communication or at alternative locations.
D. Right to Revoke Your Authorization You may revoke Your
Authorization, or any written authorization obtained in connection with your
Highly Confidential Information, except to the extent that we have taken action
in reliance upon it, by delivering a written revocation statement to the Privacy
Office identified below. A form of Written Revocation is available upon request
from the Privacy Office.
E. Right to Inspect and Copy Your Health Information. You
may request access to your laboratory results and billing records maintained
by us in order to inspect and request copies of the records. Under limited
circumstances, we may deny you access to a portion of your records but will
allow you to choose a person to access your records on your behalf. If you
desire access to your records, please obtain a Access Request Form from the
Privacy Office and submit the completed form to the Privacy Office. If you
request copies, we may charge you $0.10 (10 cents) for each page. We may also
charge you for our postage costs, if you request that we mail the copies to
you.
F. Right to Amend Your Records You have the right to request
in writing that we amend Protected Health Information maintained by NorDx.
If you desire to amend your records, please obtain an amendment request form
from the Privacy Office and submit the completed form to the Privacy Office.
We will comply with your request unless we believe the information that would
be amended is accurate and complete or other special circumstances apply.
You will always be allowed to add a statement to your records, and if you
do so we may add a response. We will provide you a copy of our response.
G. Right to Receive An Accounting of Disclosures Upon request,
you may obtain an accounting of certain disclosures of your PHI made by us
during any period of time prior to the date of your request provided such
period does not exceed six years and does not apply to disclosures that occurred
prior to April 14, 2003. If you request an accounting more than once during
a twelve (12) month period, we may charge you $25 per hour of preparation
and $0.10 per page of the accounting statement.
H. Right to Receive Paper Copy of this Notice. Upon request,
you may obtain a paper copy of this Notice.
VI. Effective Date and Duration of This Notice
A. Effective Date This Notice is effective on April 14,
2003.
B. Right to Change Terms of this Notice We may change the
terms of this Notice at any time. If we change this Notice, we may make the
new notice terms effective for all Protected Health Information that we maintain,
including any information created or received prior to issuing the new notice.
If we change this Notice, we will post the new notice in waiting areas of
NorDx Patient Service Centers and on our Internet site at www.nordx.org. You
also may obtain any new notice by contacting the Privacy Office.
VII. Privacy Office
You may contact the Privacy Office at:
Privacy Office
NorDx
102 Campus Drive Unit 118
Scarborough, ME, 04074
Telephone Number: (207) 885-7840;
E-mail: www.NorDxPrivacy@mmc.org
VIII. NorDx Locations
Scarborough, ME
102 Campus Dr.
96 Campus Dr.
Portland, ME
22 Bramhall St.
887 Congress St.
335 Brighton Ave.
331 Veranda St.
Falmouth, ME
5 Bucknam Rd.
Gorham, ME
94 Main St.
Windham, ME
4B Commons Ave., Ste. 2
Yarmouth, ME
60 Forest Falls Dr.
Auburn, ME
4 Washington Street
Bangor, ME
12 Stillwater Ave
Biddeford, ME
4 Wellspring Rd.
Brunswick, ME
6 Farley Rd.
Oakland, ME
25 First Park
Westbrook, ME
1 Harnois Ave.
Exeter, NH
27 Hampton Road
Hampton, NH
23 Stickney Terrace
Portsmouth, NH
161 Corporate Dr.
Stratham, NH
118 Portsmouth Ave
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