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This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

DCL Pathology, LLC is required by law to protect the privacy of your health information. We are also required to:

  • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  • Abide by the terms of this notice
  • Notify you if we are unable to agree to a requested restriction
  • Accommodate reasonable request you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and make the new provisions effective for all protected health
information we maintain.

We will not use or disclose your health information without your authorization, except as described in this notice.

HOW WE MAY USE OR DISCLOSE INFORMATION

We must use and disclose your health information to provide information:

  • To you or someone who has the legal right to act for you;
  • To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected; and
  • Where required by law.

We have the right to use and disclose health information to pay for your health care and operate our business.
For example, we may use your health information:

  • For Payment. We may use and disclose your PHI to bill and collect payment for health care services provided to you.
  • For Treatment. We may disclose health information to your doctors, healthcare providers or hospitals to help them provide, coordinate, and manage your medical care and any related services. We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him/her in your treatment.
  • For Healthcare Operations. We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to, business planning and development, quality assessment and improvement, medical review, legal services and auditing functions.

We may use or disclose your health information for the following purposes under limited circumstances:

  • To Persons Involved With Your Care We may use or disclose your health information to a person involved in your care, such as a family member, when you are incapacitated or in an emergency, or when permitted by law.
  • Health Information Organization. We may elect to use a health information organization, or other such organization, to facilitate the electronic exchange of information for the purposes of treatment, payment or healthcare operations.
  • For Reporting Victims of Abuse, Neglect or Domestic Violence to government authorities, including a social service or protective service agency.
  • For Health Oversight Activities such as governmental audits and fraud and abuse investigations.
  • For Judicial or Administrative Proceedings such as in response to a court order or subpoena.
  • For Law Enforcement Purposes such as providing limited information to locate a missing person.
  • Provide Information Regarding Decedents. We may disclose information to a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law. We may also disclose information to funeral directors as necessary to carry out their duties.
  • Research. We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information

If none of the above reasons applies, then we must get your written authorization to use or disclose your health
information. If a use or disclosure of health information is prohibited or materially limited by other applicable law,
it is our intent to meet the requirements of the more stringent law. You may take back or “revoke” your written
authorization, except if we have already acted based on your authorization. To revoke an authorization, refer to
“Exercising Your Rights” of this notice.

WHAT ARE YOUR RIGHTS

The following are your rights with respect to your health information.

  • You have the right to ask to restrict uses or disclosures of your information for treatment, payment, or healthcare operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in your health care or payment for your health care. We may also have policies on dependent access that may authorize certain restrictions. Please note that while we will try to honor your request and will permit requests consistent with its policies, we are not required to agree to any restriction.
  • You have the right to receive confidential communications of information in a different manner or at an alternative address, designated by you (for example, by sending information to a P.O. box instead of your home address).
  • You have the right to see and obtain a copy of health information that may be used to make decisions about you such as claims and case or medical management records. You also may receive a summary of this health information. You must make a written request to inspect and copy your health information. In certain limited circumstances, we may deny your request to inspect and copy your health information.
  • You have the right to ask to amend information we maintain about you if you believe the health information about you is wrong or incomplete. If we deny your request, you may have a statement of your disagreement added to your health information.
  • You have the right to receive an accounting of disclosures of your information made by us during the six years prior to your request. This accounting will not include disclosures of information: (i) made prior to January 1, 2012; (ii) for treatment, payment, and health care operations purposes; (iii) to you or pursuant to your authorization; and (iv) to correctional institutions or law enforcement officials; and (v) other disclosures that federal law does not require us to provide an accounting.
  • You have the right to receive written notice in the event we learn of an unauthorized acquisition, use or disclosure of your PHI that has not otherwise been properly secured, as required by HIPAA.

EXERCISING YOUR RIGHTS

If you have any questions about this notice, want to file a complaint, or want to exercise any of your rights, please call the Compliance Officer at 317-874-1254 or by mail: DCL Pathology LLC, Attention: Compliance Officer, 10291 N. Meridian Street, Suite 100, Indianapolis, IN 46290.

We will not take any action against you for filing a complaint.