You Have the Right to:

• Obtain a copy of your paper or electronic health record
• Ask us to limit the information we share
• Request confidential communication
• Amend your health record
• Obtain a list of those with whom we've shared your information
• Obtain a copy of this privacy notice
• File a complaint if you believe your privacy rights have been violated
• Notification by Clinical Pathology Laboratories of any changes to our health information practices

We May Use and Share Your Information to:

• Assist in treating you
• Bill for services provided
• Manage our organization
• Comply with the law
• Help with public health and safety issues

We are Required to:

• Maintain the privacy and security of your health information
• Inform you if a breach occurs that may have compromised the privacy or security of your information
• Provide you with a notice of our legal duties and privacy practices regarding the information we collect and maintain about you
• Abide by the terms of this notice
• Notify you by mail, upon your request, if Clinical Pathology Laboratory's health information practices change
• Obtain your written authorization for any uses or disclosures of your health information not described in this notice. You may revoke the authorization at any time, except to the extent that action has already been taken.

Obtain a copy of your paper or electronic health record

• You can ask to see or obtain an electronic or paper copy of your laboratory record. Click here to be directed  to the form you will need to submit to obtain your record.
• We will provide a copy of your laboratory record in the timeframe required by law. You will be informed in writing if the delivery of your record will be delayed.

Ask us to limit the information we share

• We are allowed to use your health information for treatment, payment and healthcare operations without your consent. You can ask us to limit or not use your information for these purposes, but we are not required by law to agree to your request.
• If you pay for laboratory services out-of-pocket in full, you can ask us not to share that information with your health insurer. We will say yes to your request unless a law requires us to share that information.
• If you would like us to limit the information that we share about you, contact CPL's Privacy Officer by calling 800.595.1275 or email to [email protected].

Request confidential communication

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address than we have on record for you. We will say yes to all reasonable requests.
• If you have a request for confidential communication, contact CPL's Privacy Officer by calling 800.595.1275 or email to [email protected].

Amend your health record

• You can ask us to amend health information about you that you think is incorrect or incomplete, but we are not required to agree to your request. You will be notified in writing within 60 days of your request if we do not agree to your request.
• If you have a request to amend your health information, contact CPL's Customer Service Department at 800.595.1275.

Obtain a list of those with whom we've shared your information

• You can ask us to prepare a list for you of the people with whom we have shared your health information within the past six years of your request.
• We will provide you with a description of the information that we shared, who we shared it with, and why we shared it.
• Under the law, we are not required to include in the list the occasions that we shared your health information for the purposes of treatment, payment or healthcare operations.
• If you would like to obtain a list of those with whom we've shared your information, contact CPL's Privacy Officer by calling 800.595.1275 or email to [email protected].

Obtain a copy of this privacy notice

• You may obtain a copy of this privacy notice at the bottom of this web page in the box marked Notice of Privacy Practices.
• If you wish to have a copy of this privacy notice mailed to you, contact CPL's Privacy Officer by calling 800.595.1275 or email to [email protected].

• If you have questions or comments regarding CPL's Notice of Privacy Practices, or have a complaint about our use or disclosure of you Protected Health Information or our privacy practices, please contact CPL's Privacy Officer by calling 800.595.1275 or email  [email protected].

You may file a complaint directly with the Secretary of Health and Human Services. There will be no retaliation by CPL for you filing a complaint.

• Assist in your treatment: for example, we will report the results of your laboratory test(s) to the health care practitioner who requested the test(s).
• Bill for services rendered to you: for example, a bill may be sent to you or a third party payer. The bill may include information that identifies you and the tests that were performed.
• Manage our organization: for example, we may use information about you to assess the timely reporting of the results of your test(s); this information will then be used in an effort to continually improve the quality and effectiveness of the service we provide.
• We may provide your PHI to other companies or individuals that need the information to provide services to us. These other entities, known as "business associates", are required to maintain the privacy and security of PHI. For example, we may provide information to companies that assist us with billing of our services. We may also use an outside collection agency to obtain payment when necessary.
• Comply with the law; for example: We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability or to avert a serious threat to the health or safety of a person or the public.
• To comply with laws relating to workers compensation or other similar programs established by law.
• We may provide your PHI to other companies or individuals for research purposes.  We will only do this if an Institutional Review Board or privacy board allows CPL to disclose your PHI without your authorization.  An Institutional Review Board or privacy board may only waive the authorization requirement when your privacy is protected.
• We may disclose your health information for law enforcement purposes as required by law or in response to a valid subpoena.

Maintain the privacy and security of your health information

• Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), CPL is required by law to maintain the privacy of health information that identifies you, called protected health information or "PHI". CPL will make reasonable efforts to ensure the confidentiality of your PHI, as required by statute and regulation.

Inform you if a breach occurs that may have compromised the privacy or security of your information

• CPL is required to provide patient notification if it discovers a breach of unsecured PHI unless there is a demonstration, based on a risk assessment, that there is a low probability that the PHI has been compromised. You will be notified without unreasonable delay and no later than 60 days after the discovery of the breach.

Provide you with a notice of our legal duties and privacy practices regarding the information we collect and maintain about you

• CPL is required to provide you with this notice of our legal duties and privacy practices. A copy of our privacy practices is available on our website, www.cpllabs.com. You may also request that a printed copy be mailed to you (see below).

Abide by the terms of this notice

• CPL is required by law to maintain the privacy of your PHI and to abide by all of the terms of this notice.

Notify you by mail, upon your request, if CPL's health information practices change

• CPL may change the content of this notice of privacy practices at anytime because of operational or regulatory requirements. The changes will apply to all information CPL has about you. Whenever changes are made to this notice of privacy practices, they will be posted on CPL's website at www.cpllabs.com. If you request, you may be notified by mail whenever these changes occur. If you wish to have a copy of the changed notice of privacy practices mailed to you, contact CPL's Privacy Officer by calling 800.595.1275 or email to [email protected].

Obtain your written authorization for any uses or disclosures of your health information not described in this notice. You may revoke the authorization at any time, except to the extent that action has already been taken.

• For purposes not described above, CPL will ask for your authorization before using or disclosing your PHI. If you signed an authorization form, you may revoke it, in writing, at any time, except to the extent that CPL has already acted on any prior uses or disclosures previously authorized by you.

Effective Date: October 6, 2014