This notice describes the privacy practices of InforMed Centers and
affiliated websites. Furthermore this notice describes the privacy practices
of the physicians providing medical overseeing, counseling and/or
consultations. These companies and physicians have agreed to the terms of
this Notice of Privacy Practices, and are sending you one notice instead of
sending you a separate notice from each of them. This privacy notice and the
privacy practices explained in this notice notify you of our commitment to
protecting private health information, and permitting people to exercise
their rights concerning health information. No legal relationship between
these physicians and companies is created or implied for any other purpose.
Your Health Care Information is Your Personal Information. We
know that information about your health is private. To process the ordering
of your Health tests, we must create certain records which contain
information about you and the results of your tests. These records include
your name, test/s ordered, results and billing records. The law requires
that we give you notice of our privacy practices, and requires that we
follow the terms of our privacy notice currently in effect. This Notice of
Privacy Practices describes our commitment and the commitment of the
physicians to the protection and confidentiality of your health information.
This notice also describes your rights concerning your health information,
including your right to inspect and amend your health information. We are
committed to following the law which requires that protected health
information is kept private subject to legal requirements which authorize or
require its disclosure in limited circumstances.
How We May Use and Disclose Health Information. Unless we have
your written authorization, we will not use and disclose your protected
health information, except under the limited circumstances explained below.
We will not disclose protected health information about you for any other
reason without your written authorization. If you give us an authorization
permitting us to release protected health information, you may revoke the
authorization in writing, except to the extent we have already disclosed
information pursuant to the authorization
A. Limited Information is Used to Obtain Payment for Services.
We obtain payment for our services through money orders and/or your credit
card company or through a check processing service. We do not share any
information with your credit card company or check processing service which
discloses the type or the reason of the payment made by our customers.
B. Information May Be Used for Health Care Operations. We may
use or disclose health care information for our operations. For example, we
may use information concerning your test/s to evaluate the quality of
services our staff is providing to you.
C. Follow up testing procedures.
We may use health care
information to contact you by phone for the purpose of follow up the course
of your testing. For example, we may have a need to change your referral to
a different Service Center. Please advise our Privacy Officer at the time of
ordering test/s or by e-mail or U.S. mail at the privacy contact address
described at the end of this Notice if you do not wish us to contact you.
D. Disclosures as Required by Law. We may use or disclose
protected health information if required to do so by federal, state, or
local law. The use or disclosure will be made in compliance with the law,
and will be limited to the relevant requirements of the law. For example, we
may be required to disclose your health information to respond to a
subpoena, or order of a court or administrative tribunal.
E. Disclosures for Public Health Activities. We may be
required to disclose protected health information for public health
activities to a public health authority authorized by law to collect or
receive this information, such as the Food and Drug Administration, for the
purpose of preventing or controlling disease, injury, or disability.
F. Disclosures to Coroners and Medical Examiners. We may be
required to disclose health information about patients who have died to
coroners and medical examiners so they may carry out their duties, such as
determining the cause of death
G. Disclosures Concerning Organ Donors. If you are an organ
donor, we may be asked to disclose information concerning your health or
drugs we have prescribed to organ procurement organizations, eye banks, and
other similar organizations for the purpose of facilitating organ, eye or
tissue donation and transplantation.
H. Disclosures to Avert a Serious Threat to Health. As
required by law and standards of ethical conduct, we are permitted to
release your health information to the proper authorities if we believe, in
good faith, that such release is necessary to prevent or minimize a serious
and imminent threat to your, the public's, or another individual's health or
I. Disclosures for Health Oversight Activities. We are
permitted to disclose your health information to a health oversight agency
for monitoring and oversight activities authorized by law. This might
include release of information to the state agency that licenses Physicians
for the purpose of monitoring or inspection
Your Rights Pertaining to Your Health Care Information
- Right to Request Confidential Communications. We intend to
communicate with our customers primarily by phone call or e-mail at the
e-mail address which you provided to us. You have the right to request
that we communicate with you in a certain way or at a certain location.
For example, you can ask that we only contact you by U.S. mail at a
private post office box. We will not ask you the reason for your request.
B. Right to Request Restrictions. You have the right to ask
for restrictions on how your health information is used or to whom your
information is disclosed, even if the restriction affects your treatment,
our payment, or health care operation activities. However, we are not
required to agree to your requested restriction and, even if we agree to the
requested restriction, we are permitted to use your information without
complying with the restriction if necessary to treat you in an emergency
C. Your Right to Inspect and Obtain a Copy of Your Health Information.
You have the right to inspect and obtain a copy of health information that
we maintain about you. This includes copy of the test records and billing
records. To inspect or request a copy of your health information please
contact our Privacy Officer as described later in this Notice. In certain
very limited circumstances, the law provides that we may deny your request
to inspect or copy these records. If you are denied access to health
information, you may request that the denial be reviewed by a licensed
health care professional chosen by us who did not participate in the
original decision to deny your access to review your request and the reasons
for the denial.
D. Your Right to Request an Amendment to Your Health Information.
If you believe the health information within your medical record is
incorrect, you may ask us to amend the information. We are not required,
however, to honor your request if we did not create the information you are
requesting be amended or if the information in your record is correct. We
will respond to your request in writing within 60 days of the date of
receipt of your written request for amendment of your information, unless we
advise you we require an additional 30 days.
E. Right to an Accounting of Disclosures. You have the
right to request a list accounting for any disclosures of your protected
health information we have made, except for uses and disclosures for a)
payment, and health care operations, b) disclosures to you, c) disclosures
pursuant to your authorization, and d) disclosures for certain other limited
reasons specified by law. To request a list of disclosures, please contact
our Privacy Officer by e-mail or U.S. mail at the address listed below. Your
request must state a time period which may not be longer than six years, and
may not include dates before April 14, 2003. The first list you request
within a 12 month period will be free.
F. Right to a Paper Copy of this Notice. You have the right to
obtain a paper copy of this notice at any time. To obtain a paper copy,
please request it from our Privacy Officer at the address listed below.
G. Effective Date. This revised Notice of Privacy Practices is
effective on April 14, 2003; and pertains to all protected health
information we maintain.
H. Changes to this Notice. We reserve the right to change this
notice, and we may make the revised or changed notice effective for all
protected health information we already have about you as well as any
information we receive in the future. We will post a copy of the current
notice on our website. The notice will contain an effective date.
I. Complaints. We are committed to safeguarding your protected
health information. Despite our good faith efforts, questions, concerns,
mistakes, and misunderstandings may arise. If you have a concern or believe
that we may have violated your privacy rights, we encourage you to bring
that to our attention. You may bring any complaints or concerns regarding
your privacy rights to our attention by calling 866-478-3417 and requesting
to speak with our Privacy Officer or their authorized representative. If you
prefer, you may submit a complaint in writing to our Privacy Officer at
InforMed Centers. 5517 State Rd. Cleveland OH 44134 or by e-mail to