|Dominion Pathology Laboratories Notice of Privacy
Effective Date: April 14, 2003 Revised: September 23, 2013 to reflect
the 2013 HIPAA/HITECH Omnibus Final Rule
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.
If you have any questions about this notice, please contact:
Dominion Pathology Laboratories Privacy Contact Person
PO Box 2453
Norfolk, VA 23501
Our Pledge Regarding Medical Information:
We understand that medical information about you and your health
is personal. We are committed to protecting medical information
about you. We create a record of the services you receive by Dominion
Pathology Laboratories. We need this record to provide you with
quality care and to comply with certain legal requirements. Your
personal provider may have different policies or notices regarding
the doctor's use and disclosure of your medical information created
in the doctor's office or clinic. This notice tells you about
the ways in which we may use and disclose your medical information.
It also describes your rights and certain obligations we have
regarding use and disclosure of information.
We Are Required By Law to:
• make sure that medical information that identifies you
is kept private;
• give you this notice of our legal duties and privacy practices;
• follow the terms of the notice that is currently in effect.
How We May Use and Disclose Medical Information
The following categories describe different ways that we use and
disclose medical information. For each category of uses or disclosures
we will explain what we mean and give examples. Not every use
or disclosure in a category will be listed, however all of the
ways we are permitted to use and disclose information fall within
one of the categories.
For Treatment. We may use medical information
about you to provide you with medical treatment or services. We
may disclose medical information about you to doctors, nurses,
technicians, medical students, or other people outside our laboratory
who are involved in your care. f the ways we are permitted to
use and disclose information fall within one of the categories.
For Payment. We may use and disclose your health
information so that we or others may bill and receive payment
from you, an insurance company or third party for treatment and
services you received. For example, we may give your health plan
information about you so that they will pay for your treatment.
For Health Care Operations. We may use and disclose
health information about you for our health care operations. These
uses and disclosures are necessary to make sure that all of our
patients receive quality care and to operate and manage our laboratory.
We may also disclose information to private accreditation organizations
such as The College of American Pathologists or other accreditation
entities, in order to obtain accreditation from these organizations.
For example, we may use medical information to review our treatment
and services and to evaluate the performance of our staff.
Research. Under certain circumstances, we may
use and disclose health information for research. For example,
a research project may involve comparing the health of patient
who receives one treatment to those that receive another.
As Required By Law. We will disclose medical
information about you when required to do so by federal, state
or local law. This includes, but is not limited to, disclosures
to mandated patient registries.
To Avert a Serious Threat to Health or Safety.
We may use and disclose medical information about you to a person
able to help prevent a serious threat to your health and safety
or the health and safety of the public or another person.
Business Associates. We may disclose health information
to our business associates that perform functions on our behalf
or provide us with services if the information is necessary for
such functions or services. For example, we may use another company
to perform billing services on our behalf. All of our business
associates are obligated to protect the privacy of your information
and are not allowed to use or disclose any information other than
as specified in our contract.
To Sponsors of Group Health Plans. We may disclose
your medical information to the sponsor of a self-funded group
health plan, as defined under ERISA. We may also give your employer
information on whether you are enrolled in or have dis-enrolled
from a health plan offered by the employer.
Organ and Tissue Donation. We may release medical
information to organizations that handle organ procurement or
organ, eye or tissue transplantation or to an organ donation bank,
as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. We may release medical
information about members of the domestic or foreign armed forces
as required by the appropriate military command authorities.
Workers' Compensation. We may release medical
information about you for workers' compensation or similar programs.
Public Health Activities. We may disclose medical
information about you for public health activities. These activities
include the following:
• to prevent or control disease, injury or disability;
• to report births and deaths;
• to report child abuse or neglect;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease or condition;
• to notify the appropriate government authority if we believe
a patient has been the victim of abuse, neglect or domestic violence
where you agree or when required or authorized by law.
Health Oversight Activities. We may disclose
medical information to a health oversight agency for activities
authorized by law. These oversight activities include, but are
not limited to, audits, investigations, examinations, inspections,
Lawsuits and Disputes. If you are involved in
a lawsuit or a dispute, we may disclose medical information about
you in response to a court or administrative order. We may also
disclose medical information about you in response to a subpoena,
discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you
about the request. We also may disclose your information to Dominion
Pathology Laboratories’ attorneys and, in accordance with
applicable state law, to attorneys working on our behalf.
Law Enforcement. We may release medical information
if asked to do so by a law enforcement official:
• In response to a court order, subpoena, warrant, summons
or similar process;
• To identify or locate a suspect, fugitive, material witness,
or missing person;
• About the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person's agreement;
• About a death we believe may be the result of criminal
• About criminal conduct at the location of a Dominion Pathology
• In emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description or location
of person(s) who committed the crime.
Coroners, Medical Examiners and Funeral Directors.
We may release medical information to a coroner, medical examiner
or funeral director as necessary for them to carry out their duties.
National Security and Intelligence Activities.
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, or other national
Protective Services for the President and Others.
We may disclose medical information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons, or foreign heads of state or conduct special
Inmates and Individuals in Custody. If you are
an inmate of a correctional institution or under the custody of
a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement official.
This release would be necessary (1) for the institution to provide
you with health care; (2) to protect your health and safety or
the health and safety of others; or (3) for the safety and security
of the correctional institution.
Uses and Disclosures Regarding Food and Drug Administration
(FDA)-Regulated Products and Activities. We may disclose
protected health information, without your authorization, to a
person subject to the jurisdiction of the FDA for public health
purposes related to the quality, safety or effectiveness of FDA-regulated
products or activities such as collecting or reporting adverse
events, dangerous products, and defects or problems with FDA-regulated
Disaster Relief. We may disclose your PHI to
disaster relief organizations that seek your PHI to coordinate
your care, or notify family and friends of your location or condition
in a disaster. We will provide you with an opportunity to agree
or object to such a disclosure whenever we practically can do
All Other Uses & Disclosures of PHI. Any
other use and/or disclosure of your PHI not specified in this
notice will require a signed authorization prior to use.
Your Rights Regarding Medical Information We Maintain
You have the following rights regarding your medical information:
Right to Inspect and Copy. You have the right
to inspect and copy medical information that may be used to make
decisions about your care. Usually, this includes medical and
billing records, but does not include psychotherapy notes. To
inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing on
a form provided by Dominion Pathology Laboratories. You may also
request where the information is to be sent. If you request a
copy of the information, we may charge a fee for the costs of
copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information,
you may request that the denial be reviewed. Another licensed
health care professional chosen by Dominion Pathology Laboratories
will review your request and the denial. The person conducting
the review will not be the person who denied your request. We
will comply with the outcome of the review.
Right to Amend. If you feel that medical information
we have about you is incorrect or incomplete, you may ask us to
amend the information. You have the right to request an amendment
for as long as the information is kept by our laboratory. To request
an amendment, your request must be made in writing and submitted
to the Privacy Contact Person. You must provide a reason that
supports your request. We may deny your request for an amendment
if it is not in writing or does not include a reason to support
the request. In addition, we may deny your request if you ask
us to amend information that:
• Was not created by us, unless the person or entity that
created the information is no longer available to make the amendment;
• Is not part of the medical information kept by or for
Dominion Pathology Laboratories;
• Is not part of the information which you would be permitted
to inspect and copy; or
• Is accurate and complete.
Right to an Accounting of Disclosures. You have
the right to request an "accounting of disclosures."
This is a list of the disclosures we made of medical information
about you. It does not include disclosures made for treatment,
payment, health care operations, disclosures you authorize or
other disclosures for which an accounting is not required under
HIPAA. To request this list or accounting of disclosures, you
must submit your request in writing to the Dominion Pathology
Privacy Contact Person. 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. For additional lists, we may charge
you for the costs of providing the list. We will notify you of
the cost involved and you may choose to withdraw or modify your
request at that time before any costs are incurred.
Right to Request Restrictions. You have the right
to request a restriction or limitation on the medical information
we use or disclose about you for treatment, payment or health
care operations. You also have the right to request a limit on
the medical information we disclose about you to someone who is
involved in your care or the payment for your care, like a family
member or friend. For example, you could ask that we not use or
disclose information about a surgery you had. We are not required
to agree to your request. If we do agree, we will comply with
your request unless the information is needed to provide you emergency
treatment. To request restrictions, you must make your request
in writing. In your request, you must tell us (1) what information
you want to limit; (2) whether you want to limit our use, disclosure
or both; and (3) to whom you want the limits to apply, i.e. disclosures
to your spouse.
Right to Request Confidential Communications.
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For
example, you can ask that we contact you at work or by mail. To
request confidential communications, you may make your request
in writing. You may also telephone the office of the Privacy Contact
Person, however in order to protect your privacy we may not be
able to accommodate requests made by telephone. We will not ask
you the reason for your request, and will accommodate all reasonable
requests. Your request must specify how or where you wish to be
Right to a Paper Copy of This Notice. You have
the right to a paper copy of this notice at any time. You may
obtain a paper copy of this notice from our web site, www.dominionpathology.com.
Right to Breach Notification. In the event that
unsecured protected health information is inappropriately disclosed,
an investigation of the event will be conducted. If it is determined
to be a breach of your information, you will receive notification
of the breach by first class mail.
Rights of the Deceased. PHI of an individual
that has been deceased for 50 years or more is NOT covered by
HIPAA. Covered Entities are permitted to disclose a deceased person’s
PHI to family members and others who were involved in the care
or payment for care if not contrary to prior expressed preference.
Change to this Notice
We reserve the right to change this notice and make the new notice
apply to health information we already have as well as any information
we receive in the future. We will post a copy of our current notice
at our office. The notice will contain the effective date of the
If you believe your privacy rights have been violated, you may
file a complaint with Dominion Pathology Laboratories or with
the Secretary of the Department of Health and Human Services.
To file a complaint with Dominion Pathology Laboratories, contact
the Privacy Contact Person. All complaints must be submitted in
writing. You will not be penalized or retaliated against for filing
Other Uses of Medical Information.
Other uses and disclosures of medical information not covered
by this notice or the laws that apply to us will be made only
with your written permission. If you provide us permission to
use or disclose medical information about you, you may revoke
that permission, in writing, at any time. If you revoke your permission,
we will no longer use or disclose medical information about you
for the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already
made with your permission, and that we are required to retain
our records of the care and services that we provided to you.
Dominion Pathology Privacy Contact Person
PO Box 2453
Norfolk, VA 23501