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Notice of Privacy Practices
Effective Date: October 2013
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
American Medical Diagnostics, Ltd (AMDx, Ltd.), NeuroDiagnostic Laboratories, LLC (NDL) and their employees follow the privacy practices described within this notice. AMDx, Ltd. / NDL maintain your health information confidential records, as required by law. AMDx, Ltd./ NDL may use, disclose or share your health information only as pertains to your treatment, payment of services and the general healthcare operations, necessary to provide you with quality health care.
2. What Are Treatment, Payment, and Health Care Operations?
Treatment may include sharing information with the other health care providers who are involved in your care. For example, your health care provider may need to share information about your condition with a pharmacist in order for you to receive medications. Payment may include use of your health information as required by your insurance carrier to obtain prior authorization, when applicable, and payment for services rendered. Health Care Operations may include limited use of your health information to help improve the quality of your care and/or for educational purposes as it relates to the training of AMDx, Ltd. / NDL employees and staff.
3. How Will AMDx and NDL Use and Disclose My Health Information?
Your health information may be used for the following reasons or disclosed to the following entities, unless you request restrictions on a specific use or disclosure.
Note: You may refuse any/all communications outlined below, when shown with an asterisk (*).
- Family members or close friends involved in your care or payment for treatment(*)
- Disaster relief agency if you are involved in a disaster relief effort(*)
- Information provided to you, regarding alternative treatments or services related to your health(*)
- Appointment reminders
- Public Health Activities, such as; disease prevention, injury or disability, reporting of births/deaths, reporting adverse reactions to medications or product concerns, notification of recalls, infectious disease control, and notification to government agencies for suspected abuse, neglect or domestic violence
- Health Oversight Activities, such as: audits, inspections, investigation and licensure
- Law enforcement
- Coroners, Medical Examiners and Funeral Directors
- Organ and Tissue Donation.
- Certain research projects
- Disclosures necessary to prevent serious threats to health or safety
- Military Command Authorities, if you are a member of the armed forces or a member of a foreign military authority
- National security and intelligence activities to authorized person who use the disclose to conduct special investigations
- Worker’s Compensation Payers, as it relates to any injury and/or illness reported to or by a worker’s compensation office
- Use or disclosure necessary to initiate and complete health care treatment, payment and operations or functions by business associates, such as; installation of a new computer software system
- To carry out health care treatment, payment, and operations functions through business associates, such as to install a new computer system.
Note: Alcohol and drug abuse information has special privacy restrictions. AMDx, Ltd. / NDL will not disclose any information identifying an individual as being such a patient nor will any health information relating to a patient’s substance abuse treatment be provided, except where the patient provides written consent to do so, the disclose is necessary to carry out treatment, payment and operations, or where it may be required by law.
4. Your Authorization Is Required for Other Disclosures.
Except where otherwise described, use and/or disclose of your medical information will be not be released by AMDx, Ltd. / NDL. If you would like us to release your medical information to a party/parties not otherwise mentioned, your request must be provided in writing and will only be effective as of the date you indicate.
5. You Have Rights Regarding Your Health Information.
You have the following rights, when requested on the form(s) provided by AMDx, Ltd. / NDL:
- Right to request restriction. You may request certain limitations on the usage or disclosure of your health information in relation to your health care, treatment, payment or operations. However, we are not required to comply with these types of requests.
- Right to confidential communications. You may request that communication regarding your health information be provided in a certain way or at a location, other than the personal address you provided. When submitting such a request, you must also provide a written method of contact for yourself; i.e., alternate phone number or address.
- Right to inspect and copy. You may review and request a copy of your medical or health record(s). For certain requests, an administrative fee to cover the cost of the request may be applied. Under limited circumstances, your request may be denied. You then have the right to request review of the denial by another licensed health care professional, as selected by AMDx, Ltd. / NDL. After the review is completed, AMDx, Ltd. / NDL will comply with the outcome.
- Right to request amendment. You may request an amendment to your medical or health record(s), if you believe that information maintained by AMDx, Ltd. / NDL is incorrect or incomplete. However, we are not required to accept the amendment.
- Right to accounting of disclosures. You may request the name(s) of persons or entities where a disclosure was released and was unrelated to your health care, treatment, payment or operations within in the previous six (6) years. Any request for information provided prior to April 14th 2003 is not applicable. AMDx, Ltd. / NDL may apply an administrative fee for any request received after the initial request.
- Right to a copy of this Notice. You may request a paper copy of this notice at any time, even if you have been provided with an electronic copy. To obtain an electronic copy of this notice, please refer to our website, at: http://www.ndxlabs.com/.
6. What requirements apply to this notice?
AMDx, Ltd. / NDL is required by law to provide you with this notice and will continue to comply with the provisions outlined within, for as long as it is required by law. AMDx, Ltd. / NDL reserves the right to change the terms outlined within this notice and any such changes will be effective for all information that may be in our health records for you, as well as for all future information we receive for or by you. All revisions to this notice will be available on our website, at http://www.ndxlabs.com/. Revised paper copies will also be available, upon request. A copy of the notice may be provided to you, each time you register to receive services by AMDx, Ltd. / NDL.
7. What if I have a complaint regarding privacy practices?
If you believe your privacy rights have been violated, you may file a complaint with the AMDx/NDL Privacy Officer or with the Secretary of the United States Department of Health and Human Services. All complaints must be made in writing and must describe the situation giving rise to the complaint. We will not penalize or retaliate against you in any way for making a complaint to AMDx/NDL or to the Department of Health and Human Services.
Contact the AMDx/NDL Privacy Officer if:
- You have any questions about this Notice;
- You wish to request restrictions on uses and disclosures for health care treatment, payment, or operations; or
- You wish to obtain a form to exercise your individual rights
described in paragraph 5.
ATTN: Privacy Officer
2423 W. Dunlap Ave | Suite 175
Phoenix, AZ 85021-5818
(P) 602.424.4450 | (F) 602.424.4451
NeuroDiagnostic Laboratories Corporate Office
2423 W. Dunlap Ave. #175
Phoenix, AZ 85021
NeuroDiagnostic Laboratories corporate office is located in the Dunlap Health Center in Phoenix, Arizona.