THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this Notice, please contact:
Sequenom Center for Molecular Medicine, LLC
301 Michigan Street NE, Suite 580
Grand Rapids, MI 49503
Who Will Follow This Notice
For purposes of this Notice, “Sequenom Center for Molecular Medicine, LLC” or “SCMM” will refer to all laboratories, facilities and operations within the Sequenom Center for Molecular Medicine, LLC. SCMM is a laboratory that provides molecular based laboratory developed test services.
This Notice also applies to SCMM facilities and healthcare and other service providers who, while not necessarily legally affiliated with SCMM, participate in your care or treatment, including:
- Any health care professional authorized to enter information into any health record established and maintained by SCMM
- All employees, staff, volunteers, students and other SCMM personnel
- The laboratory medical staff of any SCMM facility and the individual members of that laboratory medical staff and
- Any health care or service provider who, although not employed by a SCMM facility, provides services to you at a SCMM facility or other facility, including but not limited to laboratory and diagnostic providers.
Our Pledge Regarding Health Information
We understand that health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the testing and diagnostic services you receive from SCMM. We need this record to provide you with quality service and to comply with certain legal requirements. This Notice applies to all of the records of or related to the services provided to you which are maintained by SCMM, whether electronic or paper and whether made by lab personnel, your personal doctor, a consulting or other treating doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your health information.
This Notice covers the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of health information.
We are required by law to:
- Maintain the privacy of your health information that identifies you;
- Give you this Notice of our legal duties and privacy practices with respect to health information about you; and
- Follow the terms of the Notice that is currently in effect.
How We May Use And Disclose Health Information About You
In many situations, we can use and share your health information without your written permission (Authorization). In some situations, your written Authorization is required to use or share your health information. The following categories describe different ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Test Services. We may use health information about you to provide you with laboratory tests or services. We may disclose health information about you to health care providers who are involved in taking care of you or with whom we may consult or to whom we may refer you as part of our services to you as customer of SCMM, including but not limited to: doctors, nurses, technicians, students, laboratory and diagnostic providers, pharmacies, and other health professionals, such as nurse practitioners, physician assistants, physical therapists or other personnel who plan or provide treatment to you.
We also may disclose health information about you to people outside SCMM who may be involved in your health care following laboratory testing. We also may disclose your health information to another health care provider you are referred or transferred to for health care services.
Doctors and other providers who may treat you outside of SCMM need access to the most complete information possible in order to make sound decisions. These providers are able to access your electronic and paper SCMM records for this purpose. Also, when these providers have referred you to SCMM for testing, they are able to access your records in order to better follow your treatment progress. SCMM has procedures and technology in place to protect the privacy and security of your records in these cases.
For Payment. We may use and disclose health information about you including laboratory test results, procedures, and supplies used so that the services you receive at SCMM may be billed to (and payment may be collected from) you, an insurance company or other third party. We may also tell your health plan about a test or service you are going to receive to obtain prior approval or to determine whether your plan will cover the test or service. Another example is attempting to contact you in writing or on the telephone for purposes of verifying or gaining more information regarding insurance coverage.
For Health Care Operations. We may use and disclose health information about you for SCMM operations. These uses and disclosures are necessary to run SCMM entities and make sure that all of our customers receive quality service. For example, we may use health information to review our processes and services and to evaluate the performance of our staff in servicing you. We may also combine health information about many customers to decide what additional services SCMM should offer, what services are not needed and whether certain new tests are effective. We may also disclose information to doctors, nurses, technicians, students and laboratory personnel for review and learning purposes. We may also combine the health information we have with health information from other organizations to compare how we are doing and see where we can make improvements in the services we offer. In these cases, we will remove information that identifies you so others may use it to study health care and health care delivery without learning who the specific customers are. We may also use certain health and non-health information to contact you to solicit your opinions on the quality of services you received from SCMM and how we may improve our services.
Incidental Uses and Disclosures. We may use or disclose your health information when such use or disclosure is incidental to another use or disclosure that is permitted or required by law. For example, conversations between laboratory personnel or other SCMM personnel regarding your health condition or test results may at times be overheard. Please be assured that we have appropriate safeguards to avoid such situations as much as possible.
Treatment Alternatives. We may use and disclose health information to tell you about or recommend possible options or alternatives, such as alternative or complementary laboratory or diagnostic tests or services.
Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related services or benefits that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. We may disclose health information about you to a friend or family member who is involved in your health care and testing. We may also give information to someone who is involved with payment or helps pay for your care and testing.
Research. Under certain circumstances, we may use and disclose health information about you to researchers for research purposes when their research has been approved and established protocols to ensure the privacy of your health information have been set.
As Required by Law. We will disclose health information about you when required to do so by federal, state or local law or regulation. For instance, we are required to report certain injuries or illnesses for public health purposes.
To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces, we may disclose health information about you as required by military command authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority. If a family member is in the military, in certain circumstances we may disclose information about you to the military or an approved social services agency such as the Red Cross to advise your family member of your condition.
Workers’ Compensation. We may disclose health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose health information about you for public health activities. These activities generally include the following to:
- Prevent or control disease, injury or disability;
- Report births and deaths and to participate in disease registries;
- Report child abuse or neglect;
- Report reactions to medications or problems with products;
- Notify people of recalls of products they may be using;
- Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or
- Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, only if you have agreed to such a release, except that your consent will not be required if the information disclosure has been ordered by a court of law.
Law Enforcement. We may disclose health information if asked to do so by a law enforcement official in the following situations:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness or missing person;
- If the information is in regard to a victim of a crime, and if, under certain limited circumstances, we are unable to obtain the person’s agreement to the disclosure;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at a SCMM facility; or
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
National Security and Intelligence Activities. We may disclose health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose health information about you to authorized federal officials so they may conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose health information about you to the correctional institution or law enforcement official. This disclosure 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.
To Third Parties. We may disclose your health information to certain third parties with whom we contract to perform services on behalf of a SCMM entity. If we do so, we will have written assurances from the third party that the third party will safeguard your information.
Highly Confidential Information. Certain types of health information receive special privacy protection. We will only use or share your highly confidential health information as permitted or required by law, or with your written permission.
Your Rights Regarding Health Information About You
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and obtain a copy of health information that may be used to make decisions about your care. During an inspection of your information, a laboratory professional may be in attendance to assist you. The information available to you includes health and billing records.
To inspect or obtain a copy of your health information that may be used to make decisions about you, you must submit your request in writing to the SCMM facility that provided the related services. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies or other charges incurred or associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
In some cases, if you are participating in research, we may deny your request to inspect and copy some of your health information related to that research, but only if you have agreed to this access restriction in the consent you sign when you agree to participate in the research. We may also deny access as otherwise permitted by law.
Right to Amend. If you feel that health 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 or for SCMM.
To request an amendment, your request must be made in writing and submitted to the specific SCMM facility that provided the related services. In addition, 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 health information kept by or for a SCMM entity;
- 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 health information about you. To request this list or accounting of disclosures, you must submit your request in writing to the specific SCMM facility that provided the related services. Your request must state a time period which may not be longer than six years.
Your request should indicate in what form you want the list (for example, on paper or electronically). 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 costs 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 health information we use or disclose about you for test services, health care operations, or payment. SCMM recognizes that you may wish to exercise your rights differently at various SCMM facilities, your physician’s office, or outpatient treatment center. It is your responsibility to notify individual SCMM facilities of specific restrictions to use or disclose your health information. You must notify each specific SCMM facility and make those restrictions known. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend.
We are not required to agree to your request to restrict the use or disclosure of your health information. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. If we do agree to a restriction, the restriction will not apply to certain disclosures, such as disclosures which are: (1) required because of transfer of your health care to another health care facility; (2) required by law; or (3) required by a third-party payment contract.
To request restrictions, you must make your request in writing to the SCMM facility. 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, for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to the privacy official at the specific SCMM facility from which confidential communications are requested. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at any SCMM facility.
Changes To This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for 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 in the facilities covered by this Notice. In addition, each time you request the services of a SCMM facility for testing, a copy of the current Notice in effect will be made available to you upon your request.
If you believe your privacy rights have been violated, you may file a complaint with the SCMM entity involved or with the secretary of the Department of Health and Human Services.
To file a complaint with SCMM, contact the SCMM Privacy Officer, at 301 Michigan Street NE, Grand Rapids, MI 49503, (877) 821-7266, or send an e-mail to email@example.com in writing. You will not be penalized for filing a complaint.
Other Uses Of Health Information
Other uses and disclosures of health 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 with permission to use or disclose health 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 health information about you for the reasons covered by your written authorization. You understand that we are unable to reverse any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Questions or Concerns
Sequenom Center for Molecular Medicine
301 Michigan Street NE
Grand Rapids, MI 49503