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Notice of Privacy Practices
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Effective Date: April 14, 2003 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. OUR PLEDGE REGARDING MEDICAL INFORMATION Greensboro Pathology Associates, (GPA) understands that medical information about you and your health is personal. We are committed to securing your protected health information. We create a record of the care and services you receive from Greensboro Pathology Associates. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by GPA. Your personal physician may have different policies and notices regarding his or her use and disclosure of your protected health information created in the physician’s office, clinic, or hospital. This notice will tell you about the ways in which GPA may use and disclose protected health information about you. We also describe your rights, and certain obligations we have regarding the use and disclosure of protected health information. If you should have any questions concerning this notice, please contact: Ron Gray Privacy Officer Greensboro Pathology Associates Green Valley Road, Suite 104 Greensboro, North Carolina 27408 (336) 510-0025 HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU The following categories describe different ways that we use and disclose protected health information. For each category of uses and disclosures, we will explain the types of information that may be disclosed and give at least one example. This list is not exhaustive and, therefore, not every use or disclosure in a category will be listed. 1. For treatment: We may use protected health information about you to provide you with medical treatment or services. We may disclose protected health information about you to doctors, affiliates, technologists, or other health care personnel who are involved in your care. For example, a doctor caring for you may need to know the results of prior pathology reports to assist him or her in making treatment decisions. GPA may also share protected health information about you in order to coordinate the various tests you may need. 2. For payment: GPA may use and disclose protected health information about you so that the services you receive from GPA may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about professional services you received from GPA so your health plan will pay us or reimburse you for the professional services. 3. For health care operations: We may use and disclose protected health information about you for health care operations. The uses and disclosures are necessary to make sure you receive quality care. For example, we may use protected health information to review our services and evaluate the performance of our staff in providing services to you. We may also disclose information to doctors, nurses, technicians, medical students, and other health care personnel for review and learning purposes. We may remove information that identifies you from this set of protected health information so others may use it to study health care and health care delivery without learning the names of the specific patients. ADDITIONAL USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION 1. Individuals involved in your care or payment for your care: We may release protected health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose protected health information about you to an entity assisting in an emergency so that your family can be notified about your condition, status and location. 2. As required by law: We will disclose protected health information about you when required to do so by federal, state, or local law. 3. Public health risk: We may disclose protected health information about you for public health activities. These activities may include the following: a. To prevent or control disease, injury or disability; b. To report births and deaths; c. To report child abuse or neglect; d. To report reactions to medications or problems with products; e. To notify people of recalls of products they may be using; f. 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; g. To 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. 4. Health oversight activities: We may disclose protected health information to a health oversight agency for activities authorized by law. These oversight activities can include 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. 5. Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose protected health information about you in response to a court or administrative order. We may also disclose protected health information about in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. 6. Law Enforcement: We may release protected health information if asked to do so by law enforcement official: a. In response to a court order, subpoena, warrant, summons, or similar process; b. To identify or locate a suspect, fugitive, material witness or missing person; c. About the victim of a violent crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; d. About a death we believe may be the result of criminal conduct; e. About criminal conduct; and f. 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. 7. Coroners or Medical Examiners: We may release protected health informationto a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. 8. Organ or Tissue Donation: If you are an organ donor, we may release protected health 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. 9. Research: Under certain circumstances, we may use and disclose protected health information about you for research purposes. For example, a research project may involve the results of pathology services and correlation of these results with patient outcomes. Many, but not all, research projects are subject to a special approval process that evaluates the proposed research project’s use of medical information, trying to balance the research needs with the patient’s need for privacy of their protected health information. We will encourage that the protected health information be de-identified at the earliest opportunity, and that there are adequate assurances that the protected health information will not be reused or disclosed to any other person or entity, except at required by law or otherwise permitted under this document. 10. To Avert a Serious Threat to Health and Safety: We may use and disclose protected health information about you when necessary to prevent a serious threat to you health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat (i.e. Department of Health). 11. Military and Veterans: If you are a member of the armed forces, we may release protected health information about you as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority. If you are a veteran, we may use and disclose protected health information about you to the Department of Veteran Affairs to determine whether you are eligible for certain benefits. 12. National Security and Intelligence Activities: We may release protected health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. 13. 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 of the United States of America, other authorized persons or foreign heads of state or conduct special investigations. 14. Inmates: 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 for the institution to provide you with health care; to protect your health and safety of others; or for the safety and security of the correctional institution. 15. Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. 16. Workers’ Compensation: We may release protected health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries and illness. Other uses and disclosures will be made only upon your written consent. You may also have the right to revoke such consent, in writing, except where we have previously taken action in reliance on your prior consent or if the consent was a condition to obtaining insurance coverage and other law provides the insurer with the right to contest a claim under the policy. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU You have the following rights with respect to your protected health information: 1. Right to Inspect and Copy: Upon reasonable notice, you have a right to inspect and copy your protected health information that may be used to make decisions about you care. Generally, this information includes medical and billing records, but does not include psychotherapy notes; information prepared in anticipation of or for use in a civil, criminal, or administrative action; and protected health information maintained by a covered entity that is subject to the Clinical Laboratory Improvements Amendments (“CLIA) of 1988, 42 U.S.C. 263a, if access to the individual would be prohibited by law, or exempt from CLIA pursuant to 42 CFR 493.3(a)(2). To inspect and copy protected health information maintained by Greensboro Pathology Associates, you must submit your request in writing to Ron Gray, Greensboro Pathology Associates, P.A. at 706 Green Valley Road, Suite 104, Greensboro, NC 27408 . We may charge a fee for the costs of copying, mailing or other supplies associated with your request. Please allow 7(seven) to 10 (ten) working days for us to respond to your request. We may deny your request to inspect and copy your protected health information in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed by our Compliance Officer or another licensed health care professional chosen by GPA. We retain the right to deny access and/or refer the matter to our legal counsel for resolution, which may result in disclosure of your protected health information. 2. Right to Amend: If you believe that the protected health information about you is inaccurate or incomplete, you may ask us to amend the information. You have the right to request an amendment so long as the information is kept by GPA. Your request must be made in writing to Ron Gray, Greensboro Pathology Associates, P.A. at 706 Green Valley Road, Suite 104, Greensboro, NC 27408. You must provide a reason to support your request. We will generally make a decision regarding your request for an amendment no later than 60 (sixty)days after receipt of your request. However, if we are unable to act on the request within this time, we may extend the time for 30 (thirty) more days but we will provide with a written notice to the reason for the delay. We reserve the right to contact our legal counsel for advice in this matter which may result in the disclosure of your protected health information. Also we will notify the physician or health care professional of record concerning the particular protected health information you requested be amended. If we deny your requested amendment, we will provide you with a written denial. GPA has the right to deny your request for an amendment if it is not in writing or does not include a reason to support your request. We are not required to agree to your request if you ask us to amend protected health information that: a. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; b. Is not part of the protected health information kept by or for GPA; c. Is not part of the protected health information which you would be permitted to inspect and copy; or d. Is already accurate and complete. 3. Right to an Accounting of Disclosures: You have the right to request an accounting if disclosures of protected health information we have made about you. This request must be made in writing to Ron Gray, Greensboro Pathology Associates, at 706 Green Valley Road, Suite 104, Greensboro NC 27408. Your request must also state a time period which may be no longer than six (6) years and may not include dates before April 14, 2003. We may charge you for the costs of providing the list. We may notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Please allow 7 (seven) to 10 (ten) working days for us to respond to your request. 4. Right to Request Restriction of Uses and Disclosures: You have the right to request that we restrict the uses and disclosures of protected health information about you to carry out treatment, payment or health care operations. We are not required to agree to your request; however, if we do agree, we will comply with our request unless the information is needed to provide you with emergency medical treatment. You must make your request in writing to Ron Gray, Greensboro Pathology Associates, at 706 Green Valley Road, Suite 104, Greensboro NC 27408. Your request must state what protected health information you want to limit; whether you want to limit our use, disclosure, or both; and to whom you want the limits to apply (i.e. disclosures to your spouse). We may terminate our agreement to the restriction if you orally agree to the termination and it is documented, you request termination in writing, or we inform you that we are terminating our agreement with respect to any information created or received after receipt of our notice. 5. Right to Confidential Communications: You also 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 may request that we only contact you at work or by mail. To request confidential communications, you must make the request in writing to Ron Gray, Greensboro Pathology Associates, at 706 Green Valley Road, Suite 104, Greensboro NC 27408. We will not ask you the reason for the request. We will accommodate all reasonable requests. You must be specific how and where you wish to be contacted. 6. Right to Receive Notice Electronically: You have the 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 this notice electronically, you have the right to receive a paper copy of this notice. You may obtain a copy of this notice at our website www.gsopath.com. To obtain a paper copy of this notice, please call (336) 387-2500. CHANGES TO THIS NOTICE We reserve the right to change our privacy practices that are described in the Notice. We reserve the right to make the revised or changes privacy practices applicable to protected health information we already have about you as well as any information we receive in the future. A copy of our current notice will be available in our office. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint in writing to Ron Gray, Privacy Officer, Greensboro Pathology Associates, at 706 Green Valley Road, Suite 104, Greensboro NC 27408. A complaint can also be filed with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint. 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 authorization. If you provide us permission to use or disclose protected health information about you, you may revoke that consent, in writing, at any time. If you revoke your consent, we will no longer use or disclose medical information about you for the reasons covered by written authorization. You understand that we are unable to take back any disclosures we have already made with your consent, and that we are required to retain our records of the care that we provided to you. 
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Greensboro Pathology Associates
706 Green Valley Road, Suite 104, Greensboro, North Carolina 27408 P: 800.345.3376 F: 336.387.2501
www.greensboropathology.com