Metropolitan Medical Laboratory, PLC
 QC Pathologists, LLC
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Definitions:

Health Information: any information, whether oral or recorded in any form or medium that (1) is created or received by Metropolitan Medical Laboratory, PLC; and (2) relates to the past, present, or future physical or mental health or condition of an individual; provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual.

Individually Identifiable Health Information: Information that is a subset of health information, including demographic information… (1) is created or received by Metropolitan Medical Laboratory, PLC…(2) relates to the past, present or future physical or mental health or condition of an individual ; the provision of health care to an individual; or the part, present or future payment for the provision of health care to an individual and…(i) identifies the individual, or (ii) with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

Protected Health Information: Means individually identifiable health information that is (1) transmitted by electronic media, (2) maintained in any medium, (3) transmitted or maintained in any other form or medium.

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Allowable Uses and Disclosures of Protected Health Information:

Treatment: The provision, coordination, or management of healthcare and related services by one or more healthcare providers. This includes coordination of care with a third party, consultations between providers and referrals to other providers. Examples include: receiving PHI from your physician to identify, complete and report back to the physician laboratory testing; using your PHI as part of our internal quality control system(s).

Payment: Activities undertaken by the laboratory to obtain or provide reimbursement for healthcare. Example being billing, claims management, determining eligibility or coverage of service, coordination of benefits, and disclosing information to collection agencies. Examples include: we may contact your health insurer to certify that you are eligible for benefits (and for which range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover or pay for treatment. We may also use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.

Healthcare Operations: Activities directly related to the provision of healthcare or the processing of health information. This includes sharing of information between healthcare providers who are directly related to the provision of care to the individual, quality assessment and improvement, reviewing competence and qualifications of health care professionals, obtaining medical review and legal or audit services.

Disclosing Information to the Individual: Example: We may disclose health information to the individual who the health information relates to.

As Required by Law: Example: To the Secretary of Health and Human Services or as permitted or required by local, state and federal law, reporting child abuse or neglect.

To Public Health Agencies: Example: We may use or disclose information for the purpose of preventing or controlling disease, injury or disability.

As Authorized by and to the Extent Necessary to Comply with Laws Relating to Workers' Compensation or other similar programs: Example: To programs that provide benefits for work-related injuries or illnesses.

To the Food & Drug Administration to Track Events or Products

To the Sponsor of your Health Plan

We may contract with individuals and/or entities (known as "Business Associates") to perform functions on our behalf or to provide certain types of services. Examples may be reference laboratories to perform physician requested testing that we do not perform.

Individual Rights:

You have the right to:
• Request in writing restrictions on certain uses and disclosures of health information
Metropolitan Medical Laboratory, PLC is not required to agree to a requested restriction. If we do agree, we will comply with the restriction unless the information is needed to provide emergency treatment to you.
• Request in writing to inspect and copy health information maintained by Metropolitan Medical Laboratory, PLC
You have the right to inspect and copy your protected health information that is contained in a "designated record set". Generally, a "designated record set" contains medical and billing records, as well as other records that are used to make decisions about your laboratory health care.
• Request in writing to amend health information maintained by Metropolitan Medical Laboratory, PLC
If you believe that your protected health information is incorrect or incomplete, you may request that we amend your information. In certain cases, we may deny your request for an amendment. For example, we may deny your request if the information you want to amend is not maintained by us, but by another entity. If we deny your request, you have the right to file a statement of disagreement with us. Your statement of disagreement will be linked with the disputed information and all future disclosures of the disputed information will include your statement.
• Request in writing to receive confidential communications from Metropolitan Medical Laboratory, PLC by alternative means or to alternative locations
You can ask that we only contact you at a different address, phone number or e-mail address.
• Request in writing and receive an accounting of disclosures of health information
You have a right to an accounting of most disclosures of your protected health information that are for reasons other than treatment, payment or health care operations. An accounting will include the date(s) of the disclosure, to whom we made the disclosure, a brief description of the information disclosed and the purpose for the disclosure. Your request may be for disclosures made up to six years before the date of your request, but in no event, for disclosures made before 14 April 2003 (the effective date of the regulations). 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 the time before any costs are incurred.
• A paper copy of this Notice.

ALL REQUESTS MUST BE IN WRITING ON THE HIPAA: PRIVACY REQUEST FORM -
available from any Metropolitan Medical Laboratory Client/Patient Service Personnel

We are required by law to maintain the privacy of health information and to provide individuals with notice of the legal duties and Privacy practices with respect to health information.

We are required by law to obtain Authorization from individuals if we are to use or disclose Protected Health Information in any other way that is not related to Treatment, Payment or Healthcare Operations. This includes, but is not limited to, Marketing, fundraising and releasing results.

Any needed changes in a Privacy practice written in this Notice must be applied by Metropolitan Medical Laboratory, PLC and revisions will be made in future Notices available from our Client Service Department.

We are required to abide by the terms of this Notice.

We reserve the right to change a Privacy practice described in this Notice and to make such change effective for all PHI. Revised Notice will be posted in our office and available upon request.

Comments / Complaints:

Individuals may complain about Privacy practices or receive additional information by contacting:
Compliance Officer:
William Fer
Metropolitan Medical Laboratory, PLC
1520 7th Street
Moline, Illinois 61265
(309) 762-8555 ext. 3630

and/or

and/or

Secretary of the Department of Health & Human Services
200 Independence Avenue S.W.
Washington, D.C. 20201
(877) 696-6775

No individual will be retaliated against for filing a compliant.

Effective Date:

14 April 2003