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.
When your sample is submitted to us, you agree that we may use the information you provide -- including your personal information, billing information, and health information -- in the following ways. If we need to share your information for any other purpose, we will ask for your written or electronic authorization. You may later revoke that authorization by notifying us in writing of your decision.
We will use and share your information to perform the tests you authorize, to inform your doctor of the results, and to provide you with genetic counseling.
Example: Our lab technicians use your information to create your Counsyl report and notify you and your doctor when it is available to view.
We will use and share your health information to run our organization, improve and develop new screenings and other services, and provide customer service when you have questions about your billing or results.
Example: We use your information for internal controls to improve our genetic tests.
We use and share your information to bill and receive payment from health plans or other entities that pay for all or part of the Counsyl services.
Example: We give information about you to your health insurance plan so it knows what tests to pay Counsyl for.
Note: If you pay for your services outside of your health insurance plan, we will not share any health information with your insurer except if required by law.
We may also choose to share your information with organizations that support medical research to find and cure diseases. We de-identify this information before it is disclosed.
Example: We participate, when appropriate, in providing genetic data to the NCBI ClinVar database, which improves the quality of information available to interpret genetic screens.
We will share health information about you if required by the Department of Health and Human Services, to demonstrate that we’re complying with federal privacy laws.
We may disclose your information if we believe, after due consideration, that doing so is reasonably necessary to comply with a law, regulation, or valid legal process. If we are going to release your information, we will do our best to provide you with notice in advance unless we are prohibited by court order from doing so.
We may disclose health information about you to a friend or family member whom you designate.
Example: If you and a partner consent to perform a joint genetic test, we will share the test results with both of you.
This is your medical information. You are entrusting us with its safekeeping. You have the following rights:
A copy of your test results may be downloaded from your account. If you prefer that we send you a paper copy, or would like to receive any other health information from us, please contact Client Services at firstname.lastname@example.org.
You may update or correct information pertaining to you from your account on counsyl.com. If you believe that we have collected any health information about you that is incorrect or incomplete, or that you can not correct in your account, please contact Client Services for assistance.
You may ask us to contact you at a specific phone number or to send mail to a specific address. We will agree to all reasonable requests.
You may ask us not to use or to share certain health information for treatment, payment, or other internal operations. We are not required to agree to your request, and we may refuse if it would affect your care or our ability to be paid for the services we provide you.
You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
We will notify you in the event that the confidentiality of your information has been breached where required by state and federal laws and regulations.
If you are concerned that we have violated your privacy rights, you may contact us by email at email@example.com, or by written letter: Privacy Officer, Counsyl, Inc., 180 Kimball Way, South San Francisco, CA 94080; 1-888-COUNSYL (1-888-268-6795). If you are not satisfied with our response, you may file a written complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201.
We may change our policies at any time and the changes will apply to health information we already hold, as well as new information after the change occurs. Before we make a significant change, we will post the new notice on our website at counsyl.com/policies. The new notice will be available upon request.
This notice is effective: May 7, 2014.