YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
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.
Aurelia (“Aurelia,” “we,” “us,” or “our”) respects the privacy of your health information and is committed to protecting the information entrusted to us.
This Notice of Privacy Practices (“Notice”) explains how Aurelia may use and disclose protected health information (“PHI”), when applicable, and describes your rights regarding your health information.
Depending on the services provided and Aurelia’s relationship with a healthcare provider, laboratory, or other covered entity, certain information may be subject to the federal Health Insurance Portability and Accountability Act (“HIPAA”) and other applicable privacy laws.
SECTION 1
Your privacy rights
You have certain rights regarding your health information. Depending on applicable law and Aurelia’s role in providing services, you may have the right to:
Request access to your health information
You may request access to certain health information maintained by Aurelia.
Request a correction
You may ask Aurelia to correct health information that you believe is inaccurate or incomplete, subject to applicable legal requirements.
Request confidential communications
You may request that Aurelia communicate with you about your health information through a particular method or at a particular location when permitted by law.
Request restrictions
You may ask Aurelia to limit how your health information is used or disclosed.
Aurelia is not required to agree to every requested restriction unless applicable law requires it.
Request an accounting of certain disclosures
You may request information about certain disclosures of your health information made by Aurelia, subject to applicable exceptions and limitations.
Receive a copy of this Notice
You may request a paper copy of this Notice at any time. You may also access the current version through our website.
Choose someone to act on your behalf
If you have legally authorized a personal representative, such as a healthcare power of attorney or legal guardian, that individual may exercise applicable privacy rights on your behalf.
Aurelia may verify the person’s authority before releasing information.
File a privacy complaint
You may file a complaint with Aurelia or with the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated.
Aurelia will not retaliate against you for filing a privacy complaint.
SECTION 2
How we may use and disclose your health information
When applicable, Aurelia may use or disclose your health information without your written authorization as permitted or required by law.
Treatment
We may use or disclose information to assist with your healthcare or coordinate services. For example, information related to specimen collection may be provided to an ordering healthcare provider or laboratory when necessary to perform requested testing or coordinate your care.
Payment
We may use or disclose information when necessary to obtain payment for services. For example, information may be provided to an applicable healthcare organization, laboratory, insurer, or payment-related service provider when permitted by law.
Healthcare operations
We may use or disclose information for business and healthcare operations necessary to provide and maintain our services. Examples may include quality improvement, training, administrative activities, compliance, auditing, and coordinating services with applicable healthcare organizations or laboratories.
Laboratory testing
When you request laboratory services, specimens and information necessary to perform the requested testing may be provided to the appropriate laboratory or testing organization.
Laboratories may have their own privacy practices and legal obligations.
Individuals involved in your care
When permitted by law, Aurelia may disclose limited health information to a family member, caregiver, or other person involved in your care or payment for your care when appropriate.
Required by law
Aurelia may use or disclose health information when required by federal, state, or local law.
Public health activities
We may disclose information for legally authorized public health activities, such as reporting certain diseases, injuries, or other conditions when required or permitted by law.
Abuse, neglect, or domestic violence
We may disclose information to appropriate authorities when legally permitted or required to report suspected abuse, neglect, or domestic violence.
Health oversight
We may disclose information to government agencies authorized to conduct audits, investigations, inspections, or other oversight activities.
Legal proceedings
We may disclose information in response to a court order, subpoena, warrant, or other lawful process when permitted or required by law.
Law enforcement
We may disclose information to law enforcement when permitted or required by applicable law.
Serious threats to health or safety
We may use or disclose information when necessary to prevent or lessen a serious and imminent threat to the health or safety of an individual or the public, when permitted by law.
Workers' compensation
We may disclose health information as authorized by and to the extent necessary to comply with workers’ compensation laws and similar programs.
SECTION 3
Uses requiring your authorization
Certain uses and disclosures of health information require your written authorization when applicable. These may include certain:
- Marketing activities
- Disclosures involving the sale of protected health information
- Other uses or disclosures for which applicable law requires authorization
If you provide written authorization, you may generally revoke that authorization in writing, except to the extent Aurelia or another authorized party has already relied upon it.
SECTION 4
We do not sell your personal information
Aurelia does not sell your personal information for commercial purposes.
We may use or disclose information as necessary to provide services, coordinate laboratory testing, operate our business, comply with legal obligations, or as otherwise permitted by applicable law.
SECTION 5
Your right to request restrictions
You may request that Aurelia restrict certain uses or disclosures of your health information.
If you pay for a service or healthcare item completely out of pocket and request that information not be disclosed to your health plan for payment or healthcare operations purposes, Aurelia will comply with the request when required by applicable law, unless another legal requirement requires disclosure.
SECTION 6
Our responsibilities
Aurelia is committed to protecting the privacy and security of health information that we are legally required to protect.
Where applicable, Aurelia is required to:
- Maintain the privacy of protected health information
- Provide individuals with this Notice describing our legal duties and privacy practices
- Follow the terms of the Notice currently in effect
- Notify affected individuals as required by law if a breach occurs involving unsecured protected health information
Aurelia will not use or disclose your health information for purposes other than those described in this Notice or otherwise permitted by law without the appropriate authorization.
SECTION 7
Changes to this Notice
Aurelia reserves the right to change this Notice and make the revised Notice applicable to health information we already maintain as well as information received in the future, when permitted by law.
The current Notice will be available on our website and upon request.
The effective date will appear at the beginning of the Notice.
SECTION 8
Questions or privacy concerns
If you have questions about this Notice, want to exercise an applicable privacy right, or wish to file a complaint with Aurelia, please contact:
AURELIA
Atlanta, Georgia
Privacy Contact: Ryleigh Davidson, CPT — Privacy Officer
You may also contact the U.S. Department of Health and Human Services Office for Civil Rights regarding a HIPAA privacy complaint.
U.S. HHS OFFICE FOR CIVIL RIGHTS
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
hhs.gov/ocr/privacy/hipaa/complaints
Complaints may also be submitted through the HHS Office for Civil Rights website.
Aurelia will not retaliate against you for filing a privacy complaint.
SECTION 9
Acknowledgment of receipt
I acknowledge that I have received or been offered a copy of Aurelia’s Notice of Privacy Practices.
I understand that this acknowledgment confirms receipt of the Notice and does not constitute authorization for any use or disclosure of my health information beyond what is permitted or required by law.
PATIENT / CUSTOMER NAME
SIGNATURE
DATE
IF SIGNED BY PERSONAL REPRESENTATIVE
NAME
RELATIONSHIP / AUTHORITY
SIGNATURE
DATE
Prefer to acknowledge digitally? Complete our Client Consent Form — HIPAA acknowledgment is included.
Important Notice: This document is intended as a business template and should be reviewed by a qualified healthcare/privacy attorney before Aurelia publishes or distributes it. Whether Aurelia is legally required to maintain its own HIPAA Notice of Privacy Practices depends on its specific role and relationships with covered entities. A business associate, by itself, generally is not required by HIPAA to create its own NPP.