Patient Notification Regarding State-Mandated Reportable Conditions Certain infectious diseases and conditions and the identity of those who test positive for them, are required, by federal and/or state law, to be reported to local or state health authorities by your health care providers, including New Century Lab’s Ordering physicians, Quest Diagnostics, its physicians, staff, and the laboratories that run the medical tests, in addition to third party facilitators contracted with New Century Labs, LLC. The time frames and reporting requirements vary according to the disease or condition. These local and state health authorities are considered Public Health Authorities according to the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) which means that they are legally authorized to receive your Protected Health Information (“PHI”). However, both New Century Labs, LLC and these health authorities will not otherwise share or release any confidential information, unless mandated by law or authorized by you in writing.

You understand that if you test positive for any infectious disease or condition on the state’s list of reportable conditions, your test result and your identifying information will be reported to the applicable local or state health authority. Reporting this information does not require your permission or consent. Additionally, you understand that if you test positive for any infectious disease or condition, neither New Century Labs, LLC, nor its staff, Quest Diagnostics, its physicians, staff, or the laboratories that run the medical tests, will treat, prescribe medications, or refer you for medical treatment. It is your sole responsibility to seek and comply with necessary treatment and all required follow-up with your physician or local public health department. I authorize my health care providers, including, its physicians and its staff and the laboratories that run medical tests for me to use and/or disclose certain protected health information about me to New Century Labs, LLC for the purposes state below.

This authorization applies to the following protected health information about me: the laboratory requisition submitted by New Century Labs, LLC and the laboratory test values which are the result of the laboratory test(s) requested in the requisition. For avoidance of doubt, I specifically authorize the transfer of this information between and among me and the following Participants, organizations and their representatives: i) New Century Labs, LLC ii) Quest Diagnostics staff and physician of record, and iii) the reference laboratory of record. I understand that  physician of record may be required to receive my lab test results before I do, and that this physician’s authorization to release those results to New Century Labs, LLC may also be required before I receive my results.

The protected health information will be used or disclosed for the sole purpose of complying with the state and federal laws which may require a physician or their agent to: 1) review and approve a laboratory requisition; and 2) review the laboratory test results. This review may be conducted for any reason, including in the event laboratory values, which are outside of normal ranges, require the physician or its agent to contact me. The purposes outlined above are provided so that I can make an informed decision whether to allow release of the information to the parties referenced in this authorization. This authorization will expire one year after the date of this authorization. I understand that I have a right to receive a copy of this authorization. I understand that the sole purpose of the laboratory test is to generate the results of the tests that I and New Century Labs, LLC have requested, and the laboratory tests will not be requisitioned unless I sign this authorization. I have the right to refuse to agree to this authorization. When my information is used or disclosed pursuant to this authorization, it may be subject to re-disclosure by the recipient and may no longer be protected by the federal HIPAA Privacy Rule. I have the right to revoke this authorization in writing at any time, except that the revocation will not apply to any information already disclosed by the parties referenced in this authorization have acted in reliance upon this authorization. My written revocation must be submitted to the NCL privacy officer. Patient Authorization for Use and Disclosure of Protected Health Information

 

 

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PWNHealth

Notice of Privacy Practices Regarding Health Information

 

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.

 

How We May Use and Disclose Your Health Information. PWN Remote Care Services, P.A., PWN Remote Care Services, P.C., PW Medical Professional and certain other affiliated professional entities and PWNHealth, LLC (the administrative services provider of the professional entities (collectively, “PWNHealth”, “we” or “us”) may use your health information and disclose it to appropriate persons, authorities and agencies, as allowed by federal and state law. Please be aware that state and federal law may have more requirements on how we use and disclose your health information. If there are specific, more restrictive requirements, even for some of the purposes listed above, we may not disclose your health information without your written permission as required by such laws. We may also be required by law to obtain your written permission to use and disclose your information related to treatment for a mental illness, developmental disability, or alcohol or drug abuse. We may do this without your written permission for the following limited purposes:

1. Treatment.

2. Payment.

3. Required by Law.

4. Public Health.

5. Reporting Victims of Abuse or Neglect.

6. Health Care Oversight.

7. Legal Proceedings & Law Enforcement.

8. Death.

9. Serious Threats to Health or Safety.

We may also disclose any information that you provide to use or that is provided on your behalf.  You have the right to request a restriction or limitation on the disclosure of such information as set forth below. 

Your Health Information Rights. You have the right to:

1. Read and copy your health information.

2. Request to correct your health information.

3. Request to restrict certain uses and disclosures of your information. You have the right to request in writing that we restrict how your health information is used or disclosed. For most requests, under the law, we are not required to agree to your request. In some cases, we may not be able to agree to your request because we do not have a way to tell everyone who would need to know about the restriction. There are other instances in which we are not required to agree with your request. We will inform you when we cannot find a way to carry out your request.

4. Receive a record of how we disclosed your information.

5. Receive notification of a breach and obtain a paper copy of this notice.

 

Contact us at info@pwnhealth.com or PWNHealth, 123 W 18th Street, New York, NY 10011 Attn:  Privacy Officer with any questions or concerns regarding the above.