Patient Notification Regarding Reportable Health Conditions

Certain infectious diseases and medical conditions, along with the identity of individuals who test positive for them, must be reported to local or state health authorities under federal and/or state law. This reporting requirement extends to health care providers, including New Century Labs' ordering physicians, Quest Diagnostics, its medical personnel, and third-party facilitators contracted with New Century Labs, LLC. The time frame and requirements for reporting vary depending on the specific disease or condition.

Local and state health agencies are classified as Public Health Authorities under the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996, granting them the legal authority to receive Protected Health Information (PHI). However, both New Century Labs, LLC, and these authorities will not disclose or distribute any confidential information beyond legal requirements unless expressly authorized by you in writing.

If you test positive for an infectious disease or condition listed under state-mandated reportable conditions, your test result and identifying information must be reported to the appropriate health authority. Your consent is not required for this disclosure. Additionally, please note that neither New Century Labs, LLC, its staff, Quest Diagnostics, nor the laboratories processing these tests provide treatment, prescribe medication, or offer referrals for medical care. You are responsible for seeking appropriate treatment and complying with necessary medical follow-ups with your physician or public health department.

By signing this document, you authorize health care providers, physicians, and laboratories conducting tests on your behalf to share certain protected health information with New Century Labs, LLC.

This authorization applies to the following protected health information:

• Laboratory requisitions submitted by New Century Labs, LLC

• Laboratory test results generated as a result of the requisitioned tests

To clarify, I specifically authorize the transfer of this information among:

1. New Century Labs, LLC

2. Quest Diagnostics’ staff and its physician of record

3. The reference laboratory conducting the tests

I understand that a physician of record may be required to review my test results before I receive them and that their approval may also be required before New Century Labs, LLC can release my results to me.

Purpose of Disclosure

The disclosed health information will be used solely to comply with federal and state laws requiring a physician or their agent to review and approve laboratory requisitions and review test results. In certain cases, if laboratory values fall outside normal ranges, the physician or their agent may be required to contact me directly.

This authorization is being provided so that I may make an informed decision regarding the release of my health information to the above-mentioned parties. This authorization will expire one year after the date of signing.

I understand that:

• I have the right to receive a copy of this authorization.

• The purpose of the requested laboratory test(s) is strictly to generate test results, and the laboratory will not process my request unless I sign this authorization.

• I have the right to refuse authorization, but if I do, the requested test(s) will not be conducted.

• Once my information is disclosed under this authorization, it may no longer be protected by HIPAA privacy rules and may be subject to further disclosure by the recipient.

• I have the right to revoke this authorization at any time in writing, except where information has already been disclosed in reliance on this authorization.

• Written revocations should be submitted to the New Century Labs Privacy Officer.

Your Health Co and New Century Labs – Privacy Practices Regarding Health Information

How We Use and Disclose Your Health Information

Your Health Co. and New Century Labs, LLC, and related professional entities, along with Your Health Co, LLC and New Century Labs, LLC (administrative service provider for these entities), collectively referred to as “Your Health Co” and "New Century Labs", may use and disclose your health information as permitted under federal and state laws.

State and federal laws may impose additional restrictions on the use and disclosure of your health information. Where stricter requirements apply, we will only disclose your health information with your written consent, except in specific circumstances where permitted by law.

The following are instances where we may disclose your health information without your prior written authorization:

• Treatment

• Payment

• Required by Law

• Public Health Reporting

• Reporting of Abuse or Neglect

• Health Care Oversight

• Legal Proceedings & Law Enforcement

• Death Notification & Reporting

• Serious Threats to Public Health or Safety

Additionally, we may disclose information you provide to us or that is provided on your behalf. You have the right to request restrictions on such disclosures, but under certain legal circumstances, we may not be required to agree to those restrictions.

Your Health Information Rights

You have the following rights regarding your health information:

• Access & Copying: You may request a copy of your health records.

• Request Corrections: You may request amendments to your health information.

• Request Restrictions: You may request limitations on how your health information is used or disclosed. However, we may not always be able to accommodate such requests.

• Disclosure Record: You may request a record of entities that have received your health information.

• Notification of a Breach: You will be informed in the event of a security breach involving your health information.

• Paper Copy of This Notice: You may request a paper copy of this privacy policy at any time.

For any inquiries, requests, or concerns regarding this notice, please contact us at:
customerservice@newcenturylabs.com New Century Labs, 5200 Meadows Rd STE 150, Attn: Privacy Officer