For Protected Health Information
Moleculera Labs, Inc. (“Moleculera,” “we,” “our,” or “us”) respects and is committed to protecting your privacy. This Notice describes how your medical information may be used and disclosed and how you can get access to that information. It applies to health information that is protected by HIPAA, used to make decisions about your care, and generated or maintained by Moleculera. Please review this Notice carefully.
Uses and Disclosures of Your Health Information
The following describes how Moleculera may use or disclose your health information that is protected by HIPAA.
Services: Moleculera will use your health information to provide you with laboratory testing services. This information will be shared with health care providers involved in your care for diagnosis, treatment or other authorized purposes.
Payment: Moleculera may share your health information with third party service providers who perform payment activities or other services on our behalf. For example, your health information may be released to an insurance company to get payment for services rendered.
Operations: Moleculera may use your health information for uses necessary to run its business. This may include but is not limited to conducting audits, training, quality assessment activities, or arranging for legal services.
Business Associates: Your health information may be disclosed to consultants or other entities that provide a service to Moleculera or on our behalf, provided that Moleculera has received assurance that the consultant or entity will protect your health information.
Individuals Involved in Your Care or Payment for Your Services: Moleculera may release your health information to a family member, friend, legal guardian or other person who is involved in your care or who helps pay for services we provide to you.
Research: Moleculera may use or disclose your health information to researchers for research purposes, provided that Moleculera has received assurance that the researcher will protect your health information.
Fundraising/Marketing: Moleculera will not sell your health information to anyone. We may use your health information to contact you to see if you are interested in participating in fundraising or marketing activities.
Uses and Disclosures Permitted or Required by Law: Without your authorization, Moleculera may use or disclose your health information to regulatory agencies, law enforcement officials or other third parties as we, in our sole discretion, believe necessary or appropriate in connection with an investigation, court order, regulatory compliance or other legally permitted use.
Other Uses and Disclosures: For other uses or disclosures not contained in this Notice, or permitted or required by law, Moleculera will get your authorization for that use or disclosure.
Oklahoma law requires that Moleculera inform you that health information used or disclosed may indicate the presence of a communicable or noncommunicable disease. It may also include information related to mental health.
Your Rights Regarding Your Health Information
The following describe your rights in regard to the health information that is protected by HIPAA that Moleculera maintains about you. You must submit a written request to exercise these rights. Forms are available to help you with your request. You may get these forms by contacting us at 405-239-5250 or via email at email@example.com.
Right to Inspect/Copy: You have the right to inspect and get a copy of your health information maintained by Moleculera. By law, we may charge for the copies, supplies, and postage, payable prior to the release of the requested records. (Amounts are set by law). Moleculera may deny your request in certain circumstances. You may request a licensed health care professional chosen by Moleculera to review a denial based on medical reasons. Moleculera will comply with the decision.
Right to Amend: If you believe the health information Moleculera created is inaccurate or incomplete, you may ask us to amend it. You must provide a reason for your request. Moleculera cannot delete or destroy any information already included in your medical record. We may deny your request if you ask to amend information that Moleculera did not create (unless the creator is not available to make the amendment); that is not part of the health information Moleculera maintains; that is not part of the information you are permitted by law to inspect and copy; or that is accurate and complete.
Right to Accounting of Disclosures: You have the right to ask for a list of disclosures Moleculera has made of your health information. Moleculera is not required to list all disclosures, such as those you authorized or those pertaining treatment, payment, or health care operations. You must state a time period, which may not be longer than 6 years. If you request more than one accounting in a 12-month period, we may charge you for the cost involved.
Right to Request Restrictions: You have the right to request a restriction or limit on how Moleculera uses or discloses your health information. You must be specific in your request for restriction. You may restrict disclosure of your health information to a health plan only if the disclosure is for payment or health care operations and pertains to a service for which you pay out-of-pocket in full at the time the service is provided. For example, you may want to pay cash in advance for services rather than have your insurance billed. Moleculera is not required to agree to other requests. If Moleculera agrees or is required to comply, we will comply with the request unless the information is required to be disclosed by law or is needed in case of emergency.
Right to Request Confidential Contacts: You have the right to request that Moleculera contact you about medical issues in a certain way, such as by mail. You must specify how or where you wish to be contacted; we will try to accommodate reasonable requests.
Right to a Copy of This Notice: You have the right to a paper or electronic copy of this Notice.
Right to Designate a Representative: If you have given someone a medical power of attorney or have a legal guardian, that person can exercise your rights under HIPAA and make choices about your health information. We may require proof of this person’s status.
Right to be Notified: You have the right to be notified of breaches that may have compromised the privacy or security of your health information.
Changes to this Notice
Moleculera reserves the right to change this Notice and to make the revised Notice effective for health information Moleculera created or received about you prior to the revision, as well as to information it receives in the future.
If you believe your privacy rights have been violated, you may file a complaint with Moleculera’s Privacy Official at 405-239-5250; firstname.lastname@example.org; or 755 Research Parkway, Suite 410, Oklahoma City, OK 73104; or with the Secretary of Department of Health and Human Services. Complaints must be submitted within 180 days of when you knew or should have known of the circumstance leading to the complaint. You will not be retaliated against for filing a complaint.