NOTICE OF PRIVACY PRACTICES
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.
Belay Diagnostics, Inc. (“Belay”) is committed to maintaining the privacy of your protected health information (“PHI”). This document specifies our privacy practices with respect to PHI, including how we use and disclose it in compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). We are required by law to protect your PHI, provide you with notice of our legal duties and privacy practices regarding PHI, and abide by the terms of this Notice of Privacy Practices (the “Notice”). PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition, treatment, or payment for health services. This Notice describes how we may use and disclose your PHI to carry out treatment, payment for health care operations, and for other specified purposes that are permitted or required by law. This Notice also describes your rights with respect to your PHI.
How We Receive Your PHI
In order to provide you with testing services, we receive your PHI from your health care provider or another laboratory that asked us to test your sample. We store and protect your PHI in the same manner regardless of the form in which we receive it (e.g., oral, written, or recorded in other media).
Belay’s Use or Disclosure of Your PHI
Belay may generally use and disclose your information without obtaining your authorization for the following purposes:
Treatment. For treatment purposes, including disclosure to physicians, nurses, pharmacies, and other professionals who provide you with health care services or are involved in the coordination of your care, such as providing your physician with your laboratory test results.
Payment. For billing and collecting payment for laboratory services we provide. For example, Belay may provide PHI to your health plan to receive payment for the health care services provided to you.
Health Care Operations. For necessary health care operations purposes including, for example, evaluating the quality of our laboratory testing and accuracy of results, accreditation functions, and other management purposes. Belay may also disclose PHI to other health care providers or health plans that are involved in your care for their health care operations. For example, Belay may disclose PHI to coordinate health care or benefits or to schedule or confirm appointments.
You or Personal Representative. To you or your personal representative, as established under applicable law, or to an administrator, executor, or other authorized individual associated with your estate.
Individuals Involved in Your Care or Payment for Your Care. To a person who is authorized to receive updates regarding or be involved with your care, or helps pay for your care, such as a family member, relative, or personal friend. For example, if you are covered by your spouse’s, parents’, or other individual’s health insurance, we may disclose information to that individual relevant to payment for the services we have provided you. As allowed by federal and state law, we may disclose the PHI of minors to their parents or legal guardians. In all cases, we will use our best judgment and restrict the information shared to only that which is relevant to your family’s and others’ involvement in your care.
Business Associates. To Belay’s business associates to perform certain functions or provide certain services to Belay. For example, we may use another company to perform billing services on our behalf. All of our business associates are required to maintain the privacy and confidentiality of your PHI. In addition, at the request of your health care providers or health plan, Belay may disclose PHI to their business associates for purposes of performing certain functions or services on their behalf. For example, we may disclose PHI to a business associate of Medicare for purposes of medical necessity review.
Required by Law or Judicial or Administrative Proceedings. If required to do so by federal, state, or local law, including in the course of a judicial or administrative proceeding, or in response to a court order, subpoena, discovery request, or other lawful process.
Law Enforcement. For law enforcement purposes, including the identification or location of suspects, fugitives, witnesses, or victims of crime. These disclosures may be made in response to a court order, warrant, subpoena, or summons.
Public Health. For public health activities, including, but not limited to, disclosures: (1) to a public health authority to report, prevent, or control disease, injury, or disability; (2) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or (3) to a person subject to the jurisdiction of the Food and Drug Administration (FDA) for purposes related to the quality, safety, or effectiveness of an FDA-regulated product or activity.
Abuse, Neglect, or Domestic Violence. To a government authority, if we reasonably believe that an individual is a victim of abuse, neglect, or domestic violence.
Health Oversight Activities. To a government oversight agency conducting audits, investigations, inspections, and related oversight functions.
Coroners, Medical Examiners, and Funeral Directors. To a coroner, medical examiner, or funeral director for the purpose of identifying a deceased person, determining cause of death, or for performing some other duty authorized by law.
Organ and Tissue Donation. To organizations that handle organ or tissue procurement or donations, as necessary to make organ and tissue donation and transplantation possible.
Correctional Institution. With respect to an inmate, upon request by a correctional institution or law enforcement official for health, safety, and security purposes.
Serious Threat to Health or Safety. To prevent or lessen a serious or imminent threat to your safety, including in cases of emergency or disaster relief efforts (where disclosure is made to a person reasonably able to prevent or lessen the threat).
Research. To researchers when the research they are conducting has been approved by you or by an institutional review or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI or to people preparing to conduct a research project.
Government Functions. With respect to military personnel and veterans, as required by military command authorities. Belay may also disclose PHI to authorized officials for national security activities such as conducting intelligence.
Workers’ Compensation. To comply with workers’ compensation or other similar programs established to provide work-related injury or illness benefits.
De-identified Information. Belay may generally use and disclose PHI that has been “de-identified” by removing certain identifiers making it unlikely that you could be identified.
Other Uses and Disclosures of PHI
Belay will ask for your authorization before using or disclosing PHI for any purposes not described above, including for marketing purposes and disclosures that would constitute a sale. You may revoke an authorization at any time by submitting written notice to us as described below. A revocation will not be applicable to any action already taken in reliance upon the authorization.
Patient Rights Regarding PHI
Under HIPAA, you have the following rights. These rights may be exercised by submitting notice to us as described below.
Right to Receive this Notice. You can request to receive a free copy of this Notice in printed or electronic form by writing or calling the contact person listed in this Notice.
Right to Request Limitations on Use or Disclosure. You may ask us to limit the use and disclosure of your PHI for the purposes of treatment, payment, and health care operations (as described above). We will consider your request carefully but we may not be required to agree to the requested restriction to the extent that it affects our ability to comply with any applicable law.
Right to Confidential Communications. You have the right to receive confidential communications of PHI from us, and we will accommodate reasonable requests regarding same.
Right to Inspect and Copy PHI. You have the right to receive a copy of your PHI that may be used to make decisions about your care or payment for your care. If we maintain the PHI you have requested in an electronic format you can ask for it to be provided to you electronically, and also ask us to electronically send copies to another person.
Right to Amend PHI. You have the right to request an amendment of your PHI. We will honor your request unless we are not the originator of the PHI or we believe the PHI is accurate.
Right to Receive an Accounting of Disclosures of PHI. You can get a written accounting of all of our disclosures of your PHI not directly related to treatment, payment, health care operations, or disclosed based on a signed authorization or for other legitimate purposes as stated above. You can request a list including disclosures made up to six (6) years prior to the date of your request.
Right to Breach Notification. You will be notified within sixty (60) days in the event that we or one of our business associates discover a breach of your unsecured PHI.
How to Contact Us or File a Complaint
If you would like to exercise any rights regarding your PHI, or have questions about this Notice or a complaint about our use or disclosure of your PHI, please contact Belay by email at contact@belaydiagnostics.com, by telephone at +1 (331) 320-0155or by sending a letter to the following address:
Belay Diagnostics
1375 W Fulton St., Ste. 900
Chicago IL, 60607
Attention: Kimberly Dulac, Privacy Officer
If you believe that we have violated any of your rights, you also may file a complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services (HHS) by email at OCRComplaint@hhs.gov, or by sending a letter to at the following address:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
Belay will not take any retaliatory action against you for filing a complaint with us or with HHS.
Changes to Notice
We reserve the right to amend this Notice at any time and make the amendments effective for all PHI maintained at the time of amendment. Amended versions of this Notice will be posted on this website. Please review this website periodically to ensure that you are aware of any such updates.
Effective Date of Notice: 10/1/24