For
health care operations: We may use and disclose PHI in
performing business activities. (Example: Our Quality Coordinators
may review information in your health care record to monitor the
performance of the research staff in an effort to continually
improve the quality and effectiveness of the research services we
provide).
We also may use or
disclose PHI for the following purpose without your authorization:
“Pre-screening” activities: Prior to agreeing to
participate in a study, we may review PHI (for example, your medical
record) to determine if you meet basic eligibility requirements to
participate. If so, one of our research staff would meet with you
to explain the study to see if you want to participate. We will
only conduct such pre-screening activities if we receive written
approval of a waiver of authorization from an Institutional Review
Board or Privacy Board.
Your Rights
You have the
following rights pertaining to your PHI:
-
To
revoke authorization: Even if you have agreed to
participate in a study and have given your authorization to use your
PHI for this purpose, you may revoke this authorization at any
time. If you revoke your authorization, you will be withdrawn from
the study. Upon receipt of the written revocation, we will stop
using or disclosing your PHI about you. However, once your
information has been released, it is no longer protected and may be
used or released by the recipient.
-
To
obtain a paper copy of this Notice upon request: You may
request a paper copy of this Notice, or any revised notice, at any
time by asking any Discovery Alliance International employee.
-
To
request restrictions: You may request restrictions on
certain uses and disclosures of PHI. However, we are not required
to agree to the requested restriction
-
To
receive confidential communications: You may request that
we contact you about medical matters only in writing or at a
different residence or post office box. To request a change in the
confidential communication of PHI, you must submit a request in
writing to the Discovery Alliance contact person listed in the
consent form. Your request must state how or where you would like
to be contacted. We will accommodate all reasonable requests.
-
To
inspect and obtain a copy of your PHI: You have the right
to see a copy of PHI about you that is maintained by Discovery
Alliance International. However, you might not be allowed to see
these records until after the study has been completed.
-
To
request an amendment of your PHI: If you feel that PHI we
maintain about you is incomplete or incorrect, you may request that
we amend it for as long as we maintain the PHI. To request an
amendment, contact the Discovery Alliance contact person listed in
the consent form. You must include a reason that supports your
request. In certain cases, we may deny your request for amendment.
If we deny your request for amendment for certain reasons, you have
the right to file a statement of disagreement, and we may give
rebuttal to your statement.
-
To
receive an accounting of disclosures of PHI: You have a
right to receive an accounting of the disclosures we have made of
PHI about you after April 14, 2003 for some purposes, not including
treatment, payment, or health care operations. The accounting will
also exclude certain other disclosures, such as disclosures made
directly to you, disclosures you authorize, disclosures to friends
or family members involved in your care, and disclosures that have
been approved by and Institutional Review Board or Privacy Board.
To request an accounting, you must submit a request in writing to
the Discovery Alliance contact person listed in the consent form.
Your request must specify the time period, but may not be longer
than six years. You may be charged for the cost of providing such
an accounting. We will notify you of the cost involved, and you may
choose to withdraw or modify your request at that time.
-
To
complain: If you believe your privacy rights have been
violated, you may file a complaint to the Compliance Department at
the following address or to the Secretary of Health and Human
Services. There will be no retaliation for filing a complaint.
-
To
request more information: If you have questions or would
like additional information about our privacy practices, you may
contact us at the address below.
Discovery Alliance International, Inc.
Compliance Department
5409 Maryland Way, Suite 200
Brentwood, TN 37027
Phone: (615) 522-5400
Our Rights and Duties
We have the following rights and duties with
regard to PHI:
-
To
abide by this notice: We are required to abide by the terms
of the notice currently in effect
-
To
change the terms of this notice: We reserve the right to
change the terms of this notice and to make the new notice
provisions effective for all PHI that we maintain. You may request
an updated notice at any time.
