Notice of Privacy Practices

Effective April 14, 2003

This notice describes how medical information may be used and disclosed and how you can get access to this information. Please review it carefully

Massachusetts Department of Public Health
State Laboratory Institute
Childhood Lead Screening Laboratory
305 South Street
Boston, MA 02130

The Massachusetts Department of Public Health (DPH) Childhood Lead Screening Laboratory (CLSL) has always taken great care to protect your privacy rights and will continue to do so.

By law, the DPH Childhood Lead Screening Laboratory must make this notice available, which explains how the DPH Childhood Lead Screening Laboratory uses and discloses your health information, and that the DPH Childhood Lead Screening Laboratory must follow the terms of this notice.

DPH Childhood Lead Screening Laboratory reserves the right to change how it uses and shares your health information. These changes will apply to information DPH Childhood Lead Screening Laboratory already holds, and any information DPH Childhood Lead Screening Laboratory receives in the future. DPH Childhood Lead Screening Laboratory will post any changes on its website and provide them to anyone upon request. 

DPH has a Privacy Office to address privacy issues. If you would like to exercise any of the rights described in this notice, or if you feel that your rights have been violated, contact the DPH Privacy Office in writing at the following address:

Department of Public Health
Privacy Office
2nd Floor
250 Washington Street
Boston, MA  02108-4619

You may also file a complaint with the U.S. Secretary of Health and Human Services:

Department of Health and Human Services
Regional Manager, Office for Civil Rights
J.F. Kennedy Federal Building
Room 1875
Boston, MA 02203
Phone:  617-565-1340
FAX:  617-565-3809
TDD:  617-565-1343

The DPH Childhood Lead Screening Laboratory provides lead testing services. DPH Childhood Lead Screening Laboratory collects information about you to provide these services, including the kind of medical service you receive, and the date you receive treatment.  

This notice explains:
•	When DPH Childhood Lead Screening Laboratory may use and share your health information; and,
•	What your individual rights are regarding your health information.

DPH Childhood Lead Screening Laboratory may use or share your health information:

•	For treatment: the DPH Childhood Lead Screening Laboratory may share your health information with doctors, nurses and other health care personnel who are involved in providing your health care. For example, DPH Childhood Lead Screening Laboratory shares your test result information with your physician or other authorized individual who requested the test, to create and carry out a plan for treatment.
•	For payment: the DPH Childhood Lead Screening Laboratory may use or share your health information in order to bill and collect payment for your health care services. For example, DPH Childhood Lead Screening Laboratory may share information with other government agencies, with your healthcare provider, or with our billing agent to receive payment.
•	For health care operations: the DPH Childhood Lead Screening Laboratory may use or share information in order to better manage its program and activities. For example, DPH Childhood Lead Screening Laboratory may use your health information to review the quality and effectiveness of services you receive.
•	For public health activities: DPH Childhood Lead Screening Laboratory must disclose your health information to public health authorities, including other parts of DPH, to track blood lead exposures as required or authorized by law.
•	Other permitted uses and disclosures: DPH Childhood Lead Screening Laboratory may use and disclose your health information for the following:
•	Research studies that meet all privacy requirements;
•	To state and federal health oversight agencies authorized by law to receive this information for necessary purposes, including fraud and abuse investigations and accreditation, or;
•	To monitor the quality and effectiveness of the health services provided by DPH Childhood Lead Screening Laboratory. 
•	Required disclosures: In addition, the DPH Childhood Lead Screening Laboratory must use and disclose you personal health information:
•	When requested by the United States Department of Health and Human Services to make sure your privacy is being protected, and;
•	When required by law.

Some services, such as billing, are provided to DPH Childhood Lead Screening Laboratory by business associates.  When these services are contracted, DPH Childhood Lead Screening Laboratory may disclose your health information to our business associates so they can perform the job we are requesting them to do. To protect your health information, however, DPH Childhood Lead Screening Laboratory requires that its business associates appropriately safeguard your information.

Please note that the DPH Childhood Lead Screening Laboratory is subject to federal law, the Clinical Laboratory Improvements Amendments (CLIA) of 1988, 42 U.S.C. §263a, which prevents the DPH Childhood Lead Screening Laboratory from allowing patients direct access to their laboratory test result. Based on Massachusetts Law, only individuals authorized to request laboratory tests are entitled to receive the results of these tests.   

As an indirect treatment provider, we do not disclose test results based on individual authorizations. All patient requests for direct access to their laboratory test result must be made directly to their physician or the authorized person who requested the laboratory test. 

Except as described above, the DPH Childhood Lead Screening Laboratory cannot use or share your health information.

You Have the Right:

•	To get a list of disclosures. You may ask DPH Childhood Lead Screening Laboratory to provide you a list of when and with whom DPH Childhood Lead Screening Laboratory has shared your health information with certain exceptions. Your request must be made in writing.
•	To received a paper copy of this notice. You have the right to ask for a paper copy of this notice at any time.  To obtain a paper copy please send your written request to:

Massachusetts Department of Public Health
State Laboratory Institute
Childhood Lead Screening Laboratory
Attention: Julianne Nassif, Program Director
305 South Street
Boston, MA 02130