HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: July 30, 2018
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.
In this Notice of Privacy Practices, we at Adaptive Biotechnologies Corporation, its subsidiaries and affiliates (“Adaptive,” “we” or “us”), explain our practices regarding the use and disclosure of medical and other personal information about you that we collect in conjunction with our clinical laboratory businesses, such as our clonoSEQ® service, and your rights relating to that information.
You have the right to:
• Get a copy of your medical record
• Correct your medical record
• Request confidential communications
• Ask us to limit the information we use or share
• Get a list of those with whom we’ve shared your information for certain purposes
• Get a copy of this privacy notice
• Choose someone to act for you
• Ask questions
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information, such as how or whether we:
• Tell family and friends about your condition
• Provide information so that you may be located or rescued
• Engage in sales and marketing activities
Our Uses and Disclosures
We may use and share your information for various reasons, such as when we:
• Provide clinical laboratory services for you
• Run our organization
• Bill for testing services
• Help with public health and safety issues
• Do research under certain conditions
• Work with a coroner, medical examiner, or funeral director
• Comply with the law
• Address workers’ compensation, law enforcement, and other government or judicial requests
• Respond to lawsuits and legal actions
Each of the topics above is discussed in greater detail below.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. In each case, if you have questions about how to exercise your rights, please email us at firstname.lastname@example.org.
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee for any copy or summary.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but if we do, we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain of your health information. Except as noted just below, we are not required to agree to your request, and we may say “no” if it would affect your care or for other justifiable reasons.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share with your health insurer any information about your receipt of that service or health care item. We will say “yes” unless a law requires us to do otherwise.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include in that list all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal representative or guardian (or, in some cases, if someone is an administrator, executor, or other authorized person responsible for your estate), that person can exercise your rights and make choices about our uses and disclosures of your health information.
• If you are an unemancipated minor, your parent or legal guardian may exercise your rights and make choices about our uses and disclosures of your health information on your behalf.
• We will do what we can to make sure that any person who purports to be your legal representative has this authority before we take any action as directed or authorized by that person.
• You can ask questions about this notice and your rights at any time. Please contact our Customer Service Department or email us at email@example.com.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us either by mail at Adaptive Biotechnologies Corporation, Attn: Privacy Officer, 1551 Eastlake Avenue East Suite 200, Seattle, Washington 98102, or by email at firstname.lastname@example.org.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting http://www.hhs.gov/ocr/privacy/hipaa/complaints
• We will not retaliate against you for complaining to us or filing a complaint.
In certain circumstances, you have the right to choose when and how much of your health information we may share. If you have a clear preference for how we share your information in any of the situations described below, please email us at email@example.com. Tell us what you want us to do, and we will follow your instructions regarding the choices described below.
You have the right to tell us to:
• Share information with your family, close friends, or others involved in your care or payment for your care
• Share information with a disaster relief organization or others in order to help notify a person involved in your care about your location, condition, or vital status
• Share information with organ procurement organizations or related entities for the purpose of facilitating organ or tissue donation and transplantation
If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In the cases below, we are prohibited from sharing your personal health information unless you give us written permission:
• Disclosure to third parties for marketing purposes
• Sale of your information, although as we continue to develop our business, we might sell or acquire subsidiaries, affiliates or business units. In such transactions, health records information generally is one of the transferred business assets. Also, in the unlikely event that Adaptive or substantially all of its assets are acquired, health records will of course be one of the transferred assets.
OUR USES AND DISCLOSURES
In accordance with applicable federal and state law, we typically use or share your health information in the following ways.
Providing clinical laboratory services for you
We can use your health information and share it with other professionals who are treating you.
Example: Discussions of the minimal residual disease result with your treating physician.
Run our organization or help your health care provider run their organization
We can use and share your health information to run our laboratory, develop and improve our services to improve your care, and contact you when necessary. We can also share your health information with your health care provider to help them run their business, such as to process claims for payment for services they provide to you or to conduct quality control.
Example: We share health information about you with our third party service providers to manage our business, for example helping us process your test orders and helping us securely store your information.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We may give information about you to a third party billing business associate to forward to your health insurance plan so it will pay for the services you received.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Participating in public health investigations
• Helping with product recalls
• Reporting adverse reactions to medications or certain other injuries
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
We may maintain certain of your information in certain databases, which may be used or accessed by individuals within our organization for research purposes. We can use or share your information for health research (1) if we have obtained your signed authorization or (2) if we have received approval from an Institutional Review Board or Privacy Board to conduct the research without your express authorization. We can also use your information without your signed authorization to prepare for research, such as to prepare a research protocol, or share it for those purposes. We generally may share information for research purposes about anyone who is deceased without the deceased’s signed authorization.
Work with a coroner, medical examiner, or funeral director
We can share health information about an individual with a coroner, medical examiner, or funeral director when the individual dies.
Address workers’ compensation, law enforcement, and other government requests
Subject to certain limitations, we can use or share health information about you:
• For workers’ compensation claims or benefits
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Comply with the law
We will share information about you if state, federal or national laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to lawsuits and legal actions or proceedings
We can share health information about you in response to a court or administrative order, or in response to a subpoena or other lawful process.
How else can we use or share your health information?
We are allowed or required to share your information in other ways and to other individuals–often in ways that contribute to the public good, such as public health or for law enforcement purposes. For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
We may not use or share your information other than as described in this notice without your written authorization. If you do provide such authorization, you may revoke that authorization, in whole or in part, at any time. You must send us your revocation in writing.
We are required to:
• Maintain the privacy and security of your personal health information in accordance with applicable law;
• Provide you with this notice of our legal duties and privacy practices with respect to your personal health information;
• Notify you if a breach occurs that may have compromised the privacy or security of your personal health information; and
• Adhere to the duties and privacy practices described in this notice and give you a paper copy of the notice upon your request..
For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
CHANGES TO TERMS OF THIS NOTICE
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
OTHER INSTRUCTIONS FOR NOTICE
Adaptive’s U.S. Privacy Officer and International Data Protection Officer is
Kate Godfrey, Vice President, Compliance and Privacy Officer, who can be reached by mail at
1551 Eastlake Avenue East, Suite 200,
Seattle, Washington 98102,
by telephone at (206) 693-2227 or by email at firstname.lastname@example.org.