THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Avellino Lab USA, Inc. and its wholly owned subsidiaries (collectively “Avellino”) are committed to protect
the privacy of your identifiable health information (“protected health information” or “PHI”). PHI is your
demographic information, medical history, laboratory results, and other health information that may be
collected, generated, used, and communicated by Avellino to produce genetic testing results and bill for
Avellino’s testing services. Examples of PHI include your name, date of birth, medical record number, social
security number, and genetic information.
Avellino is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to
maintain the privacy of your PHI. Avellino must provide you with this notice, which describes Avellino’s
legal duties, privacy practices, as well as your patient rights under the HIPAA. Avellino is required to
notify affected individuals in the event of a breach involving unsecured protected health information. This
notice does not apply to non-diagnostic services that PHI may perform -eg, clinical trials testing
Your PHI may be used for treatment, payment, healthcare operations, or for
other purposes permitted or required by law. Avellino may use and disclose your health information for the
Avellino provides laboratory testing for physicians and other healthcare professionals, and Avellino uses
your information in its testing process. Avellino discloses your health information to authorized
healthcare professionals who order tests or are otherwise involved in your care and need access to your
test results for treatment purposes. Examples of other treatment-related purposes include disclosure to a
genetic counselor to help interpret your test results. To the extent disclosure is made to a genetic
counselor for treatment purposes, Avellino does not anticipate having access to the genetic counselor’s
notes. Notwithstanding, Avellino may use or disclose your genetic counseling notes to the extent
required by law; for treatment, payment, or healthcare operations; to defend itself in a legal action or
other proceeding brought by you; or to avert a serious threat to health or safety. Any other use or
disclosure of your genetic counseling notes requires your written consent.
Avellino will use and disclose your PHI for purposes of billing and payment. For example, Avellino may
disclose your PHI to health plans or other payers to determine whether you are enrolled with the payer or
eligible for health benefits or to obtain payment for Avellino’s services. If you are a minor or otherwise
insured under another person’s health insurance policy (for example, parent, spouse, domestic partner, or
a former spouse), Avellino may also send invoices to the subscriber whose policy covers your health
Avellino may use and disclose your PHI for activities necessary to support its healthcare operations,
such as performing quality checks on testing, internal audits, arranging for legal services, or developing
reference ranges for tests.
Avellino may provide your PHI to third-party companies or individuals that need the information to
provide services. For example, Avellino may provide information to companies that assist with billing.
Avellino may use an outside collection agency to obtain payment to the extent necessary. These third-party
entities are known as "business associates" under the law and, as a result, are also required to maintain
the privacy and security of PHI.
Avellino may use and disclose your PHI, if necessary, to prevent or lessen a serious threat to your health
and safety or that of the general public. To the extent so required, Avellino may also provide PHI to law
enforcement officials, for example, in response to a warrant, investigative demand or similar legal
process, or for officials to identify or locate a suspect, fugitive, material witness, or missing person.
Avellino may also disclose PHI to appropriate agencies, as required under the law, if it reasonably
believes an individual to be a victim of abuse, neglect, or domestic violence. Avellino may also disclose
your PHI as required to comply with a subpoena, court or administrative order, or other legal process.
Avellino may disclose PHI for research purposes when an Institutional Review Board or privacy board has
reviewed the research proposal and established protocols to ensure the privacy of your PHI and determined
that the researcher does not need to obtain your authorization prior to using your PHI for research
purposes. Avellino may also disclose information about decedents to researchers under certain
Avellino will never sell your PHI to any third party without your express written consent.
Avellino may use and disclose your PHI as required by law. For all of the purposes articulated herein,
when state or municipal law is more restrictive than federal law, Avellino is required to and will follow
the more restrictive law.
Avellino may disclose your PHI for public health-related activities -eg, reporting diseases to
authorized public health authorities; public health investigations; or notifying a manufacturer of a
product regulated by the U.S. Food and Drug Administration of a possible problem encountered when using
the product in Avellino’s testing process.
Avellino may disclose your PHI to a healthcare oversight agency for activities that are authorized by
law, such as audits, investigations, inspections, and licensure activities. For example, Avellino may
disclose your PHI to agencies responsible for ensuring compliance with the rules of government health
programs such as Medicare or Medicaid.
You, or your authorized or designated personal representative, have the right to inspect and copy the PHI
maintained by Avellino. Avellino may deny access to certain information for specific reasons, for example,
if the access requested is reasonably likely to endanger the life or safety of you or another person. If
your request for information is denied, you may request that the denial be reviewed.
You may request amendments to your PHI by making a written request. However, Avellino may deny the
request in some cases (such as if Avellino determines that the PHI is accurate), in which case Avellino
will provide you with a written explanation of the reason for the denial and additional information
regarding further actions that you may take.
You have the right to receive a list of certain disclosures of your PHI made by Avellino in the past 6
years from the date of your written request. Under the law, this does not include disclosures made for
purposes of treatment, payment, or healthcare operations or certain other purposes.
You have the right to request restrictions on Avellino’s use and disclosure of your PHI. While Avellino
will consider all requests for additional restrictions carefully, it is not required to agree to a
requested restriction except for payment or operations restrictions where payment has been made
"out-of-pocket" and paid-in-full. If Avellino agrees to a requested restriction, you will be notified in
You have the right to request that Avellino send your health information by alternative means or to an
alternative address, and Avellino will accommodate reasonable requests.
You have the right to obtain a paper copy of this notice upon request.
You may write or send an email to Avellino with your specific request, including requesting a form to
complete to obtain a copy of your test results. Avellino will consider your request and provide you a
Avellino is required to notify you following the discovery of a breach of unsecured PHI, unless there is a
demonstration, based on a risk assessment, that there is a "low probability" that the PHI has been
compromised. You will be notified in a timely fashion, no later than 60 days after discovery of the
If you believe your privacy rights have been violated, you have the right to file a complaint with
Avellino. You also have the right to file a complaint with the Secretary of the US Department of Health
and Human Services, Office for Civil Rights. Avellino will not retaliate against any individual for filing
a complaint. To file a complaint with Avellino, or should you have any questions about this notice, send
an email to Privacy@Avellino.com, or write to Avellino at the following address:
Avellino Lab USA, Inc.
1505 Adams Drive, Suite B2
Menlo Park, CA 94025
You may also contact the Privacy Officer at +1-650-353-7280.
Avellino reserves the right to change its privacy practices and the terms of this notice at any time,
provided such changes are permitted by applicable law. Avellino will promptly post any changes to this
notice on its website at www.avellino.com. Please review this website periodically to ensure that you are
aware of any updates.