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Health Insurance Portability and Accountability Act (HIPAA) Agreement

Business Associates Right to Privacy Declaration

As specified under the Health Insurance Portability and Accountability Act (HIPAA), Pacific Oral and Maxillofacial Pathology Laboratory (POMPL) herein provide a declaration of privacy to all of our contributing clinicians and surgeons.

POMPL receives biopsy specimens from your office/clinic along with demographic and historical data pertinent to the diagnosis.

Patient consent forms for submission of these materials to our laboratory are provided with biopsy mailer kits. This patient information is known only to key staff persons in our laboratory who are aware of the stipulations of law under the act.

Information Practices

No information regarding the patient or their diagnosis is transmitted to anyone other than yourself and our billing clearinghouse (Rand Medical Billing).

Copies of pathology reports are faxed to your office by our staff and must be handled in a confidential fashion with filing into appropriate storage systems that are not available to unauthorized scrutiny or entities outside your facility.

Other health professional agencies or individuals will be denied access to pathology findings without authorization by patient. Authorization forms will be provided upon request.

POMPL may request additional diagnostic material from other laboratories or imaging centers when it pertains to the diagnosis.

POMPL may request expert opinion from pathologists outside our establishment when the case is difficult and such consultations will benefit the healthcare of the patient.

If you have any questions about these policies, please contact:

Contact Person Regarding Complaints: Dr. Roy Eversole, 415.929.6560
Privacy Officer Designate: Ms. Tessie Arenas, 415.929.6560