Notice of Privacy Practices

This notice explains how medical information about you may be used or disclosed by our pharmacy and how you can obtain access to that information. Please review it carefully.

Protecting Medical Information

Our pharmacy is required by the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA, to protect the privacy of your Protected Health Information, or PHI.

PHI includes medical records and other health information that identifies you. It may include information that we create, receive, maintain, use or disclose electronically, on paper or through verbal communication.

HIPAA requires us to provide you with this notice and make a good-faith effort to obtain your acknowledgement that you received it. This notice explains how we may use and disclose your PHI, your rights regarding that information and our responsibility to follow the terms of the notice currently in effect.

How We May Use Your Information

The law permits us to use and disclose your protected health information without additional authorization for treatment, payment and health care operations.

Treatment

Treatment includes providing, coordinating or managing health care and related services involving one or more health care providers.

For example, we may contact your doctor or another health care provider to obtain refill authorization, ask questions about medication doses, identify possible drug interactions or confirm the validity of a prescription.

We may also use or disclose information when another pharmacy or health care provider contacts us regarding services you have asked them to provide.

Payment

Payment activities may include confirming health-plan coverage, billing your insurance company, collecting payment or determining the amount you are responsible for paying.

For example, we may electronically bill an insurance company or health plan when filling a prescription. Insurance companies may also contact us to request information about services provided to you.

Health Care Operations

Health care operations include the business activities required to manage and operate our pharmacy, such as planning, financial analysis, quality review and customer service.

For example, we may review pharmacy records to evaluate the quality of service provided by our pharmacists and technicians.

Other Uses of Your Information

We may use your PHI to provide prescription-refill reminders, information about medication alternatives, information about pharmacy services or notices about health screenings, special events and wellness programs.

We may disclose relevant information to a family member, caregiver or another person involved in your medical care. This may include situations where a family member collects a prescription for you or a nursing assistant helps manage your medication.

When another person receives information on your behalf, we will make reasonable efforts to disclose only the minimum information necessary to support the quality and coordination of your care.

We may disclose PHI for law-enforcement purposes when required by law or in response to a valid subpoena, court order or other lawful request.

We may also use or disclose PHI when reasonably necessary to prevent or reduce a serious threat to your health and safety or to the health and safety of another person or the public.

Uses and disclosures that are not otherwise permitted or required by law will generally be made only with your written authorization. You may revoke an authorization in writing, except where we have already relied on it and taken action.

Your Rights

You have certain rights regarding your protected health information. These rights may be exercised by submitting a written request to the pharmacy’s Privacy Official.

• You may request restrictions on certain uses or disclosures of your PHI, including disclosures to specific people or groups identified by you.
• We are generally not required to agree to a requested restriction. However, restrictions may apply when the information relates only to a health care item or service that you paid for completely out of pocket and you ask us not to disclose it to a health plan for payment or health care operations.
• You may request that confidential communications be sent to you through an alternative method or at an alternative location.
• You may inspect and obtain a copy of your PHI, subject to applicable legal limitations. A reasonable fee may be charged for gathering, copying or delivering the requested information.
• You may request an amendment when you believe information in your record is incomplete or incorrect.
• You may request an accounting of certain disclosures of your PHI by completing the appropriate request form.
• You may request a printed copy of this Notice of Privacy Practices.

Our Legal Responsibilities

We are required by law to maintain the privacy of your protected health information, provide you with notice of our legal duties and privacy practices and notify affected individuals following a breach of unsecured PHI when required.

Effective Date of Notice

This notice became effective on October 1, 2013. We are required to follow the terms of the Notice of Privacy Practices currently in effect.

We reserve the right to revise this notice and make the revised provisions effective for all protected health information that we maintain. A revised notice will be displayed at the pharmacy, and a written copy may be requested verbally or in writing.

Complaint Process

If you believe your privacy rights have been violated, you may submit a formal written complaint to the pharmacy using the contact information provided by the pharmacy.

You may also file a complaint with the United States Department of Health and Human Services Office for Civil Rights. The pharmacy will not retaliate against you for submitting a complaint.

Department of Health and Human Services

Additional information about HIPAA rights and the complaint process is available through the Department of Health and Human Services Office for Civil Rights: www.hhs.gov/ocr/hipaa