Notice of Privacy Practices
How the Pharmacy May Use and Disclose
Your PHI The following is an accounting of the ways that the pharmacy is permitted, by law, to use and disclose your PHI. Uses and disclosures of PHI for Treatment: We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care. Uses and disclosures of PHI for Payment: The pharmacy will disclose your PHI to obtain payment or reimbursement from insurers for your health care services. Uses and disclosures of PHI for Health Care Operations: The pharmacy will use your PHI to conduct quality assessments, improvement activities, and evaluate the pharmacy workforce.
Additional Uses and Disclosures
The following is an accounting of additional ways in which the pharmacy is permitted or required to use or disclose PHI about you without your written authorization:
- Uses and disclosures as required by law: The pharmacy is required to use and disclose PHI about you as required and as limited by law.
- Uses and disclosures for public health activities: The pharmacy may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing, controlling disease, injury, or disability.
- Uses and disclosures about victims of abuse, neglect, or domestic violence: The pharmacy may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect, or domestic violence.
- Uses and disclosures for health oversight activities: The pharmacy may use or disclose PHI about you to a health oversight agency for oversight activities that it is authorized by law to conduct.
- Disclosures for judicial and administrative proceedings: The pharmacy may disclose PHI about you in the course of any judicial or administrative proceedings, provided that proper documentation is presented to the pharmacy.
- Disclosures for law enforcement purposes: The pharmacy may disclose PHI about you to law enforcement officials for authorized purposes.
- Uses and disclosures about the deceased: The pharmacy may disclose PHI about a deceased, or prior to, and in reasonable anticipation of an individual’s death, to coroners, medical examiners, and funeral directors.
- Uses and disclosures for cadaveric organ, eye, or tissue donation purposes: The pharmacy may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.
- Uses and disclosures for research purposes: The pharmacy may use and disclose PHI about you for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board.
- Uses and disclosures to avert a serious threat to health or safety: The pharmacy may use or disclose PHI about you, if it believes in good faith and is consistent with applicable law and ethical standards, to avert a serious threat to health or safety.
- Uses and disclosures for specialized government functions: The pharmacy may use or disclose PHI about you for specialized government functions including military and veterans’ activities, national security and intelligence, protective services, Department of State functions, and correctional institutions and law enforcement custodial situations.
- Disclosure for workers’ compensation: The pharmacy may disclose PHI about you as authorized by and to the extent necessary to comply with workers’ compensation laws or programs established by law.
- Disclosures for disaster relief purposes: The pharmacy may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts.
- Disclosures to business associates: The pharmacy may disclose PHI about you to the pharmacy’s business associates for services they provide to or on behalf of the pharmacy.
Other Uses and Disclosures
The pharmacy may contact you for the following purposes:
- Refill reminders: The pharmacy may contact you to remind you of your prescription when they are ready to be refilled.
- Information about treatment alternatives: The pharmacy may contact you to notify you of alternative treatments and/or products.
- Health-related benefits or services: The pharmacy may use your PHI to notify you of benefits and services the pharmacy provides.
- Fundraising: If the pharmacy participates in fundraising activities, it may use demographic PHI to send you fundraising materials, or disclose such information to a business associate or institutionally related foundation for that purpose. No further disclosure will be made without your written authorization.
For All Other Uses and Disclosures
The pharmacy will obtain a written authorization from you for all other uses and disclosures of PHI, and the pharmacy will only use or disclose pursuant to such an authorization. In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact the pharmacy.
Your Health Information Rights
The following are a list of your rights in respect to your PHI:
- Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions on how the pharmacy uses and discloses your PHI; however, the pharmacy is not required to agree to such requests. To request restrictions, please obtain and complete the “Request for Restriction of Uses & Disclosures” form from the pharmacy.
- The right to have your PHI communicated by alternate means or locations: You have the right to request confidential communication through an alternative address or phone number. However, the pharmacy must maintain accurate contact information for emergencies and will consider all reasonable requests.
- The right to inspect and/or obtain a copy of your PHI: You have the right to request access to and obtain copies of your PHI maintained by the pharmacy. A reasonable cost-based fee may apply for copying.
- The right to amend your PHI: You have the right to request corrections to your PHI if you believe it is incorrect or incomplete.
- The right to receive an accounting of disclosures of your PHI: You have the right to receive a record of certain disclosures made by the pharmacy, excluding those for treatment, payment, and healthcare operations.
- The right to receive additional copies of the Notice of Privacy Practices: You have the right to request additional paper copies of this Notice, even if you originally agreed to receive it electronically.
Revisions to the Notice of Privacy Practices
The pharmacy reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The revised Notice will be available, upon request, to all individuals. The pharmacy will also post the revised version of the Notice in the pharmacy.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the pharmacy and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with the pharmacy, please contact the Privacy Officer.
If you wish to file a complaint with the Secretary, please write to:
The U.S. Department of Health and Human Services
Office of the Inspector General
200 Independence Ave,
S.W. Washington, D.C. 20201
The pharmacy will not take any adverse action against you as a result of your filing of a complaint.