NOTICE OF PRIVACY PRACTICES effective date: April 14, 2003
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
Warren Pharmacy has always protected the privacy of your health information. We understand that information about you & your health is personal. We have always held prescriptions, drug orders, records & patient information in strictest confidence!
A Federal law, The Health Insurance Portability & Accountability Act (HIPAA) of 1996, now also requires us to protect the privacy of your individual health information (information we refer to in this notice as “Protected Health Information” or ³PHI²). We are also required to provide you with this NOTICE OF PRIVACY PRACTICES, beginning 14 April 2003, regarding your Protected Health Information (PHI) and to abide by the terms of this notice, as it may be updated periodically. We reserve the right to change the terms of this notice and to make new notice provisions effective for all PHI we maintain. You may receive a current copy of this notice by contacting us as outlined in Section C or by requesting one upon the receipt of pharmacy care services.
For some activities, we must have your written authorization to use or disclose your health information. However, we are permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and healthcare operations purposes.
SECTION A: Uses and Disclosures of Protected Health Information
These are some examples of how Federal law permits the use & disclosure of your PHI without your permission:
For treatment purposes: Information obtained by the Pharmacy will be used to dispense prescriptions to you. We may use PHI providing, coordinating, or managing healthcare and its related services by one or more of your providers, such as when your Pharmacist consults with your physician or a specialist regarding your medications, treatment or condition.
For payment purposes: We may use or disclose your health information to determine who will authorize reimbursement for providing prescriptions, medical supplies or other pharmaceutical care services. For reimbursement purposes, your PHI may be disclosed to one or several intermediaries employed by your plan sponsor (if you have one), or by us, including, but not limited to, insurers, pharmacy benefits managers, claims administrators and computer switching companies.
For healthcare operations purposes: We may use or disclose your health information in a number of ways, including, but not limited to, the following:
For quality assessment and improvement, provider review and training, underwriting activities, reviews and compliance activities; planning, development, management and administration.
To assist in the evaluation of the quality of care you were provided.
We may disclose your health information to your plan sponsor, if you have one.
We may use your name to reference your prescriptions and pharmaceutical care services. You, or your representative, may be required to sign a signature log form or to acknowledge receipt of service, to acknowledge receipt of this notice and the disclosure of PHI as outlined herein. We may disclose this information to other persons who ask for you or your prescriptions by name.
We may also offer prayer to the God of Heaven, the great Physician, for your healing and quick recovery.
We may contact you to wish you a happy birthday, unless you object.
We may notify you, if you win a prize in a drawing, and we may publish that fact.
We may contact you for the purpose of community fundraising activities, or to notify you of community events, unless you object.
We may use and disclose your PHI, without your authorization, when the pharmacy needs to contact a physician or physician¹s staff and is permitted or required to do so without individual written consent or authorization.
We may use and disclose your PHI if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them.
We may contact you to provide refill reminders, health screenings, wellness events, inoculations, vaccinations or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
From time to time, we may employ the services of business associates who may assist us in one or more tasks and who may use, change or create PHI. Business associates are required to comply with all the privacy regulations on your behalf.
We may disclose PHI about you without your authorization to notify the Food & Drug Administration (FDA) about adverse drug events, to comply with workers compensation laws, as required by law enforcement, legal proceedings, court orders, a subpoena, public health requirements, health oversight activities, national security, to coroners, medical examiners, funeral directors and as required by federal, state or local law or governing agencies.
If you are a member of the armed forces, we may release your PHI as required by military command authorities.
If you are or become an inmate of a correctional institution, we may disclose PHI to the institution, or its agents, necessary for your health and the health & safety of others.
We may disclose to one of your family members, to a relative, to a close personal friend, a neighbor, or to any other person identified by you, PHI that is directly relevant to the person¹s involvement with your care or payment related to your care. In addition, unless you object, we may use or disclose your PHI to notify, identify, or locate a member of your family, your personal representative, another person responsible for care, or certain disaster relief agencies, of your location, general condition, or death. If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do what in our judgment is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person¹s involvement with your healthcare. We will also use our judgment and experience regarding your best interest in allowing people to pick-up filled prescriptions, or similar forms of PHI.
SECTION B: How you can control & access your Protected Health Information
You may give us written authorization to use or disclose your health information to anyone for any purpose. You may revoke your authorization at any time by notifying us as described in Section C, except to the extent the Pharmacy has already taken action in reliance on a previously signed authorization form.
You may ask us to restrict uses and disclosures of your PHI to carry out treatment, payment, or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care. You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative in writing of your restriction or prohibition. However, we are not required to agree to your request.
You have the right to request the following with respect to your PHI: (i) inspection and copying; (ii) amendment or correction; (iii) an accounting of the disclosures of this information by us; (We are not required to account to you for disclosures made for treatment, payment, operations, disclosures to you, disclosures to your care givers, for notifications or as otherwise excluded by law); and (iv) receipt of a paper copy of this notice upon request. The Pharmacy may require patients to make requests for access to their PHI in writing.
In addition, you may request, and we must accommodate the request, if reasonable, to receive communications of PHI by alternative means or at alternative locations. For example, you may ask us to contact you at work, rather than at home, or, to mail information to another address. To make this request please contact us as described in Section C.
The Pharmacy may charge for services, supplies, labor and the postage involved in preparing PHI for your request. If you desire a price quote for this service you must request one. You have the right to withdraw your request of the PHI prior to the delivery.
If you request our services, we are able to provide treatment services to you, even if you object to signing the acknowledgment of the receipt of this notice or if we decide not to honor a request regarding the information in this document while noting your requests and refusals in our records. In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preference, and what we determine to be in your best interest. We will inform you of any such uses or disclosures under such circumstances and give you an opportunity to object as soon as is practical.
Section C: Contacting Us
If you believe that your privacy rights have been violated, you may file a complaint with us at the location described in Section C or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Ave SW, Washington, DC 20201. You will not be retaliated against for filing a complaint.
You may contact us for further information at:
Warren Pharmacy
Attention: Privacy Officer
P. O. Box 345
Warren, IN 46792-0345
Fax# 375-7030
This notice is effective 4/14/03.