Your Rights With Respect To Your PHI
The Health Insurance Portability and Accountability Act of
1996 (HIPAA) provides you with several rights related to
your PHI. These rights are summarized below. If you would
like more information about any of these, please contact our
Pharmacy Privacy Officer at the address or telephone number
of our pharmacy.
1. You have the right to receive this written Notice
of Privacy Practices describing how we will protect your PHI
and your rights related to PHI. You are entitled to request
this written Notice at any time.
2. You have the right to request a limitation on our
use and disclosure of your PHI. But please be aware that we
may not be able to agree to your requested limitation if it
results in our not being able to provide health care
products and services to you or if we are required to use
and disclose the PHI under federal or state law. All
requests for limitation on the use and disclosure of your
PHI must be submitted to our Pharmacy Privacy Officer in
writing using a form that we will provide to you.
3. You have the right to review or receive
photocopies of our records that contain your PHI, to the
extent that these records are part of a designated record
set as defined by HIPAA. The most common such records are
your prescriptions on file with us, our patient profile for
you, and our billing records for health care products and
services that have been provided to you. We will be pleased
to allow you to review such records at no charge during
normal business hours. However, we may charge you a
reasonable, cost-based fee for photocopies of the records,
together with any expenses for mailing, special courier,
faxing, and supplies necessary to fulfilling your request
for records.
If we are unable to provide our records to you, we will
provide you a written explanation of why we are not able to
provide the records. Depending on the reason, you may submit
a written request for us to reconsider. All requests to
review or receive photocopies of our records that contain
your PHI must be submitted to our Pharmacy Privacy Officer
in writing using a form that we will provide to you.
4. You have the right to request changes in the
content of your PHI contained in our records where you
believe the content is incomplete, inaccurate, or for some
other reason needs to be changed. We may not be able to
agree to your requested change if we no longer have the
records or if the requested change would cause your PHI to
become inaccurate. If we are not able to agree to your
requested change, we will notify you in writing as to why we
are not able to agree. You will then have the right to
submit to us a written statement of disagreement, to which
we may elect to further respond in writing to you. All
requests for changes to your PHI in our records must be
submitted to our Pharmacy Privacy Officer in writing, using
a form that we will provide to you.
5. You have the right to request that we communicate
with you about your PHI in a confidential manner and only to
locations (such as a post office box) or by means (such as
personal cellular telephone) specified by you. All requests
for confidential communications must be submitted to our
Pharmacy Privacy Officer in writing, using a form that we
will provide to you.
6. You have the right to obtain an accounting of
some of our disclosures of your PHI made after April 14,
2003. By an accounting, we mean a written record of these
disclosures. Some of our disclosures of your PHI are not
required by HIPAA to be included in the accounting. Most
notable among these are disclosures for purposes of
treatment, obtaining payment, and carrying out health care
operations. Other disclosures of your PHI that are not
required to be included in the accounting are disclosures
made directly to you or that you have authorized, made to
family, friends, and others who assist you with your care
(caregivers) and made for other purposes allowed by HIPAA.
Please consult with our Pharmacy Privacy Officer for more
information on the disclosures not required to be including
in the accounting.
The period of time for which we are required to provide the
accounting is the six-year period immediately prior to the
date of your request for the accounting but no earlier then
April 14, 2003; however, your request for an accounting can
be for a shorter period of time. You may obtain from us,
without charge, one accounting during a 12-month period.
However, if you request additional accountings during the
same 12-month period, we may charge you a reasonable,
cost-based fee for printing or photocopying of the
accounting, together with any expenses for mailing, special
courier, faxing, and supplies necessary to fulfilling your
request for the accounting. If it is becomes necessary for
us to charge you for an accounting, we will notify you in
advance and allow you to withdraw or modify your request for
the accounting. All requests for an accounting of our
disclosures of your PHI must be submitted to our Pharmacy
Privacy Officer in writing, using a form that we will
provide to you.
7. You have the right to file a complaint if you
believe that we have violated your rights as described
above, and to not fear retaliation or adverse action by us
against you for exercising your right. You can file the
complaint with us directly, or with the United States
Department of Health and Human Services (HHS). Please be
assured that we will work with you to resolve any complaint,
including providing you with the address for filing a
complaint with HHS.
IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR RIGHTS AS DESCRIBED
ABOVE, PLEASE CONTACT OUR PHARMACY PRIVACY OFFICER AT THE
ADDRESS OR TELEPHONE NUMBER OF OUR PHARMACY.
Ways That We May Use and Disclose Your PHI
The Health Insurance Portability and Accountability Act of
1996 (HIPAA) requires that this Notice tell you how we may
use and disclose your PHI. These uses and disclosures are
summarized below, but if you would like more information
about any of these please contact our Pharmacy Privacy
Officer at the address or telephone number of our pharmacy.
1. Treatment. HIPAA defines treatment as “the
provision, coordination, or management of health care and
related services by one or more health care providers,
including the coordination or management of health care by a
health care provider with a third party; consultation
between health care providers relating to a patient; or the
referral of a patient for health care from one health care
provider to another.” We will maintain records that contain
your PHI, and we will use and disclose your PHI as necessary
to provide health care products and services to carry out
and support your treatment. As a pharmacy, we may use and
disclose your PHI as necessary to maintain a patient profile
on you, which may include information about you; your
medical condition, medications, and prescription devices
that you use; any allergies that you may have; and other
information, such as any health insurance that you may have.
We may use and disclose your PHI in dispensing prescription
medicines and related products and services, including
counseling you and your caregivers about proper use of your
medications. We may discuss such problems with your other
health care professionals, such as your physician or
dentist, and through such discussions we may use and
disclose your PHI. Finally, we may use and disclose your PHI
to you and your caregivers in our discussions with you and
your caregivers about your treatment.
2. Payment. HIPAA defines payment, in relation to
health care providers such as us, as activities to obtain
reimbursement for the health care products and services that
we provide to you. These activities include primarily
billing you directly or someone who pays for your health
care, such as a family member or health insurance company,
for health care products and services that we provide to
you. Activities related to billing may include claims
management, collections, and related health care data
processing. Depending on who pays for the health care
products and services that we provide you, other activities
may include determination of eligibility or coverage;
medical necessity; review of health care services with
respect to medical necessity, coverage under a health plan,
appropriateness of care, or justification of charges;
utilization review activities, including precertification
and preauthorization of services; concurrent and
retrospective review of services; and disclosure to consumer
reporting agencies of some or all of the following PHI
necessary for collection of payment: name and address; date
of birth; social security number; payment history; account
number or numbers; and name and address of the health care
provider and/or health plan.
We will use and disclose your PHI to carry out the above
activities as necessary or required to obtain payment for
the health care products and services that we provide to
you. In relation to this, public and private health care
insurance programs that may provide or pay for your health
care can conduct audits, inspections, and investigations of
us in relation to our activities and your activities. We may
be required to disclose your PHI to these programs for
purposes of audits, inspections, and investigations.
3. Health care operations. HIPAA defines health care
operations as those activities necessary and related to our
providing of health care products and services to you. These
activities include, but may not be limited to, the
following.
A. Conducting quality assessment and improvement
activities, case management and care coordination, and
contacting of health care providers and patients with
information about treatment alternatives and related
functions that do not include treatment.
B. Conducting or arranging for medical review, legal
services, and auditing functions, including fraud and abuse
detection and compliance programs.
C. Our pharmacy management and general administrative
activities, including, but not limited to, activities
relating to implementation of and compliance with the
requirements of HIPAA.
We will use and disclose your PHI to carry out the above
activities as necessary or required, and especially to
monitor and improve the quality of the health care products
and services that are provided to you by us and other health
care professionals.
In addition to treatment, payment, and health care
operations as described above, we may use and disclose your
PHI for the following purposes listed in 4–15.
4. Business associates. The nature of the health
care system is such that we may not be able to provide
health care products and services to you without the
involvement of other businesses or persons. Depending on
what these other businesses or persons do for us, they may
become “business associates” as defined by HIPAA. In many
situations, it will be necessary for us to provide your PHI
to these business associates so that they can carry out the
activities that we need to have performed in order to
provide you health care products and services. Contracts
have or will be submitted to all of our business associates
to whom we provide your PHI so that they can carry out their
activities on our behalf. Very importantly to you, these
contracts require our business associates to give us their
assurance that they, like us, will protect the privacy of
your PHI.
5. Disclosures of your PHI not involving treatment,
payment, and health care operations. In providing health
care products and services to you, we may find it necessary
to communicate with businesses and individuals not already
described above. Most of these disclosures will be related
to providing
treatment to you, and to carrying out payment and health
care operations as discussed above. In addition to
communicating with these businesses and individuals, we may
also communicate with you directly, as well as others who
assist you with your health care, commonly referred to as
caregivers. We will disclose your PHI to these caregivers,
or appropriate others, as we believe necessary and
appropriate for your health care.
6. Communications with you concerning your health
and treatment. We want to do whatever we can to assist you
with maintaining your health and obtaining the most benefit
from your treatment. We routinely monitor your prescription
medications for appropriateness and take other steps to help
you use your medication properly. For example, if our
records show that a refill of your medication is due, we may
contact you to remind you to obtain the refill. We may also
call you or send you materials regarding products and
services that we believe may be of benefit to you. As a
final example, in the event of a medication recall, we may
contact you, if you are taking the medication subject to the
recall.
7. Federal and state government agencies. We may
disclose your PHI to federal and state government agencies
for a variety of purposes, most of which are directed at
monitoring health care quality and safety, and government
programs related to health care and our compliance with laws
applicable to health care. For example, the United States
Drug Enforcement Administration (DEA) monitors the
distribution and usage of controlled substances, while the
United States Food and Drug Administration (FDA) monitors
adverse drug events. We may disclose your PHI to such
agencies where required by the agency so that the agency can
carry out its required activities. Related to this, some
private businesses, such as the manufacturers of medications
and medical devices, are legally required to conduct
post-marketing surveillance in order to ensure the safety of
their products. Disclosing your PHI for such surveillance
may be necessary.
8. Federal and state government health care
insurance programs. If you apply for and receive benefits
from federal and state health care programs, such as
Medicare or Medicaid, your PHI may be disclosed to the
agency granting these benefits. If you are employed by a
business that is required to carry workers’ compensation
insurance, and you are injured in such a way that the
workers’ compensation plan covers your health care, it may
be necessary to disclose your PHI to the workers’
compensation plan. Such plans have a right to conduct
audits, inspections, and investigations of our activities
and your activities, and where required, we will disclose
your PHI for these activities.
9. Matters of public health and safety. There are a
number of federal and state laws that require health care
providers to report to various government agencies matters
related to public health. If your physical or mental health
condition and illness is of a nature that federal or state
law requires that it be reported, then we will disclose your
PHI to the appropriate government agency in order to comply
with these laws. In addition to reporting about physical and
mental health conditions and illnesses, we may also disclose
your PHI to government agencies in other situations where we
are required to submit reports, such as suspected domestic,
child or elder abuse, or neglect.
10. Law enforcement activities. A number of federal, state,
and local government agencies are charged with enforcing the
health care and drug laws, and other laws in relation to the
health care products and services that we may provide to
you. In addition, as a state licensed pharmacy, a variety of
federal, state, and local health care agencies, such as the
state board of pharmacy, regulate our activities. These
agencies may engage in a number of activities designed to
monitor and improve federal and state
health care programs and systems, including conducting of
inspections and investigations of our activities and the
health care products and services that we provide to our
patients. At any time we are required by federal or state
laws, or by court order, subpoena or other legal mandate, to
disclose your PHI, we will do so as necessary.
11. Legal disputes. Lawsuits and other legal disputes
may involve your PHI that we possess. In the event that you
are involved in a lawsuit or other legal proceeding, whether
as a plaintiff or a defendant, and without regard to the
basis for the lawsuit, such as medical malpractice or
divorce, we will disclose your PHI when required to comply
with a court order, subpoena, discovery proceeding, such as
a deposition, or other legal mandate served upon us.
12. Disclosures for the benefit of you and others. A
variety of events could occur where we would use and
disclose your PHI for your benefit and to prevent or reduce
the risk of harm to you. For example, if you are in a car
accident and are unconscious in a hospital emergency room
and the emergency room medical staff calls us with a request
for your PHI, we may disclose it for the purpose of
assisting in your prompt medical treatment. Finally, we may
disclose your PHI where necessary to protect the health and
safety of others.
13. Disclosures for national security and intelligence. We
are legally required to disclose your PHI where necessary to
national security activities and intelligence and
counterintelligence activities. Disclosures related to this
may also include those where required in relation to the
protection of the President of the United States. Any
disclosure for these purposes would be made only to
authorized government officials.
14. Disclosures if you are in the military or a veteran. We
may disclose your PHI, if you are a member of any branch of
the armed services, whether on active or reserve status as
required by the U.S. Military. If you are a veteran, we may
release your PHI, particularly if you are receiving health
care products and services from the Veterans Services. Any
disclosure for these purposes would be made only to
authorized government officials.
15. Disclosures of a miscellaneous nature. This last
category of disclosures includes a variety of
disclosures that we may make in accordance with HIPAA. We
may be required to disclose your PHI if you are placed into
the custody of a federal or state correctional system, if
necessary to protect the health and safety of you and
others. Health care is an area where much research is being
conducted, and we may disclose your PHI for purposes of a
research project. Finally, given the national need for organ
donations, we may disclose your PHI to organizations that
manage organ transplantation programs.
IF YOU HAVE QUESTIONS ABOUT WAYS THAT WE MAY USE AND
DISCLOSE YOUR PHI AS DESCRIBED ABOVE, PLEASE CONTACT OUR
PHARMACY PRIVACY OFFICER AT THE PHARMACY ADDRESS OR
TELEPHONE NUMBER
411
Main St.
