NOTICE OF PRIVACY PRACTICES
EFFECTIVE 4/28/2009
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.
As part of the federal
Health Insurance Portability and Accountability Act of 1996, known as HIPAA,
the pharmacy has created this Notice of Privacy Practices (Notice). This Notice describes the pharmacy's
privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected
Health Information (PHI). Your PHI
is information about you, or that could be used to identify you, as it relates
to your past and present physical and mental health care services. The HIPAA
regulations require that the pharmacy protect the privacy of your PHI that the
pharmacy has received or created.
This
pharmacy will abide by the terms presented within this Notice. For any uses or disclosures that are
not listed below, the pharmacy will obtain a written authorization from you for
that use or disclosure, which you will have the right to revoke at any time, as
explained in more detail below. The
pharmacy reserves the right to change the pharmacy's privacy practices and this
Notice. Revisions to the Notice will be posted in the pharmacy and
upon your request, provided to you in a paper format.
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 may use the minimum necessary amount of your PHI to conduct quality
assessments, improvement activities, and evaluate the pharmacy workforce.
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. All uses and
disclosures will be to the minimum necessary amount of your PHI. Many of these uses and disclosures will
never be made by the pharmacy; however, we are required by law to notify you of
them as a health care provider.
Uses
and disclosures as required by law: The pharmacy is required to use or
disclose PHI about you as required and as limited by law.
Uses
and disclosure 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 or controlling disease, injury, or
disability. This includes the FDA
so that it may monitor any adverse effects of drugs, foods, nutritional
supplements and other products as required by law.
Uses
and disclosure 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 which may include audits,
investigations, inspections as necessary for licensure, compliance with civil
laws, or other activities the health oversight agency 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 as required by law or in response to a court order or subpoena.
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. Otherwise, the pharmacy will request a signed authorization
by the individual for all other research purposes.
Uses
and disclosures to avert a serious threat to health or safety: The
pharmacy may use or disclose PHI about you, if it believed in good faith, and
is consistent with any applicable law and standards of ethical conduct, 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 veteran's 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 that they may provide to or
for the pharmacy to assist the pharmacy to provide quality health care. To ensure the privacy of your PHI, we
require all business associates to apply appropriate safeguards to any PHI they
receive or create.
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 upon such time 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 a fundraising activity, the pharmacy may use
demographic PHI to send you a fundraising packet, or the pharmacy may disclose
demographic PHI about you to its business associate or an institutionally
related foundation to send you a fundraising packet. No further disclosure will be allowed by the business
associates or an institutionally related foundation 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 Trisha to obtain a Request for Restriction of Uses and Disclosures.
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 of the pharmacy's uses and
disclosures of your PHI; however, the pharmacy is not required to accommodate a
request. If you wish to request
additional restrictions, please obtain the form, Request for Restriction of
Uses & Disclosures, from the pharmacy
and return the completed form to the pharmacy or return to Trisha.
The
right to have your PHI communicated to you by alternate means or locations: You have
the right to request that the pharmacy communicate confidentially with you
using an address or phone number other than your residence. However, state and federal laws require
the pharmacy to have an accurate address and home phone number in case of
emergencies. The pharmacy will consider all reasonable requests. If you wish to request a change in your
communicating address and/or phone number, please obtain a form, Request for
Alternative Arrangements for Confidential Communication, from the pharmacy and return the completed form to
the pharmacy or return to Trisha
The
right to inspect and/or obtain a copy your PHI: You have
the right to request access and/or obtain a copy of your PHI that is contained
in the pharmacy for the duration the pharmacy maintains PHI about you. If you wish to inspect or obtain a copy
of your PHI, please obtain a form, Request for Access to Records, from the pharmacy and return the completed form to
the pharmacy or return to Trisha.
There may be a reasonable cost-based charge for photocopying
documents. You will be notified in
advance of incurring such charges, if any.
The
right to amend your PHI: You have the right to request an
amendment of the PHI the pharmacy maintains about you, if you feel that the PHI
the pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny
your request for amendment. If we do deny the request, you will have the right
to have the denial reviewed by someone we designate who was not involved in the
initial review. You may also ask
the Secretary, United States Department of Health and Human Services (ÒHHSÓ),
or their appropriate designee, to review such a denial. If you wish to amend your PHI files,
please obtain a form, Request for Amendment to PHI, from the pharmacy and return the completed form to
the pharmacy or return to Trisha.
The
right to receive an accounting of disclosures of your PHI: You have
the right to receive an accounting of certain disclosures of your PHI made by
the pharmacy. If you wish to receive an accounting of disclosures of your PHI,
please obtain a form, Request for Accounting of Disclosures, from the pharmacy and return the completed form to
the pharmacy or return to the Trisha. You should be aware; however, that such an accounting
excludes uses and disclosures made for treatment, payment, or health care
operations purposes.
The
right to receive additional copies of the Pharmacy's Notice of Privacy
Practices: You have the right to receive additional paper copies of
this Notice, upon request, even if you initially agreed to receive the Notice
electronically. If you wish to
receive a paper copy of this request, please ask a pharmacy workforce member
and they will provide you with a copy.
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 Trisha.
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.
CONTACT INFORMATION
If
you have any questions on the pharmacy's privacy practices or for clarification
on anything contained within the Notice, please contact:
Leo's Lakeside Pharmacy
Trisha Hall
9943 Maine Ave
Lakeside, CA 92040
(619) 443-1013