NOTICE OF PRIVACY PRACTICES
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.
The Pharmacy is required by law to maintain
the privacy of Protected Heath Information (“PHI”)
and to provide individuals with notice of our legal duties and
privacy practices with respect to PHI. PHI is information that
may identify you and that relates to your past, present or future
physical or mental health or condition and related health care
services. This Notice of Privacy Practices (“Notice”)
describes how we may use and disclose PHI to carry out treatment,
payment or health care operations and for other specified purposes
that are permitted or required by law. The Notice also describes
your rights and with respect to PHI about you.
The Pharmacy is required to follow the terms
of this Notice. We will not use or disclose PHI about you without
your written authorization, except as described in this Notice.
We reserve the right to change our practices and this Notice
and to make the new Notice effective for all PHI we maintain.
Upon request, we will provide any revised Notice to you.
Your Heath Information Rights
You have the following rights with respect to
PHI about you:
Obtain a paper copy of the Notice upon request. You
may request a copy of the Notice at any time. Even if you have
agreed to receive the Notice electronically, you are still entitled
to a paper copy. To obtain a paper copy, contact any employee
of the Pharmacy.
Request a restriction on certain uses and
disclosures of PHI. You have the right to request additional
restriction on our use or disclosure of PHI about you by sending
a written request to Tom Hodel. We are not required to agree
to those restrictions.
Inspect and obtain a copy of PHI. You
have the right to access and copy PHI about you contained in
a designated record set for as long as the Pharmacy maintains
the PHI. The designated record set usually will include prescription
and billing records. To inspect or copy PHI about you, you must
send a written request to Tom Hodel. We may charge you a fee
for the costs of copying, mailing and supplies that are necessary
to fulfill your request. We may deny your request to inspect
and copy in certain limited circumstances. If you are denied
access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI. If you
feel that PHI we maintain about you is incomplete or incorrect,
you may request that we amend it. You may request an amendment
for as long as we maintain the PHI. To request an amendment,
you must send a written request to Soldotna Professional Pharmacy
Attn: Tom Hodel. You must include a reason that supports your
request. In certain cases, we may deny your request for amendment.
If we deny your request for amendment, you have the right to
file a statement of disagreement with the decision and we may
give a rebuttal to your statement.
Receive and accounting of disclosures of
PHI. You have the right to receive an accounting of the
disclosures we have made of PHI about you after April 14th,
2003 for most purposes other than treatment, payment, or health
care operations. The accounting will exclude certain disclosures,
such as disclosures made directly to you, disclosures you authorize,
disclosures to friends or family members involved in your care,
and disclosures for notification purposes. The right to receive
an accounting is subject to certain other exceptions, restrictions,
and limitations. To request an accounting, you must submit
a request in writing to Soldotna Professional Pharmacy ATTN:
Tom Hodel. Your request must specify the time period, but may
not be longer than six years. The first accounting you request
within a 12 month period will be provided free of charge, but
you may be charged for the cost of providing additional accountings.
We will notify you of the cost involved and you may choose
to withdraw or modify your request at that time.
Request communications of PHI by alternative
means or at alternative locations. For instance, you may
request that we contact you about medical matters only in writing
or at a different residence or post office box. To request
confidential communication of PHI about you, you must submit
a request in writing to Soldotna Professional Pharmacy. Your
request must state how or where you would like to be contacted.
We will accommodate all reasonable requests.
Examples of How We May Use and Disclose
PHI
The following are descriptions and examples
of ways we use and disclose PHI:
We will use PHI for treatment. Example:
Information obtained by the pharmacist will be used to dispense
prescription medications to you. We will document in your record
information related to the medications dispensed to you and services
provided to you.
We will use PHI for payment. Example:
We will contact your insurer or pharmacy benefit manager to determine
whether it will pay for your prescription and the amount of your
co-payment. We will bill you or a third-party payer for the cost
of prescription medications dispensed to you. The information
on or accompanying the bill may include information that identifies
you, as well as the prescriptions your are taking.
We will use PHI for health care operations. Example:
The Pharmacy may use information in your health record to monitor
the performance of the pharmacists providing treatment to you.
This information will be used in an effort to continually improve
the quality and effectiveness of the health care and service
we provide.
We are likely to use or disclose PHI for the
following purposes:
Business associates: There are some
services provide by us through contracts with business associates.
When these services are contracted for, we may disclose PHI about
you to our business associate so that they can perform the job
we have asked them to do and bill you or your third-party payer
for services rendered. To protect PHI about you, we require the
business associate to appropriately safeguard the PHI.
Communication with individuals involved
in your care or payment for your care: Health professionals
such as pharmacists, using their professional judgment, may
disclose to a family member, other relative, close personal
friend or any person you can identify. PHI relevant to that
person’s involvement in your care or payment related
to your care.
Health-related communications: We may
contact you to provide refill reminders or information about
treatment alternatives or other health-related benefits and services
that may be of interest to you.
Food and Drug Administration (FDA): We
may disclose to the FDA, or persons under the jurisdiction of
the FDA, PHI relative to advertise events with respect to drugs,
foods, supplements, products and product defects, or post marketing
surveillance information to enable product recalls, repairs,
or replacement.
Worker’s compensation: We may
disclose PHI about you as authorized by and as necessary to comply
with laws relating to worker’s compensation or similar
programs established by law.
Public health: As required by law,
we may disclose PHI about you to public health or legal authorities
charged with preventing or controlling disease, injury or disability.
Law enforcement: We may disclose PHI
about you for law enforcement purposes as required by law or
in response to a valid subpoena or other legal process.
As required by law: We must disclose PHI bout
you when required to do so by law.
Heath Oversight activities: We must
disclose PHI about you to an oversight agency for activities
authorized by law. These oversight activities include audits,
investigations, and inspections, as necessary for our licensure
and for the government to monitor the health care system, government
programs, and compliance with civil rights laws.
Judicial and administrative proceedings: If
you are involved in a lawsuit or a dispute, we may disclose PHI
about you in response to a court or administrative order. We
may also disclose PHI about you in response to a subpoena, discovery
request, or other lawful process by someone else involved in
the dispute, but only if efforts have been made to tell you about
the request or to obtain an order protecting the requested PHI.
We are permitted to use or disclose PHI about
you for the following purposes:
Research: We may disclose PHI about
you to researchers when an institutional review board that has
reviewed the research proposal and established protocols to ensure
the privacy of your information has approved their research.
Coroners, medical examiners, and funeral
directors: We may release PHI about you to a coroner or
medical examiner. This may be necessary, for example, to identify
a deceased person or determine the cause of death. We may also
disclose PHI to funeral directors consistent with applicable
law to carry out their duties.
Organ or tissue procurement organizations: Consistent
with applicable law, we may disclose PHI about you to organ procurement
organizations or other entities engaged in the procurement, banking,
or transplantation of organs for the purpose of tissue donation
and transplant.
Fundraising: We may contact you as
part of a fundraising effort.
Notification: We may use or disclose
PHI about you to notify or assist in notifying a family member,
personal representative, or another person responsible for your
care, your location, and your general condition.
Correctional institution: If you are
or become an inmate of a correctional institution, we may disclose
PHI to the institution or its agents when necessary for your
health or the health and safety of others.
To avert a serious threat to health or safety: We
may use and disclose PHI about you when necessary to prevent
a serious threat to your health and safety or the health and
safety of the public or another person.
Military and veterans: If you are a
member of the armed forces, we may release PHI about you to authorized
federal officials for intelligence, counterintelligence, and
other national security activities authorized by law.
Protective services for the President and
others: We may disclose PHI about you to authorized federal
official so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special
investigations.
Victims of abuse, neglect, or domestic violence: We
may disclose PHI about you to a government authority, such as
a social service or protective services agency. If we reasonably
believe you are a victim of abuse, neglect, or domestic violence.
We will only disclose this type of information to the extent
required by law, if you agree to the disclosure, or if the disclosure
is allowed by law and we believe it is necessary to prevent serious
harm to you or someone else or the law enforcement or public
official that is to receive the report represents that it is
necessary and will not be used against you.
Other Uses and Disclosures of PHI
The Pharmacy will obtain your written authorization
before using or disclosing the PHI about you for purposes other
than those provided for above or as otherwise permitted or required
by law. You may revoke an authorization in writing at any time.
Upon receipt of the written revocation, we will stop using or
disclosing PHI about you, except to the extent that we have already
taken action in reliance on the authorization.
For More Information or to Report a
Problem
If you have questions or would like additional
information about the Pharmacy’s privacy practices, you
may contact Tom Hodel at Soldotna Professional Pharmacy. If you
believe your privacy rights have been violated, you can file
a complaint with Tom Hodel or with the Secretary of Health and
Human Services. There will be no retaliation for filing a complaint.
Effective Date
This Notice is effective as of April 15th, 2003
Soldotna Professional Pharmacy
Copyright 2007
