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
