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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.
DATE OF NOTICE: April 14,2003
SECTION A: Uses and Disclosures of Protected Health Information
1. Under applicable law, we are required to
protect the privacy of your individual health information (information we refer
to in this notice as “Protected Health Information”). We are also required to
provide you with this Notice regarding our policies and procedures regarding
your Protected Health Information and to abide by the terms of this notice, as
it may be updated from time to time.
We are permitted to make
certain types of uses and disclosures under applicable law for treatment,
payment, and healthcare operations purposes. We may obtain information to
dispense prescriptions and for the documentation of pertinent information in
your records that may assist us in managing your medication therapy or your
overall health. For treatment purposes, such use and disclosure will take place
in 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,
such use and disclosure will take place to obtain or provide reimbursement for
providing pharmaceutical care services, such as when your case is reviewed to
ensure that appropriate care was rendered. For reimbursement purposes, your
Protected Health Information may be disclosed to one or several intermediaries
employed by your plan sponsor including but not limited to insurers, pharmacy
benefits managers, claims administrators and computer switching companies.
For healthcare operations
purposes, such use and disclosure will take place in a number of ways,
including for quality assessment and improvement; provider review and training;
underwriting activities; reviews and compliance activities; and planning,
development, management and administration. Your information could be used, for
example, to assist in the evaluation of the quality of care that you were
provided.
We store some of your
Protected Health Information in electronic computer files. We backup our
electronic records daily and store backups offsite, and employ other precautions to
safeguard the integrity of your Protected Health Information. In spite of these
precautions it is possible but unlikely that a computer crash or other
technological failure could cause the loss of data. In addition reasonable
safeguards are employed to protect your Protected Health Information stored on
electronic media.
In addition, 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. In
addition, we may disclose your health information to your plan sponsor. In
addition we may contact you for the purpose of fund raising activities.
We may use and disclose
your Protected Health Information, without your authorization when the pharmacy
needs to contact a physician or physician’s staff and is permitted or required
to do so without individual written authorization. We may use and disclose your
Protected Health Information if we are contacted by another pharmacy who states
they have your request and consent to transfer pharmacy records to them.
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 Protected Health Information. Business
associates are required to comply with all the privacy regulations on your
behalf.
We may disclose Protected
Health Information about you without your authorization to comply with workers compensation
laws, as required by law enforcement, legal proceedings, public health
requirements, health oversight activities and as required by law.
Other uses and
disclosures will be made only with your written authorization, and you may
revoke your authorization by notifying us as described in Section B.
2. You may ask us to restrict uses and
disclosures of your Protected Health Information 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. However, we are not required to
agree to your request.
3. You have the right to request the following
with respect to your Protected Health Information: (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) the
right to receive a paper copy of this notice upon request. We may require you
to pay for this request to cover our costs of copying, labor and postage.
In addition, you may request, and we must
accommodate the request, if reasonable, to receive communications of Protected
Health Information by alternative means or at alternative locations. To make
this request please contact, in writing:
Professional Pharmacy
Karen Gillis, Privacy Officer
140 Roxboro Rd.
Oxford, NC 27565
919-693-8555
4. We may use your name to reference your
prescriptions and pharmaceutical care services. You may be required to sign a
signature log form to acknowledge receipt of service, to acknowledge receipt of
this Notice and the disclosure of Protected Health Information as outlined
herein. This information may be disclosed by us to other persons who ask for
you or your prescriptions by name. You may restrict or prohibit these uses and
disclosures by notifying a pharmacy representative orally or in writing of your
restriction or prohibition. We are not required to honor those requests. We are
able to provide treatment services to you even if you object to sign the
acknowledgment of the receipt of this Notice or if we decide not to honor a
request regarding the information in this document. 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 if uses and
disclosures would require your signed authorization under such circumstances
and give you an opportunity to object as soon as practicable.
5. We may
disclose to one of your family members, to a relative, to a close personal
friend, or to any other person identified by you, Protected Health Information
that is directly relevant to the person’s involvement with your care or payment
related to your care. In addition we may use or disclose the Protected Health
Information 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 in our judgment what is in your best interest regarding
such disclosure and will disclose only the information that is directly
relevant to the person’s 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 other similar forms of Protected Health
Information.
6. We reserve the right to change the terms of
this Notice and to make new Notice provisions effective for all Protected
Health Information we maintain. You may receive a copy of this Notice by
contacting us as outlined in Section B or upon the receipt of pharmacy care
services.
7. If you believe that your privacy rights have
been violated, you may complain to us at the location described in Section B or
to the Secretary of the Department of Health and Human Services, Hubert H.
Humphrey Building,
200 Independence Avenue SW,
Washington, DC
20201. You will not
be retaliated against for filing a complaint.
Section B: Contacting Us
You may contact us for further
information at:
Professional
Pharmacy
Karen Gillis, Privacy Officer
140 Roxboro Rd.
Oxford, NC
27565
professionalpharmacy@embarqmail.com
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