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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 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:
Pharmacy Innovations
863 Fairmount Ave.
Jamestown NY, 14701
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:
Secretary of the Department of Health and Human
Services,
Hubert H. Humphrey Building
200 Independence Avenue SW, Washington, DC 20201
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You will not be retaliated against for filing a complaint.
. You will not be retaliated against for filing a complaint.
Section B: Contacting Us
You may contact us for further information at:
Pharmacy Innovations
863 Fairmount Ave. Jamestown NY, 14701
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