Notice of Privacy
Practices
This notice describes how medical information about you may be used and disclosed and how you may attain access to this information.
Please Review Carefully:
Federal and State law requires that we maintain the privacy of Protected Health Information (PHI) and to provide you with notice of our legal duties and privacy practices with respect to PHI. References to “Pharmacy”, “we”, “us”, and “our” include Pharmacy and the members of its affiliated covered entity. An affiliated covered entity is a group of organizations under common ownership or control who designate themselves as a single affiliated covered entity for purposes of compliance with the Health Insurance Portability and Accountability Act (HIPPA). Pharmacy, its employees, workforce members and members of Pharmacy affiliated covered entity who are involved in providing and coordinating health care are all bound to follow the terms of this Notice of Privacy Practices (“Notice”). The members of Pharmacy affiliated covered entity will share PHI with each other for treatment, payment and health care operations of the affiliated covered entity and as pennitted by HlPPA and this Notice. For complete listings of the members of Pharmacy’s affiliated covered entity, please contact the Privacy Office.
Our Responsibilities:
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you provide authorization in writing. If you provide us authorization, you may change your mind at any time by stating so in writing.
- Additional information: www.hbs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Our Uses and Disclosures:
PHI is information that identifies you and relates to your past, present, or future physical/mental health or condition, along with the provision of your health care products, services and payment for such servic�s. This Notice describes how we may use and disclose PHI about you, as well as how you obtain access to such PHI. This Notice also describes your rights with respect to your PHI. We are required by HIPPA to provide this Notice to you. Epiq Scripts is required to follow the terms of this Notice or any change to it that is in effect. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. If we do so, the updated Notice will be posted on our website and will be available at our facility and locations where you receive health care products and services from us. Upon request, we will provide any revised Notice to you.
Ways we may use or share your health information:
- Treating you – We may use your health information and share it with other professionals who are treating you.
- Example: We consult with your physician, nurse, or a specialist regarding your medications, treatment or condition.
- Running our organization – We may use and share your health information to run our pharmacy, improve your care, and contact you when necessary.
- Example: We use health information about you lo manage your treatment and services.
- Billing for your services – We may use and share your health information to bill and obtain payment from health plans or other entities.
- Example: We give information about you to your health insurance plan for payment of services.
Additional ways we use or share your health information:
We are allowed/required by law to share your information in additional ways. Use or disclosure (additional to listed as permitted here, or required by law), requires your written authorization in advance. You retain the right to restrict disclosures of protected health information (PHI) to a health plan where out of pocket in full for the health care item or service. However, we are required to meet numerous conditions outlined by law prior to sharing your information for these purposes. For additional information visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues and research
We may use or share your information for health research and for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
Comply with the Law
We will share information about you if state or federal laws require it, including the Department of Health and Human Services if they elect to verify that we’re compliant with federal privacy laws. We may share health information about you in response to a court or administrative order, or in response to a subpoena and for certain situations such as:
- Workers’ compensation claims
- Law enforcement /law enforcement officials
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to organ and tissue donation requests
We may share health information about you with organ procurement organizations, a coroner, medical examiner, or funeral director.
How to Request a Consultation with our Pharmacist:
Written information about this prescription has been provided for you. Please read this information before you take this medication. If you have questions concerning this prescription, a pharmacist is available during normal business hours (Monday – Friday 9:00am – 5:00pm) to answer any questions you may have. (Phone 833-654-3553 )
La informacin escrita acara de esta receta se ha proporcionado para usted. Les esta informaci6n antes de tomar el medicamento. Si usted tiene preguntas referents a esta receta, un farmaceutico esta disponible durante el horario normal (de tunes a viernes de 9:00am – 5:00pm) para responder a estas preguntas al. (Phone 833-654-3553 )
Questions Concerning Your Prescription:
Should you have questions concerning your prescription, please notify us immediately by calling 833-654-3553 and ask to speak with one of the Pharmacist on staff for prescription assistance.
Important Information Regarding Your Rights:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
- Request an electronic or paper copy of your medical record
- You may ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
- Ask us to correct your medical record
- You may ask us to correct health information about you that you think is incorrect or incomplete.
- We may deny your request, but we’ll provide you an explanation in writing within 60 days.
- Request confidential communications
- You may ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will honor all reasonable requests.
- Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless we are required by law to share that information.
- Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask (who we shared it with, and why).
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee ifyou ask for additional information within 12 months.
- Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information, including allowing this individual to accept prescriptions on your behalf.
- We will make sure the person has this authority and can act for you before we take any action.
File a Complaint If You Feel Your Rights Are Violated:
You can complain if you feel we have violated your rights by contacting us using the information below.
[email protected] 833-654-3553.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
