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.
This Pharmacy is covered by the medical information privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (generally called "HIPAA") and its Regulations. As a result, we are required to comply with HIPAA and the Regulations in the use and disclosure of health information by which our patients can be individually identified. This health information is referred to as "Protected Health Information" or "PHI" for short. We are also required to give our patients this notice (in paper or electronically as the patient wishes) of our legal duties and privacy practices concerning their PHI, and also to tell our patients about their rights under HIPAA and the Regulations.
- USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION There are two categories for the use and disclosure of our patients’ PHI: (1) information that we can use and disclose without the patient’s prior consent; and (2), information that we cannot use or disclose without the patient’s prior authorization.
A. PATIENTS’ PRIOR CONSENT NOT REQUIRED
(1). Treatment. In the first category, we are permitted to use and disclose our patients’ PHI in connection with their medical treatment in situations such as allowing a family member or other relative or a close personal friend or other person involved in the patient’s health care to pick up the patient’s prescriptions and to receive PHI that is relevant to that person’s involvement in the patient’s care. In doing so, we are to use our professional judgment and experience with common practice in determining what is in the patient’s best interest. Other examples include sending information about a patient’s prescriptions to the patient’s family doctor or to a specialist who is treating the patient or to a hospital where the patient is receiving care, particularly if the patient has suffered a health emergency. We may use and disclose your PHI if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them.
(2). Payment. If a patient is covered by a pharmacy benefit plan, we are entitled to send PHI to the plan or to another business entity involved in our billing system describing the medication or health care equipment we have dispensed so that we can be paid.
(3). Health Care Operations. In addition, we can use PHI for health care operations such as evaluations of the quality of our patients’ health care in order to improve the success of treatment programs.
(4). Other Permitted Uses and Disclosures. There are a number of other specified purposes for which we may disclose a patient’s PHI without the patient's prior consent (but with certain restrictions). Examples include public health activities; situations where there may be abuse, neglect or domestic violence; in connection with health oversight activities; in the course of judicial or administrative proceedings; in response to law enforcement inquiries; to a medical examiner in the event of death; where organ donations are involved; in support of institutionally-approved research studies; where there is a serious threat to health and safety; in cases of military or veterans’ activities; where national security is involved; for determinations of medical suitability; for government programs for public benefit; for workers’ compensation proceedings; when our records are being audited; when medical emergencies occur; and when we communicate with our patients orally or in writing about refilling prescriptions, about generic drugs that may be appropriate for a patient’s treatment, about health related services that may benefit the patient, wellness programs, or about alternative therapies. We may disclose PHI about you to our business associates with whom we contract for assistance in business tasks, but we will require the business associate to appropriately safeguard the PHI.
B. PATIENT’S PRIOR AUTHORIZATION REQUIRED
For purposes other than those mentioned above, we are required to ask for our patients’ written authorizations before using or disclosing any of their PHI. If we request an authorization, any of our patients may decline to agree, and if a patient gives us an authorization, the patient has the right to revoke the authorization at any time. By doing so, Waltz Pharmacy must stop any future uses and disclosures of the patient’s health information that the authorization covered.
- PATIENTS’ RIGHTS
HIPAA and the Regulations provide our patients with rights concerning their PHI. With limited exceptions (which are subject to review) each patient has the right to the following:
(a). Patient’s Record. Each patient has the right to inspect and copy his or her PHI by completing our request form. The only charge will be based on our cost in fulfilling and delivering the request. The patient will be notified of the fee when the patient’s request is received. In certain limited circumstances we may deny the patient’s request to inspect PHI, which the patient has the right to appeal.
(b). Accounting for Disclosures. By completing our request form, each patient is entitled to obtain a list of the disclosures of the patient’s PHI that have occurred within a period of 6 years after April 14, 2003, except those disclosures made for the purposes of treatment, payment or health care operation. 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. There will be no charge for the first request in any 12 month period, but we are entitled to charge a reasonable cost based fee for additional requests made in the same period of time. We will notify you of the cost involved, and you may choose to withdraw or modify your request.
(c). Amendments. Each patient may ask to change the record of his or her own PHI by completing our request form explaining why the change should be made. We will review the request, but may decline to make the change if in our professional judgment we conclude that the record should not be changed.
(d). Communications. By completing our request form, each patient can ask us to communicate with him or her about their own PHI health information in a confidential manner such as by sending mail to an address other than the home address or using a particular telephone number.
(e). Special Restrictions. By completing our request form, each patient can ask us to adopt special restrictions that further limit our use and disclosure of the patient’s PHI (except where use and disclosure are required of us by law or in emergency circumstances). We will consider the request; but in accordance with HIPAA and its Regulations, we are not required to agree to the request.
(f). Complaints. If a patient believes that we have violated the patient’s rights regarding the patient’s PHI under HIPAA and its Regulations, or if a patient disagrees with a decision we made about access, amendment or special restriction to the patient’s PHI, the patient has the right to complete our complaint form and deliver it to our Contact Person listed below. Our Contact Person is required to investigate, and if possible, to resolve each such complaint, and to advise the patient accordingly. The patient also has the right to send a written complaint to the U.S. Department of Health and Human Services. Under no circumstances will any patient be retaliated against by this Pharmacy for filing a complaint.
We are required by law to protect the privacy of our patients’ PHI, to provide this notice about our privacy practices, and follow the privacy practices that are described in this notice. We reserve the right to make changes in our privacy practices and this Notice and to make the new Notice effective for all PHI we maintain. A copy of our current notice will be available on request.
Privacy Officer Contact:
Dean W. Jacobs, R.Ph., CEO
Waltz Pharmacy, Inc.
P O Box 130
Camden, ME 04843
Telephone: 207-230-1053 ext 206 Fax: 207-230-0039
E-mail address: djacobs@waltzpharmacy.com