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Health Insurance Portability and Accountability Act (HIPPA) Compliance
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.
Introduction
All of us at Resident Care Pharmacy value your relationship with us, and we
know that respect for your privacy is the foundation of that relationship.
We are committed to protecting the privacy of your protected health information
(PHI) that is in our possession, and only using and disclosing your PHI as
necessary to providing you with health care products and services. PHI is any
information that we possess, use, and disclose that identifies you and relates
to your past, current, or future physical and mental health condition or illness
and the health care products and services that have been provided to you.
This “Notice
of Privacy Practices” (Notice) has been created to
help you understand our legal duties to protect your PHI
and how we may use and disclose your PHI. We will mainly
use and disclose your PHI in relation to the health care
products and services that we provide you. Specifically,
we will use and disclose your PHI as necessary to provide
treatment to you, obtaining payment for health care products
and services provided to you, and other health care operations
and activities as described later in this Notice. This
Notice also describes the legal rights that you have related
to your PHI that is in our possession. We take the matters
described in this Notice very seriously because of our
relationship with you and the requirement that we comply
with this Notice.
Your
PHI will only be used and disclosed as described in this
Notice. Should a need for use and disclosure of your PHI
occur that is not described in this Notice, we will obtain
your written authorization before the use and disclosure.
At some future time, it may be necessary for us to revise
this Notice. If such becomes necessary, we will post the
revised Notice in the pharmacy and, if you request, provide
a written Notice to you.
Your
Rights With Respect To Your PHI
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides
you with several rights related to your PHI. These rights are summarized below.
If you would like more information about any of these, please contact our Pharmacy
Privacy Officer at the address or telephone number of our pharmacy.
- You
have the right to receive this written Notice of Privacy
Practices describing how we will protect your PHI and
your rights related to PHI. You are entitled to request
this written Notice at any time.
- You
have the right to request a limitation on our use and
disclosure of your PHI. Please be aware that we may not
be able to agree to your requested limitation if it results
in our not being able to provide health care products
and services to you or if we are required to use and
disclose the PHI under federal or state law. All requests
for limitation on the use and disclosure of your PHI
must be submitted to our Pharmacy Privacy Officer in
writing using a form that we will provide to you.
- You
have the right to review or receive photocopies of our
records that contain your PHI, to the extent that these
records are part of a designated record set as defined
by HIPAA. The most common such records are your prescriptions
or CMN’s on file with us, our patient profile for
you, and our billing records for health care products
and services that have been provided to you. You may
review such records at no charge during normal business
hours. However, we may charge you a reasonable, cost-based
fee for photocopies of the records, together with any
expenses for mailing, faxing or shipping. If we are unable
to provide our records to you, we will provide you a
written explanation of why we are not able to provide
the records. Depending on the reason, you may submit
a written request for us to reconsider. All requests
to review or receive photocopies of our records that
contain your PHI must be submitted to our Pharmacy Privacy
Officer in writing using a form that we will provide
to you.
- You
have the right to request changes in the content of your
PHI contained in our records where you believe the content
is incomplete, inaccurate, or for some other reason needs
to be changed. We may not be able to agree to your requested
change if we no longer have the records or if the requested
change would cause your PHI to become inaccurate. If
we are not able to agree to your requested change, we
will notify you in writing as to why we are not able
to agree. You will then have the right to submit to us
a written statement of disagreement, to which we may
elect to further respond in writing to you. (All requests
for changes to your PHI in our records must be submitted
to our Pharmacy Privacy Officer in writing, using a form
that we will provide to you)
- You
have the right to request that we communicate with you
about your PHI in a confidential manner and only to locations
(such as a post office box) or by means (such as personal
cellular telephone) specified by you. All requests for
confidential communications must be submitted to our
Pharmacy Privacy Officer in writing, using a form that
we will provide to you.
- You
have the right to obtain an accounting of some of our
disclosures of your PHI made after April 14, 2003. By
an accounting, we mean a written record of these disclosures.
Some of our disclosures of your PHI are not required
by HIPAA to be included in the accounting. Most notable
among these are disclosures for purposes of treatment,
obtaining payment, and carrying out health care operations.
Other disclosures of your PHI that are not required to
be included in the accounting are disclosures made directly
to you or that you have authorized, made to family, friends,
and others who assist you with your care (caregivers)
and made for other purposes allowed by HIPAA. Please
consult with our Pharmacy Privacy Officer for more information
on the disclosures not required to be included in the
accounting. The period of time for which we are required
to provide the accounting is the six-year period immediately
prior to the date of your request for the accounting
but no earlier then April 14, 2003. We may charge you
a reasonable, cost-based fee for printing or photocopying
of the accounting, together with any expenses for mailing,
faxing or shipping and supplies necessary to fulfilling
your request for the accounting. If it becomes necessary
for us to charge you for an accounting, we will notify
you in advance and allow you to withdraw or modify your
request for the accounting. All requests for an accounting
of our disclosures of your PHI must be submitted to our
Pharmacy Privacy Officer in writing, using a form that
we will provide to you.
- You
have the right to file a complaint if you believe that
we have violated your rights as described above, and
to not fear retaliation or adverse action by us against
you for exercising your right. You can file the complaint
with us directly, or with the United States Department
of Health and Human Services (HHS). Please be assured
that we will work with you to resolve any complaint,
including providing you with the address for filing a
complaint with HHS.
IF YOU
HAVE QUESTIONS ABOUT ANY OF YOUR RIGHTS AS DESCRIBED ABOVE,
PLEASE CONTACT OUR PHARMACY PRIVACY OFFICER AT THE ADDRESS
OR TELEPHONE NUMBER OF OUR PHARMACY.
Ways
That We May Use and Disclose Your PHI
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires
that this Notice tell you how we may use and disclose your PHI. These uses
and disclosures are summarized below, and if you would like more information
about any of these please contact our Pharmacy Privacy Officer at the address
or telephone number of our pharmacy.
- Treatment. HIPAA
defines treatment as “the provision, coordination,
or management of health care and related services by
one or more health care providers, including the coordination
or management of health care by a health care provider
with a third party; consultation between health care
providers relating to a patient; or the referral of a
patient for health care from one health care provider
to another.” We will maintain records that contain
your PHI, and we will use and disclose your PHI as necessary
to provide health care products and services to carry
out and support your treatment. As a pharmacy, we may
use and disclose your PHI as necessary to maintain a
patient profile on you, which may include information
about you; your medical condition, medications, and prescription
devices that you use; any allergies that you may have;
and other information, such as any health insurance that
you may have. We may use and disclose your PHI in dispensing
prescription medicines and related healthcare products
and services, including counseling you and your caregivers
about proper use of your medications and healthcare products.
We may discuss such problems with your other health care
professionals, such as your physician, dentist, therapist
or VNA, and through such discussions we may use and disclose
your PHI. Finally, we may use and disclose your PHI to
you and your caregivers in our discussions with you and
your caregivers about your treatment.
- Payment. HIPAA
defines payment as activities to obtain reimbursement
for the health care products and services that we provide
to you. These activities include primarily billing you
directly or someone who pays for your health care, such
as a family member or health insurance company, for health
care products and services that we provide to you. Activities
related to billing may include claims management, collections,
and related health care data processing. Depending on
who pays for the health care products and services that
we provide you, other activities may include determination
of eligibility or coverage; medical necessity; review
of health care services with respect to medical necessity,
coverage under a health plan, appropriateness of care,
or justification of charges; utilization review activities,
including precertification and preauthorization of services;
concurrent and retrospective review of services; and
disclosure to consumer reporting agencies of some or
all of the following PHI necessary for collection of
payment: name and address; date of birth; social security
number; payment history; account number or numbers; and
name and address of the health care provider and/or health
plan. We will use and disclose your PHI to carry out
the above activities as necessary or required to obtain
payment for the health care products and services that
we provide to you. In relation to this, public and private
health care insurance programs that may provide or pay
for your health care can conduct audits, inspections,
and investigations of us in relation to our activities
and your activities. We may be required to disclose your
PHI to these programs for purposes of audits, inspections,
and investigations.
- Health
care operations. HIPAA defines health care
operations as those activities necessary and related
to our providing of health care products and services
to you. These activities include, but may not be limited
to, the following.
A.Conducting
quality assessment and improvement activities, case management
and care coordination, and contacting of health care
providers and patients with information about treatment
alternatives and related functions that do not include
treatment.
B. Conducting or arranging for medical review, legal services, and auditing
functions, including fraud and abuse detection and compliance programs.
C. Our company management and general administrative activities, including,
but not limited to, activities relating to implementation of and compliance
with the requirements of HIPAA.
We will use and disclose your PHI to carry out the above activities as necessary
or required, and especially to monitor and improve the quality of the health
care products and services that are provided to you by us and other health
care professionals
In addition to treatment, payment, and health care operations as described
above, we may use and disclose your PHI for the following purposes listed
in 4–15.
- Business
associates. The nature of the health care
system is such that we may not be able to provide health
care products and services to you without the involvement
of other businesses or persons. Depending on what these
other businesses or persons do for us, they may become “business
associates” as defined by HIPAA. In many situations,
it will be necessary for us to provide your PHI to
these business associates so that they can carry out
the activities that we need to have performed in order
to provide you health care products and services. One
of our most common business associates is a health
insurance company or a company that processes claims
that we submit for payment for health care products
and services that we provide to you, if you have health
insurance that pays for your prescription medications.
Contracts have or will be submitted to all of our business
associates to whom we provide your PHI so that they
can carry out their activities on our behalf. These
contracts require our business associates to give us
their assurance that they, like us, will protect the
privacy of your PHI.
- Disclosures
of your PHI not involving treatment, payment, and health
care operations. In providing health care
products and services to you, we may find it necessary
to communicate with businesses and individuals not
already described above. Most of these disclosures
will be related to providing treatment to you, and
to carrying out payment and health care operations
as discussed above. In addition to communicating with
these businesses and individuals, we may also communicate
with you directly, as well as others who assist you
with your health care, commonly referred to as caregivers.
We will disclose your PHI to these caregivers, or appropriate
others, as we believe necessary and appropriate for
your health care.
- Communications
with you concerning your health and treatment. We
want to do everything we can to assist you with maintaining
your health and obtaining the most benefit from your
treatment. We routinely monitor your prescription medications
for appropriateness and take other steps to help you
use your medication properly. For example, if our records
show that a refill of your medication or healthcare
products is due, we may contact you to remind you to
obtain the refill. We may also call you or send you
materials regarding products and services that we believe
may be of benefit to you. As a final example, in the
event of a medication or healthcare product recall,
we may contact you, if you are taking the medication
or using the healthcare product subject to the recall.
- We
may disclose your PHI to federal and state government
agencies for a variety of purposes, most of which are
directed at monitoring health care quality and safety,
and government programs related to health care and our
compliance with laws applicable to health care. For example,
the United States Drug Enforcement Administration (DEA)
monitors the distribution and usage of controlled substances,
while the United States Food and Drug Administration
(FDA) monitor adverse drug events. We may disclose your
PHI to such agencies where required by the agency so
that the agency can carry out its required activities.
Related to this, some private businesses, such as the
manufacturers of medications and medical devices, are
legally required to conduct post-marketing surveillance
in order to ensure the safety of their products. Disclosing
your PHI for such surveillance may be necessary.
- Federal
and state government health care insurance programs.
If you apply for and receive benefits from federal
and state health care programs, such as Medicare or
Medicaid, your PHI may be disclosed to the agency granting
these benefits. If you are employed by a business that
is required to carry workers’ compensation insurance,
and you are injured in such a way that the workers’ compensation
plan covers your health care, it may be necessary to
disclose your PHI to the workers’ compensation
plan. Such plans have a right to conduct audits, inspections,
and investigations of our activities and your activities,
and where required, we will disclose your PHI for these
activities.
- Matters
of public health and safety. There are a number
of federal and state laws that require health care
providers to report to various government agencies
matters related to public health. If your physical
or mental health condition and illness is of a nature
that federal or state law requires that it be reported,
then we will disclose your PHI to the appropriate government
agency in order to comply with these laws. In addition
to reporting about physical and mental health conditions
and illnesses, we may also disclose your PHI to government
agencies in other situations where we are required
to submit reports, such as suspected domestic, child
or elder abuse, or neglect.
- Law
enforcement activities. A number of federal,
state, and local government agencies are charged with
enforcing the health care and drug laws, and other
laws in relation to the health care products and services
that we may provide to you. As a state licensed pharmacy,
a variety of federal, state, and local health care
agencies, such as the state board of pharmacy, regulates
our activities. These agencies may engage in a number
of activities designed to monitor and improve federal
and state health care programs and systems, including
conducting of inspections and investigations of our
activities and the health care products and services
that we provide to our patients. At any time we are
required by federal or state laws, or by court order,
subpoena or other legal mandate, to disclose your PHI,
we will do so as necessary.
- Legal
disputes. Lawsuits and other legal disputes
may involve your PHI that we possess. In the event
that you are involved in a lawsuit or other legal proceeding,
whether as a plaintiff or a defendant, and without
regard to the basis for the lawsuit, such as medical
malpractice or divorce, we will disclose your PHI when
required to comply with a court order, subpoena, discovery
proceeding, such as a deposition, or other legal mandate
served upon us.
- Disclosures
for the benefit of you and others. A variety
of events could occur where we would use and disclose
your PHI for your benefit and to prevent or reduce
the risk of harm to you. For example, if you are in
a car accident and are unconscious in a hospital emergency
room and the emergency room medical staff calls us
with a request for your PHI, we may disclose it for
the purpose of assisting in your prompt medical treatment.
Finally, we may disclose your PHI where necessary to
protect the health and safety of others.
- Disclosures
for national security and intelligence. We
are legally required to disclose your PHI where necessary
to national security activities and intelligence and
counterintelligence activities. Disclosures related
to this may also include those where required in relation
to the protection of the President of the United States.
Any disclosure for these purposes would be made only
to authorized government officials.
- Disclosures
if you are in the military or a veteran. We
may disclose your PHI, if you are a member of any branch
of the armed services, whether on active or reserve
status as required by the U.S. Military. If you are
a veteran, we may release your PHI, particularly if
you are receiving health care products and services
from the Veterans Services. Any disclosure for these
purposes would be made only to authorized government
officials.
- Disclosures
of a miscellaneous nature. This last category
of disclosures includes a variety of disclosures that
we may make in accordance with HIPAA. We may be required
to disclose your PHI if you are placed into the custody
of a federal or state correctional system, if necessary
to protect the health and safety of you and others.
Health care is an area where much research is being
conducted, and we may disclose your PHI for purposes
of a research project. Finally, given the national
need for organ donations, we may disclose your PHI
to organizations that manage organ transplantation
programs.
IF YOU
HAVE QUESTIONS ABOUT WAYS THAT WE MAY USE AND DISCLOSE
YOUR PHI AS DESCRIBED ABOVE, PLEASE CONTACT OUR PHARMACY
PRIVACY OFFICER AT THE PHARMACY ADDRESS OR TELEPHONE NUMBER.
Uses
and Disclosures Not Contained in this Notice
If a use and disclosure of your PHI is not contained in this Notice, then we
will obtain your written authorization before the use and disclosure. You may
have the right to refuse to authorize the use and disclosure, or if you grant
the authorization, to revoke the authorization at any time. If such authorization
is requested, we will provide you with a form that describes the proposed use
and disclosure and your rights related to the requested authorization.
Conclusion
HIPAA requires that we give you this “Notice of Privacy Practices” and
make a good faith effort to obtain your written acknowledgement that you were
given this Notice. Upon giving you this Notice, you will be asked to sign a
document acknowledging that you received this Notice. We appreciate your cooperation
in reviewing this Notice and in giving us your written acknowledgement.
Please
consult our Pharmacy Privacy Officer if you have any questions
or want more information concerning your health care and
privacy rights under HIPAA or the laws of our state, or
our privacy practices. Also, you should consult our Pharmacy
Privacy Officer if you wish to file a complaint about our
privacy practices or if you believe we have violated any
of your rights as described in this Notice.
Again,
thank you for allowing us the privilege of being your pharmacy,
and we look forward to continuing to be of service to you.
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