NOTICE OF PRIVACY PRACTICES
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.
Drug Mart (“The Pharmacy”) will ask you to sign an acknowledgment that
you have received this notice of privacy practices (“notice”).
This Notice describes, in accordance with the HIPAA Privacy Regulation,
how Drug mart may use and disclose your protected health information
(“PHI”) to carry out treatment, payment or health care operations and
for other specified purposes that are permitted or required by law. The
Notice also describes your rights and Drug mart’s legal duties with
respect to PHI about you.
Drug Mart is required to maintain the privacy of your PHI. PHI is
information about you, including basic demographic information, that may
identify you and that relates to your past, present or future physical
or mental health or condition and related health care services. Drug
Mart is required to follow the terms of this Notice. We will not use or
disclose PHI about you without your written authorization, except as
described in this Notice. We reserve the right to change our practices
and this Notice and to make the new Notice effective for all PHI we
maintain. Upon request, we will provide a revised Notice to you.
We May Use and Disclose PHI for Treatment, Payment, and Health care
Operation
The following categories describe and provide examples of different ways
that we use and disclose PHI about you.
We will use PHI for treatment.
Example: Information obtained by the pharmacist will be used to dispense
prescription medications to you. We will document in your record
information related to the medications dispensed to you and services
provided to you.
We will use PHI for payment.
Example: We will contact your insurer or pharmacy benefit manager to
determine whether it will pay for your prescription and the amount of
your co-payment responsibility. We will bill you or a third-party payor
for the cost of prescription medications dispensed to you. The
information on or accompanying the bill may include information that
identifies you, as well as the prescriptions you are taking.
We will use PHI for health care operations.
Example: We may use information in your health record to monitor the
performance of the pharmacists providing treatment to you. This
information will be used in an effort to continually improve the quality
and effectiveness of the health care and service we provide.
We are likely to use or disclose PHI
for the following purposes:
Business associates:
There are some services provided by us through contracts with business
associates. Examples include the analysis of prescription costs and
their trends for groups and sub-groups of patient populations. When
these services are contracted for, we may disclose PHI about you to our
business associate so that they can perform the job we have asked them
to do and bill you or your third-party payor for services rendered. To
protect PHI about you, we require the business associate to
appropriately safeguard the PHI.
Communication with individuals involved in your care or payment for your
care
Health professionals such as pharmacists, using their professional
judgment, may disclose to a family member, other relative, close
personal friend or any person you identify, PHI relevant to that
person’s involvement in your care or payment related to your care.
Personal communications: We may contact you to provide refill
reminders or information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
Food and Drug Administration (FDA):
We may disclose to the FDA or its agents PHI relative to adverse events
with respect to drugs, foods, supplements, products and product defects,
or post marketing surveillance information to enable product recalls,
repairs, or replacement.
Worker’s compensation:
We may disclose PHI about you to the extent authorized by and to the
extent necessary to comply with laws relating to worker’s compensation
or other similar programs established by law.
Public health:
As required by law, we may disclose PHI about you to public health or
legal authorities charged with preventing or controlling disease,
injury, or disability.
Law enforcement:
We may disclose PHI about you for law enforcement purposes as required
by law or in response to a valid subpoena.
As required by law:
We must disclose PHI about you when required to do so by law.
Health oversight activities:
We may disclose PHI about you to an oversight agency for activities
authorized by law. These oversight activities include audits,
investigations, and inspections, as necessary for our licensure and for
the government to monitor the health care system, government programs,
and compliance with civil rights laws.
Judicial and administrative proceedings:
If you are involved in a lawsuit or a dispute, we may disclose PHI about
you in response to a court or administrative order. We may also disclose
PHI about you in response to a subpoena, discovery request, or other
lawful process by someone else involved in the dispute, but only if
efforts have been made to tell you about the request or to obtain an
order protecting the requested PHI.
We are permitted to use or disclose
PHI about you for the following
purposes:
Research:
We may disclose PHI about you to researchers when their research has
been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of
your information.
Coroners, medical examiners, and funeral directors:
We may release PHI about you to a coroner or medical examiner. This may
be necessary, for example, to identify a deceased person or determine
the cause of death. We may also disclose PHI to funeral directors
consistent with applicable law to carry out their duties.
Organ or tissue procurement organizations:
Consistent with applicable law, we may disclose PHI about you to organ
procurement organizations or other entities engaged in the procurement,
banking, or transplantation of organs for the purpose of tissue donation
and transplant.
Fundraising:
We may contact you as part of a fundraising effort.
Notification:
We may use or disclose PHI about you to notify or assist in notifying a
family member, personal representative, or another person responsible
for your care, your location, and general condition.
Correctional institution:
If you are or become an inmate of a correctional institution, we may
disclose to the institution or its agents PHI necessary for your health
and the health and safety of others.
To avert a serious threat to health or safety:
We may use and disclose PHI about you when necessary to prevent a
serious threat to your health and safety or the health and safety of the
public or another person.
Military and veterans:
If you are a member of the armed forces, we may release PHI about you as
required by military command authorities. We may also release PHI about
foreign military personnel to the appropriate military authority.
National security and intelligence activities:
We may release PHI about you to authorized federal officials for
intelligence, counterintelligence, and other national security
activities authorized by law.
Protective services for the President and others:
We may disclose PHI about you to authorized federal official so they may
provide protection to the President, other authorized persons or foreign
heads of state or conduct special investigations.
Victims of abuse, neglect, or domestic violence:
We may disclose PHI about you to a government authority, such as a
social service or protective services agency, if we reasonably believe
you are a victim of abuse, neglect, or domestic violence. We will only
disclose this type of information to the extent required by law, if you
agree to the disclosure, or if the disclosure is allowed by law and we
believe it is necessary to prevent serious harm to you or someone else
or the law enforcement or public official that is to receive the report
represents that it is necessary and will not be used against you.
Other Uses and Disclosures of PHI
We will obtain your written authorization before using or disclosing PHI
about you for purposes other than those listed above or otherwise
permitted or required by law. You may revoke this authorization in
writing at any time. Upon receipt of the written revocation, we will
stop using or disclosing PHI about you, except to the extent that we
have already taken action in reliance on the authorization.
THE PATIENT’S RIGHTS
You have the following rights with respect to PHI about you:
Obtain a paper copy of the Notice upon request.
You may request a copy of the
Notice at any time. Even if you have agreed to receive the Notice
electronically, you are still entitled to a paper copy. To obtain a
paper copy, contact the Privacy Officer at Drug Mart, 5203-A Broadway,
Request a restriction on certain uses and disclosures of PHI.
You have the right to request additional restrictions on our use or
disclosure of PHI about you by sending a written request to the Privacy
Officer at 5203-A Broadway,
Inspect and obtain a copy of PHI.
You have the right to access and copy PHI about you contained in a
designated record set for as long as DRUG MART maintains the PHI. The
“designated record set” usually will include prescription and billing
records. To inspect or copy PHI about you, you must send a written
request to the Privacy Officer at 5203-A Broadway,
Request an amendment of PHI.
If you feel that PHI we maintain about you is incomplete or incorrect,
you may request that we amend it. You may request an amendment for as
long as we maintain the PHI. To request an amendment, you must send a
written request to the Privacy Officer at 5203-A Broadway,
Receive an accounting of disclosures of PHI.
You have the right to receive an accounting of the disclosures we have
made of PHI about you after April 14, 2003 for most purposes other than
treatment, payment, or health care operations. The accounting will
exclude disclosures we have 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. To request an accounting, you must submit your request in
writing to Drug Mart Privacy Officer at 5203-A Broadway,
Request communications of PHI by alternative means or at alternative
locations.
For instance, you may request that we contact you about medical matters
only in writing or at a different residence or post office box. To
request confidential communication of PHI about you, you must submit
your request in writing to the Privacy Officer at 5203-A Broadway,
Revoke your consent to use or disclose PHI.
You may revoke consent in writing at any time. Upon receipt of the
written revocation, we will stop using or disclosing PHI about you,
except to the extent that we have already taken action in reliance on
the consent. We may refuse to continue to treat a customer that revokes
his or her consent.
For More Information or to Report a Problem
If you have questions or would like additional information about our
privacy practices, you may contact Drug Mart
privacy officer in writing at 5203-A Broadway,
State Law Addendum
Effective Date
This Notice is effective as of
April 14, 2003.