Notice
of Health Information Practices
Healthway Pharmacy
Effective Date: April 14, 2003
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.
u
Understanding Your Health Record/ Information
Each
time you visit our Pharmacy and purchase a product, or one of your
physicians contacts us concerning your prescription needs or
history, a record is made of this encounter. Typically, this
record contains medical information from your referring physician,
a prescription history, as well as other information you provide
to us. In this
“Notice of Health Information Practices,” we shall refer to
the information contained in your record as your “health
information,” which term shall have the same meaning as
“protected health information,” defined in the Health
Insurance Portability and Accountability Act of 1996, as amended
(“HIPAA”).
u Your
Health Information Rights
Within
the limits provided by federal and state law, you have the right
to:
·
Request
restrictions on certain uses and disclosures of your health
information;
·
Receive
confidential communications of your health information. You may
request that we communicate with you about your health information
by alternative means or at an alternative location;
·
Inspect
and obtain a copy of your health information, except with regard
to psychotherapy notes or information compiled in reasonable
anticipation of certain civil, criminal or administrative
proceedings;
·
Request
an amendment to your health information that we have created,
except with regard to those portions of your health information
that you are precluded from inspecting and copying as set forth
above;
·
Obtain
an accounting of certain disclosures of your health information;
and
·
Receive
a paper copy of this Notice in addition to any electronic copy you
may receive.
You may
exercise any of the above rights by submitting a written signed
letter, detailing your request and mailing or delivering the
letter to our Pharmacy. However,
we encourage you to call first so that we can help you be as
specific as possible with your request.
We will promptly provide you with any forms that need to be
completed to process your request.
u Our
Responsibilities
This
Pharmacy is required by law to:
·
Maintain
the privacy of your health information;
·
Provide
you with this Notice of our legal duties and privacy practices
with respect to health information we collect and maintain about
you;
·
Abide
by the terms of this Notice, currently in effect, and as amended
from time to time;
·
Notify
you if we are unable to honor your request to restrict a use or
disclosure of, or to amend, your health information; and
·
Accommodate
reasonable requests you may have to communicate your health
information by alternative means or at alternative locations.
We
reserve the right to change our privacy practices and to make the
new provisions effective for all of your health information we
already have, as well as any health information we receive or
create in the future. Should our privacy practices change, we will
post a copy of the revised Notice in our Pharmacy, which indicates
the effective date of the amended Notice. You may request and
obtain a copy of our Notice of Privacy Practices anytime you visit
our office. If a use or disclosure of your health information is
not permitted under law without a written authorization, we will
not use or disclose your health information without that written
authorization. You
may at any time revoke a written authorization in writing, except
to the extent that we have already taken action in reliance of
your authorization.
u For
More Information or to Report a Problem
If
you have questions and would like additional information
concerning this Notice, please call any of our Pharmacists at
989/865-9971.
If
you believe that we have violated any of your privacy rights, you
may file a written complaint with any of our Pharmacists, or mail
your written complaint to 1008 N. Saginaw St. St. Charles,
MI 48655. You
may also file your complaint with the Secretary of Health and
Human Services. There will be no penalty or retaliation for filing
a complaint.
u Examples
of Uses and Disclosures for Treatment, Payment and Health
Operations
The
following are examples of uses and disclosures of your health
information which are permitted by law:
We
will use your health information for treatment. Health
information obtained by our staff from you or one of your health
care providers, may be recorded in our medical records.
We may use this information for many treatment reasons,
including, but not limited to, verifying the accuracy of
prescriptions being filled, and to help you avoid known drug
allergies and adverse drug interactions.
Any of your prescriptions filled in our Pharmacy, or
purchases made at our Pharmacy, will be recorded. We may also
provide your health information to other health care providers
involved in your care to assist them on providing services to you.
We
will use your health information for payment. Your
health plan or health insurer may require certain information
about your condition and/or the prescriptions you fill with us,
before payment will be made, or for pre-authorization purposes.
Accordingly, for billing purposes, we may disclose your
health information to your health plan or health insurer.
We
will use your health information for regular health care
operations. Members of our staff may review health information in
your record in order to assess the care and outcomes in your case
and others like it. This information will then be used in an
effort to continually improve the quality and effectiveness of our
services.
u Additional
Uses and Disclosures
Business
Associates:
Certain of our business operations may be performed by other
businesses. We refer
to these companies as “business associates.” In order for
these business associates to perform the required service
(billing, accounting services, etc.), we may need to disclose your
health information to them so that they can perform the job
we’ve asked them to do. To protect you, we require our business
associates to appropriately safeguard your health information.
Communication
with Persons Involved in Your Care: We may disclose your health information that is
directly relevant to your care to individuals you wish to receive
such information, including family members, relatives, close
personal friends, or other persons you identify.
Before we do so, we will ask you, and follow your
instructions, as to whether or not to make such disclosures.
If you are incapacitated, or involved in an emergency, we
may use or make disclosures of your health information that we
believe in our professional judgment are in your best interests,
but only to the extent that such health information is directly
relevant to the recipients’ involvement in your care.
Required
by Law:
We may use or disclose your health information to the
extent such use or disclosure is required by law and is limited to
the relevant requirements of such law.
Public
Health, Health Oversight and the Food and Drug Administration
(FDA):
As required by law, we may disclose your health information to
public health or legal authorities charged with preventing or
controlling disease, injury, or disability.
We may also be required by law to disclose your health
information to health oversight agencies responsible for
regulating the health care system, government benefit programs,
and civil rights laws so that they may conduct, among other
things, audits, investigations, and inspections.
For the purpose of activities relating to the quality,
safety or effectiveness of a FDA-regulated product or activity, we
may disclose to the FDA your health information relating to
adverse events with drugs, supplements, and other products, as
well as information needed to enable product recalls, repairs, or
replacements.
Victims
of Abuse, Neglect or Domestic Violence: If we
reasonably believe that you are the victim of abuse, neglect or
domestic violence, we may disclose your health information to a
governmental authority responsible for receiving these types of
reports, to the extent the disclosure is required by law, or you
agree to the disclosure. If
the disclosure is authorized by law, but not required, we may
disclose your information if we determine that disclosure is
necessary to prevent serious harm to you or others.
Judicial
and Administrative Proceedings: If you
are involved in a judicial or administrative proceeding, we may,
in response to an order of a court or administrative tribunal, or
in response to a subpoena, discovery request, or other lawful
process, disclose the specific portions of your health information
that are requested. If
the subpoena, discovery request or other lawful process is not
accompanied by a court or administrative tribunal order, we may
disclose your health information only after we are assured that
reasonable efforts have been made to notify you of the request,
and the time for you to raise objections to the request has
expired, or reasonable efforts have been made by the requestor to
seek a protective order concerning the requested health
information.
Law
Enforcement:
We may disclose your health information to a law enforcement
official for law enforcement purposes as required by law, a court
ordered subpoena or summons, a grand jury subpoena or summons, or
an administrative subpoena or summons, under certain
circumstances.
In
specific situations, the law also permits us to disclose limited
pieces of your health information, when the information is needed
by law enforcement officials to: 1) identify a suspect, fugitive,
material witness, or missing person; 2) identify a victim of a
crime; 3) alert law enforcement officials concerning your
death; 4) notify law enforcement officials when a crime has been
committed on our premises; or 5) in an emergency, when necessary
to alert law enforcement officials about a crime, its location, or
the identity of a perpetrator.
Coroners,
Medical Examiners and Funeral Directors: We may disclose your health information to a
coroner or medical examiner for the purpose of identifying you
upon your passing, or to determine a cause of death.
We may also disclose your health information to your
funeral director if needed to complete his or her authorized
duties.
Organ,
Eye or Tissue Donation: If you are an organ, eye
or tissue donor, we may release your health information to
organizations that procure, bank or transplant organs for the
purpose of facilitating organ, eye or tissue donation and
transplantation.
Research:
We may disclose your health information to researchers when their
research has been approved by an institutional review board or
privacy board that has reviewed the research proposal and
established protocols to ensure the privacy of your health
information, thereby meeting the requirements under HIPAA.
We may also disclose your health information for the
purposes of research, public health or health care operations
pursuant to a Data Use Agreement protecting that information as
specified by HIPAA.
Avert
a Serious Threat to Health or Safety: Consistent
with applicable law and standards of ethical conduct, we may, in
limited circumstances, use or disclose your health information if
we, in good faith, believe such use or disclosure is necessary to
prevent or lessen a serious and imminent threat to health or
safety of a person or the public.
Military
Personnel:
If you are a member of the United States Armed Services, we
may disclose your health information to the appropriate military
command authority when such information is deemed necessary to
assure the proper execution of the military mission.
[Note – Additional disclosures are required if you are
a part of the Departments of Defense, Transportation, Veterans
Affairs, or State.]
National
Security and Presidential Protective Services:
We may disclose your health information to authorized federal
officials for the conduct of lawful intelligence and national
security activities, as well as the provision of protective
services to the President and other protected individuals.
Inmates
and Individuals in Custody: If you are an inmate or otherwise in custody, we may disclose your
health information to the correctional facility or law enforcement
official having lawful custody of you.
Workers’
Compensation: We may disclose your health information to the extent authorized and
necessary to comply with laws relating to workers’ compensation
or other similar programs established by law.
Appointment
Reminders and Information on Treatment Alternatives:
We may contact you to provide appointment reminders or information
about prescription alternatives or other health-related benefits,
alternatives and services that may be of interest to you.
Fund
Raising:
We may conduct fund raising for our office unless you
instruct us otherwise, we may use your contact and demographic
information, as well as dates of service, for this purpose.
u Our
Pledge
We will endeavor to protect the privacy of your
health information. If
you have any questions, comments, or concerns regarding the
policies set forth above, please do not hesitate to discuss such
matters with one of our Pharmacists.
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