DATE
OF NOTICE: April 14, 2003
SECTION A: Uses and
Disclosures of Protected Health Information
1.
Under applicable law, we are required to protect
the privacy of your individual health information (information we refer to in
this notice as “Protected Health Information”). We are also required to
provide you with this Notice regarding our policies and procedures regarding
your Protected Health Information and to abide by the terms of this notice, as
it may be updated from time to time.
We are permitted to make certain types of uses and disclosures under applicable
law for treatment, payment, and healthcare operations purposes. We may obtain
information to dispense prescriptions and for the documentation of pertinent
information in your records that may assist us in managing your medication
therapy or your overall health. For treatment purposes, such use and disclosure
will take place in providing, coordinating, or managing healthcare and its
related services by one or more of your providers, such as when your pharmacist
consults with your physician or a specialist regarding your medications,
treatment or condition.
For payment purposes, such use and disclosure will take place to obtain or
provide reimbursement for providing pharmaceutical care services, such as when
your case is reviewed to ensure that appropriate care was rendered. For
reimbursement purposes, your Protected Health Information may be disclosed to
one or several intermediaries employed by your plan sponsor including but not
limited to insurers, pharmacy benefits managers, claims administrators and
computer switching companies.
For healthcare operations purposes, such use and disclosure will take place in a
number of ways, including for quality assessment and improvement; provider
review and training; underwriting activities; reviews and compliance activities;
and planning, development, management and administration. Your information could
be used, for example, to assist in the evaluation of the quality of care that
you were provided.
We store
some of your Protected Health Information in electronic computer files. We
backup our electronic records daily and keep a weekly backup off site, and
employ other precautions to safeguard the integrity of your Protected Health
Information. In spite of these precautions it is possible but unlikely that a
computer crash or other technological failure could cause the loss of data. In
addition reasonable safeguards are employed to protect your Protected Health
Information stored on electronic media.
In addition, we
may contact you to provide refill reminders, health screenings, wellness events,
inoculations, vaccinations or information about treatment alternatives or other
health-related benefits and services that may be of interest to you. In
addition, we may disclose your health information to your plan sponsor. In
addition we may contact you for the purpose of fund raising activities.
We may use and
disclose your Protected Health Information, without your authorization when the
pharmacy needs to contact a physician or physician’s staff and is permitted or
required to do so without individual written authorization. We may use and
disclose your Protected Health Information if we are contacted by another
pharmacy who states they have your request and consent to transfer pharmacy
records to them.
From time to time
we may employ the services of business associates who may assist us in one or
more tasks and who may use, change or create Protected Health Information.
Business associates are required to comply with all the privacy regulations on
your behalf.
We may disclose
Protected Health Information about you without your authorization to comply with
workers compensation laws, as required by law enforcement, legal proceedings,
public health requirements, health oversight activities and as required by law.
Other uses and
disclosures will be made only with your written authorization, and you may
revoke your authorization by notifying us as described in Section B.
2.
You may ask us to restrict uses and disclosures of your Protected Health
Information to carry out treatment, payment, or healthcare operations, or to
restrict uses and disclosures to family members, relatives, friends, or other
persons identified by you who are involved in your care or payment for your
care. However, we are not required to agree to your request.
3.
You have the right to request the following with respect to your
Protected Health Information: (i) inspection and copying; (ii) amendment or
correction; (iii) an accounting of the disclosures of this information by us (we
are not required to account to you for disclosures made for treatment, payment,
operations, disclosures to you, disclosures to your care givers, for
notifications or as otherwise excluded by law); and (iv) the right to receive a
paper copy of this notice upon request. We may require you to pay for this
request to cover our costs of copying, labor and postage.
In addition, you may request, and we must accommodate the request, if
reasonable, to receive communications of Protected Health Information by
alternative means or at alternative locations. To make this request please
contact, in writing:
812/636-4600
4.
We may use your name to
reference your prescriptions and pharmaceutical care services. You may be
required to sign a signature log form to acknowledge receipt of service, to
acknowledge receipt of this Notice and the disclosure of Protected Health
Information as outlined herein. This information may be disclosed by us to other
persons who ask for you or your prescriptions by name. You may restrict or
prohibit these uses and disclosures by notifying a pharmacy representative
orally or in writing of your restriction or prohibition. We are not required to
honor those requests. We are able to provide treatment services to you even if
you object to sign the acknowledgment of the receipt of this Notice or if we
decide not to honor a request regarding the information in this document. In the
event of an emergency or your incapacity, we will do in our reasonable judgment
what is consistent with your known preference, and what we determine to be in
your best interest. We will inform you of any such uses or disclosures if uses
and disclosures would require your signed authorization under such circumstances
and give you an opportunity to object as soon as practicable.
5. We may
disclose to one of your family members, to a relative, to a close personal
friend, or to any other person identified by you, Protected Health Information
that is directly relevant to the person’s involvement with your care or
payment related to your care. In addition we may use or disclose the Protected
Health Information to notify, identify, or locate a member of your family, your
personal representative, another person responsible for care, or certain
disaster relief agencies of your location, general condition, or death. If you
are incapacitated, there is an emergency, or you object to this use or
disclosure, we will do in our judgment what is in your best interest regarding
such disclosure and will disclose only the information that is directly relevant
to the person’s involvement with your healthcare. We will also use our
judgment and experience regarding your best interest in allowing people to
pick-up filled prescriptions, or other similar forms of Protected Health
Information.
6.
We reserve the right to
change the terms of this Notice and to make new Notice provisions effective for
all Protected Health Information we maintain. You may receive a copy of this
Notice by contacting us as outlined in Section B or upon the receipt of pharmacy
care services.
7.
If you believe that your
privacy rights have been violated, you may complain to us at the location
described in Section B or to the Secretary of the Department of Health and Human
Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington,
DC 20201. You will not be retaliated against for filing a complaint.
You
may contact us for further information at:
812/636-4600 fax
812/636-8004
e-mail odonrx@rtccom.net