| NOTICE OF PRIVACY PRACTICES FOR
PROTECTED HEALTH INFORMATION
Effective Date: February 5, 2007
Medilink RxCare — 709 Haddonfield-Berlin Rd. Voorhees,
NJ 08043
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED 4t~D ROW 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 under Section 164.520 to give our
patients this notice (in paper or electronically as the patient
wishes) of our legal duties and privacy practices concerning their
Protected Health Information, and also to tell our patients about
their rights under HIPAA and the Regulations.
1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
There are two categories for the use and disclosure of our
patients Protected Health Information: (1) information that
we can use and disclose without the patients 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’ Protected Health Information
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 patients health care to
pick up the patient’s prescriptions and to receive Protected
Health Information that is directly related to 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
f the patient has suffered a health emergency.
(2). Payment. If a patient is covered by a pharmacy benefit plan,
we are entitled to send Protected Health Care Information 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 provide Protected
Health Information for health care operations such as evaluations
of the quality of our patients’ health care in order to
improve the success of treatment programs. Other examples include
reviews of health care professionals, insurance premium rating,
legal and auditing functions, and business planning and management.
(4). Other Permitted Uses and Disclosures. There are a number
of other specified purposes for which we may disclose a patient’s
Protected Health Information 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; in the event of death; where organ
donations are involved; in support of 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, or about alternative
therapies.
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 disposing any of their Protected Health Information 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 and by doing so, stop any future uses
and disclosures of the patient’s health information that
the authorization covered. An example of a situation where the
patient’s prior authorization would be required would be
if we wish to conduct a marketing program that would involve the
use of Protected Health Information.
2. PATIENTS’ RIGHTS
HIPAA and the Regulations provide our patients with rights concerning
their Protected Health Information. With limited exceptions (which
are subject to review), each patient has the right to the following:
(a). Patients Record. Each patient can obtain a copy of his or
her Protected Health Information by completing our request torn.
The only charge will be based on our cost in responding to the
request. The amount of the charge will vary depending on the format
the patient requests and whether the patient wants the record
or a summary, and whether it is to be delivered by mail or otherwise
the patient will be told of the fee when the patient’s request
is received.
(b). Accounting for Disclosures. By completing our request form,
each patient is entitled to obtain a list of the disclosures of
the patients Protected Health Information that have occurred within
a period of 6 years after April 14, 2003, except for disclosures
made for the purposes of treatment, payment or health care operations,
and certain others. 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 lime.
(c). Amendments. Each patient may ask to change the record of
his or her own Protected health Information 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 Protected
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 Protected
Health Information (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 the Regulations,
we are not required to agree to with the request.
(f). Complaints. If a patient believes that we have violated
the patient’s rights as to the patient’s Protected
Health Information under HIPAA and the Regulations, or if a patient
disagrees with a decision we made about access to the patient’s
Protected Health Information, 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 at the addresses
shown on the complaint form. Under no circumstances will any patient
be retaliated against by this Pharmacy for fling a complaint.
We are required by law 10 protect the privacy of our patients’ Protected
Health information, 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
that will apply to all the Protected Health Information we maintain.
A new notice will be available on request before any significant
change is made.
Our Contact Person’s Name Gus Tzaferos, Owner/Pharmacist
Telephone: 856-566-4300 Fax: 856-566-4301
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