Premier Pharmacy Labs, Inc.
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.
Premier Pharmacy Labs, Inc. is required by law to maintain
the privacy of Protected Health Information (“PHI”)
and to provide you with notice of our legal duties and privacy
practices with respect to PHI. PHI is 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. This Notice of Privacy Practices (“Notice”)
describes how we may use and disclose 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 with respect to your PHI. We are
required to provide this notice to you by the Health Insurance
Portability and Accountability Act (“HIPAA”).
Premier Pharmacy Labs, Inc. is required to follow the terms
of the Notice. We will not use or disclose your PHI without
your written authorization, except as described or otherwise
permitted by the 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 any
revised Notice to you.
YOUR HEALTH INFORMATION 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 agreed to receive
the Notice electronically, you are still entitled to a paper
copy. You may obtain a paper copy from the pharmacy by contacting
our Privacy Office to request that a Notice be mailed to you.
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 the Pharmacy maintains the PHI. The designated
record set will include prescription, delivery tickets, and
billing records. To inspect or obtain a copy of PHI about
you, you must send a written request to our Privacy Office.
We may charge you a fee for the costs of copying, mailing
and supplies that are necessary to fulfill your request. We
may deny your request to inspect and copy in certain limited
circumstances.
Request communications of PHI by alternative means or at
alternative locations. You have the right to request to receive
communications of PHI from the Pharmacy by alternative means
or at an alternative location. To request confidential communication
of PHI about you, you must submit a request in to the Privacy
Office. Your request must tell us how or where you would like
to be contacted. We will accommodate all reasonable requests.
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. To request an amendment, you must send a written
request to the Privacy Office. You must include a reason that
supports your request. In certain cases, we may deny your
request for amendment.
Request an accounting of disclosures of PHI. You have the
right to receive an accounting of disclosures we have made
of your PHI about you after April 14, 2003 for most purposed
other than treatment, payment, or health care operations.
The right to receive an accounting is subject to certain other
exceptions, restrictions, and limitations. To request an accounting,
you must submit a request in writing to our Privacy Office.
Your request must specify the time period for which you wish
to obtain an accounting, which may not exceed six years.
Request a restriction on certain use 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 our Privacy Office. We are not required to agree to those
restrictions.
EXAMPLES OF HOW WE MAY USE AND DISCLOSE PHI
The following categories describe different ways that we
use and disclose your protected health information. We have
provided you with examples in certain categories; however,
not every use or disclosure in a category will be listed.
Treatment. We may use your health information to provide
and coordinate the treatment, medications and services you
receive. For example, information obtained by the pharmacist
will be used to dispense prescription medications to you,
and may be used to monitor the effectiveness, safety, and
compliance of your drug therapy. In addition, we may contact
you to provide refill reminders, information about medication
management services that we offer, educational information
about current or new therapeutic products; and/or other health-related
benefits and services that may be of interest to you.
Payment. The pharmacy and its billing office may use your
health information for various payment-related functions.
Example: We may contact your insure, pharmacy benefit manager
or other health care payor to determine whether it will pay
for your medication and the amount of your co-payment. We
will bill you or a third-party payor for the cost of medications
dispensed to you. The information on or accompanying the bill
may include information that identifies you, as well as the
medications you are taking.
Health Care Operations. We my use your health information
for certain operational, administrative, and quality assurance
activities. Example: We may use information in your health
record to monitor drug usage and inventory levels.
We are permitted to use or disclose your PHI for the following
purposes. However, Premier Pharmacy Labs, Inc. may never have
reason to make some of these disclosures.
Food and Drug Administration (FDA) We may disclose to the
FDA, or persons under the jurisdiction of the FDA, 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.
Business Associates: We contract with business associates
to perform certain services or functions to or on behalf of
the Pharmacy. For example, we may contract with a business
associate to perform billing services for us. We may disclose
PHI about you to our business associates so that they can
perform the job we have asked them to do. To protect PHI about
you, we require our business associates to appropriately safeguard
the PHI.
Communication with individuals involved in your care or payment
for your care. We may disclose to a family member, other relative,
close personal friend or any other person you identify PHI
directly relevant to that person’s involvement in your
care or payment related to your care.
Workers’ Compensation: We may disclose PHI about you
as authorized by and as necessary to comply with laws relating
to workers’ compensation or 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
or other legal process.
As Required by Law: We will disclose your PHI when required
to do so by federal, state, or local law.
Health Oversight Activities: We may disclose our PHI to an
oversight agency for activities authorized by law. These oversight
activities include audits, investigations, inspections, and
credentialing, as necessary for 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 a 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.
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, of your location
and your general condition.
Correctional Institution: If you are or become an inmate
of a correctional institution, we may disclose PHI to the
institution or its agents when necessary for your health or
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, Intelligence Activities and Protective
Services for the President and Others: We may release PHI
about you to federal officials for intelligence, counterintelligence,
protection to the President, and other national security activities
authorized by law.
Victims of Abuse or Neglect: We may disclose PHI about you
to a government authority if we reasonably believe you are
a victim of abuse or neglect. 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
your or someone else.
For More Information or To Report a Problem
If you have questions or would like additional information
about Premier Pharmacy Labs, Inc. privacy practices, you may
contact our Privacy Officer at Premier Pharmacy Labs, Inc.
, P.O. Box 6510, Spring Hill, Fl 34611, or you may call the
Privacy Office toll-free at 1-800-752-7139. If you believe
your privacy rights have been violated, you can file a complaint
with our Privacy Officer or with the Secretary of Health and
Human Services. There will be no retaliation for filing a
complaint.
Effective Date: This notice is effective as of April 13,
2003. |