Notice of Privacy Practices, effective as of April 14, 2003

Revised August 29, 2013

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.

We are required by law to maintain the privacy of Protected Health Information (PHI) and to provide individuals 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 PHI about you.

We are 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. We will provide any revised Notice to you, upon request.

Your Health Information Rights

You have the following rights with respect to PHI about you:

Obtain a paper copy of the Notice upon request. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact our corporate office, 106B Rock Quarry Road, Stockbridge, GA 30281 (phone 770 474 7693.)

Request a restriction on certain uses and disclosures of PHI, such as identifying who should have access to and use of your medical information. You may also restrict disclosure of PHI to your health plan if you pay out-of-pocket in full for the services provided. You may request such restrictions by sending a written request to Pierce Pharmacy Management, Attn: Privacy Officer, at the address given above. We will make every attempt to comply with your request, but are not required to agree to certain restrictions if they not feasible or compromise our ability to meet our treatment obligations to you.

Inspect and obtain a copy of PHI. You have a right to access and copy PHI about you contained in a designated record set for up to six years. The designated record set will usually include prescription and billing records. To inspect or copy PHI about you, you must send a written request to Pierce Pharmacy Management, Attn: Privacy Officer. We may charge you a fee for the cost of copying, mailing and the supplies that are necessary to fill your request. We may deny your request to inspect and copy in certain limited circumstances. We have up to thirty (30) days to provide the requested PHI or deny your request. If you are denied access to PHI about you, you may request the denial be reviewed.

Request and amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request 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 Pierce Pharmacy Management, Attn: Privacy Officer. You must include a reason that supports your request. If we deny your request, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement.

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 within the past six years for most purposes other than treatment, payment or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures made 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 a request in writing to Pierce Pharmacy Management, Attn: Privacy Officer. Your request must specify the time period, but may not be longer than six years. The first accounting you request within a twelve month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved, if any, and you may choose to withdraw or modify your request, at that time.

Request communications of PHI by alternative means or locations. You may request that we contact you about pharmacy matters only in writing or at a different residence or post office box. To request confidential communications of PHI about you, you must submit a request in writing to Pierce Pharmacy Management, Attn: Privacy Officer. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.

Receive notice of a rules breach. We will inform you of any known breach of your PHI, intentional or otherwise.

Examples of How We May Use and Disclose PHI

Treatment. We will use PHI to dispense prescription medications to you, which will include pharmacists and other personnel involved in the dispensing function. We will document information in your record related to medications dispensed and other services provided to you. We may also contact you to provide refill reminders or information about treatment alternatives or health related benefits and services that may be of interest to you.

Payment. We will contact your insurer or pharmacy benefit manager to determine coverage for your prescription and the amount of your copayment. We will bill you or a third party payer for the cost of the medications dispensed to you. Your bill may include information that identifies you, as well as the prescriptions you are taking.

Operations. We may use the information in your health record to monitor the performance of pharmacists and other personnel providing treatment and/or other services to you. This information will be used to evaluate and improve the quality and effectiveness of the services we provide.

We are also permitted to use or disclose your PHI for the following purposes. We may, however, never have reason to make these disclosures.

Business associates. There are some services provided by us through contracts with third parties (business associates). We may disclose PHI about you to our business associates in order for them to perform their job. We require our business associates to properly safeguard the PHI they receive.

Communication with individuals involved in your care or payment for services rendered. Pharmacists and other health care associates, using their professional judgment, may disclose PHI to a family member or any other person you identify, if relevant to that person’s involvement in your care or payment related to your care. For example, we may allow a friend, family member or caregiver to pick up a prescription on your behalf.

Food and Drug Administration (FDA). We may disclose PHI to the FDA, or persons under their jurisdiction, if the PHI is relevant to suspected adverse events with respect to drugs, foods, supplements, products and product defects. This includes post marketing surveillance information to enable product recalls, repairs or replacement.

Worker’s Compensation. We may disclose PHI about you as necessary to comply with laws or regulations related to worker’s compensation or similar programs established by law.

Public Health. We may disclose PHI about you to public health or legal authorities intending to control or prevent disease, injury or disability.

Law Enforcement. We may disclose PHI about you for law enforcement purposes, as required by law.

Health Oversight Activities. We may disclose PHI about you to agencies responsible for audits, investigations and inspections, as necessary to maintain licensure and for the government to monitor the health care system, government programs and civil rights laws.

Judicial and administrative proceedings.  We may disclose PHI about you in response to a court or administrative order, subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to notify 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 and protocols have been established to ensure the privacy of your PHI.

Coroners, medical examiners and funeral directors. We may release PHI about you to a coroner, medical examiner or funeral director. This may be necessary to identify a deceased person, determine the cause of death or carry our other duties pertinent to their legal responsibilities.

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 transplantation.

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 or 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 to protect your health or the health and safety of others.

To avert a serious threat to health or safety. We may use and/or disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public.

Military and veterans. If you are or have been a member of the armed forces, we may release PHI about you as required by military authority.

National security and intelligence activities. We may release PHI about you to authorized federal officials for intelligence, counterintelligence and other national security initiatives authorized by law.

Protective services for the President and others. We may disclose PHI about you to authorized federal officials as required to protect the President, other authorized persons, foreign heads of state or to conduct special investigations.

Victims of abuse, neglect or domestic violence. We may disclose PHI about you to a government authority if we reasonably believe you are a victim of abuse, neglect or domestic violence. We will only disclose this information to the extent required by law.

Disclosures of PHI Requiring Your Authorization

We must secure your written authorization to use and/or disclose your PHI for marketing purposes or the sale of your PHI, including subsidized treatment communications.

Incidental Disclosures at the Drive-Thru Window

We make reasonable efforts to avoid any inadvertent disclosure of your PHI, however, any discussion about your PHI at a drive-thru window may be heard by passersby. We recommend you pick up your prescriptions in the store if you are concerned about the possibility of someone overhearing your drive-thru communications.

Other Use and Disclosures of PHI

We will obtain your written authorization before disclosing PHI about you for purposes other than those described in this Notice. You may revoke an authorization, in writing, at any time. We will stop disclosing or using PHI about you, upon the receipt of written revocation, except to the extent we have already taken action in reliance on the prior authorization.

Minors

If you are a minor who has lawfully provided consent for treatment and you would like the pharmacy, to the extent permitted by state law, to treat you as an adult for purposes of access to and disclosure of records related to such treatment, please notify the pharmacist.

For More Information or to Report a Problem

Contact Pierce Pharmacy Management, Attn: Privacy Officer, 106B Rock Quarry road, Stockbridge, GA 30281. If you believe your rights have been violated, file a complaint with the Privacy Officer or the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.