HIPAA Notice of Privacy Practices
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.