This notice describes how medical information about you may be used and disclosed and how you can get access or amend this information.
PLEASE REVIEW CAREFULLY!
Our goal is to take reasonable steps to safeguard your Protected Health Information (“PHI”). PHI is information about you, including basic demographic 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 about you 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.
Nora Apothecary is required to follow the terms of this Notice. We will not use or disclose your PHI 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. Upon request, we will provide a revised Notice to you.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following categories describe and provide examples of different ways that we can use and disclose PHI about you.
Required Disclosures: We are required to disclose health information about you to the Secretary of Health and Human Services, upon request, to determine our compliance with HIPAA and to you, in accordance with your right to access and to receive an accounting of disclosures.
For Treatment: We may use your PHI in your treatment. For example, Information obtained by the pharmacist will be used to dispense prescription medications to you. We will document in your record information related to the medication dispensed to you and services provided to you.
For Payment: We may use and disclose your PHI to bill for our services, or to collect payment from you or your insurance company. We will contact your insurance company or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.
For Health Care Operations: We may use and disclose your PHI for the general operation of our business. For instance, we sometimes arrange for auditors or consultants to review our practices, evaluate our operations, and tell us how to improve our services or the quality of our care.
Public Policy Uses and Disclosure: Various public policies require disclosure of PHI. We may use or disclose your PHI when required to do so by law. One such legal requirement is public health reporting requirements. For example we must disclose to the FDA or its agents PHI relative to reactions to medications or problems with products or post marketing surveillance information to enable product recalls, repairs or replacements.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These activities include, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, benefits programs such as Medicare or Medicaid, and compliance with civil rights laws and government health care regulations.
Lawsuits, Disputes and Law Enforcement: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discovery request or other lawful process by someone involved in the dispute. We will attempt to notify you of this request and/or obtain a protective order when appropriate. We may disclose PHI to assist law enforcement to identify or locate a suspect, fugitive, material witness or missing persons. We may disclose PHI to law enforcement about a victim of a crime or about a death we believe is a result of criminal conduct. We can use or disclose PHI if necessary when a crime is committed on our premises.
Coroners, Funeral Directors and Organ Donation: We may release PHI to a coroner or medical examiner to identify a deceased person or cause of death and to funeral directors. We may also release your PHI to organ procurement organizations, transplant centers, and eye or tissue banks, if you are an organ donor.
Workers Compensation: We may release your PHI to workers’ compensation or similar programs, which provide benefits for work-related injuries or illnesses.
Research: We may use or disclose certain PHI for research purposes where a Privacy Board or Institutional Review Board determines that your privacy will be adequately protected in the study or to prepare or analyze a research protocol or other research purposes.
Notification: We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.
Serious Threat to Health or Safety: Your PHI may be used if necessary to prevent a serious threat to the health and safety to yourself or others.
Members of the Military: PHI of a member of the Armed Forces may be released for activities deemed necessary by military command authorities. We may also release health information about foreign military personnel to their appropriate foreign military authority.
Inmates: If you are an inmate, we may release your PHI to a correctional institution where you are incarcerated or to law enforcement officials in certain situations such as where the information is necessary for your treatment, health or safety or that of others.
National Security & Intelligence Activities: We may disclose your PHI for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state.
USE AND DISCLOSURES THAT REQUIRE YOUR PERMISSION
We are required to obtain written authorization from you for any uses and disclosures of medical information other than those listed above. If you provide us with such permission, you may revoke that permission, in writing, at any time. If you withdraw your permission, we will no longer use or disclose that PHI in the future.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding medical information we maintain about you. To exercise any of your rights, you must contact us in writing to Privacy Officer, Sandra Justice, at 1101 East 86th Street, Indianapolis, IN 46240 or via fax at 317-251-9556.
Right to Inspect and Copy. You have the right to inspect and copy your PHI in a designated record set for as long as Nora Apothecary keeps the information about you. The “designated set” will usually include prescription and billing records. To inspect and copy your PHI you must send a written request to Sandra Justice at the address or fax number given above. By law we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If your request is denied, you have the right to have the denial reviewed by another health care professional chosen by this practice. This review will not be the same person who originally denied your request. We will abide by the decision of the reviewer.
Right to Amend. You have the right to request an amendment of any medical information we have about you if you believe that information to be incorrect or incomplete. You have this right for as long as long as we keep your information. You must give a reason for your request in writing. We may deny your request for certain reasons such as that the medical information we have is accurate and complete. You may write a response to our denial for your medical record. We reserve the right to limit the length of that response.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures, unauthorized by you or the law, we have made of your PHI after April 14, 2003. Your request must be in writing and include a time period of no longer than six years. State whether you want the information on paper or electronically. If you ask us for this information more than once every twelve months, we may charge you a fee.
Additional Rights. You have the right to ask for restrictions on the ways we use and disclose your health information for treatment, payment and health care operation purposes. You may also request that we limit our disclosures to persons assisting in your care or payment for your care. We will consider your request, but we are not required to agree to it. You have the right to receive communications containing your PHI from us by alternative means or at alternative locations. For example you may request that we only contact you at home or by mail.
You have the right to a paper copy of this notice. You may also obtain a copy at our web site: www.noraapothecary.com
CHANGES TO THIS NOTICE
We reserve the right to make changes to this notice at any time. We have the right to make the revised notice effective for PHI we have about you as of the date of the revisions as well as for future information we obtain. If there is a material change to this notice, the revised notice will be posted. You may also request a written copy of the revised notice. The current notice is effective as of April 14, 2003
If you have any complaints concerning our privacy practices, you may contract the Secretary of the Department of Health and Human Services, at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201 (e-mail:firstname.lastname@example.org). To obtain more information concerning this notice to comment or to file a complaint you may also contact our Privacy Officer, Sandra Justice, at 1101 East 86th Street, Indianapolis, IN 46240 or via fax at 317-251-9556.