| 1. |
Under applicable law, we are required to protect the privacy of your individual health
information (information we refer to in this notice as "Protected Health Information").
We are also required to provide you with this Notice regarding our policies and procedures
regarding your Protected Health Information and to abide by the terms of this notice, as
it may be updated from time to time.
We are permitted to make certain types of uses and disclosures under applicable law for treatment,
payment, and healthcare operations purposes. We may obtain information to dispense prescriptions
and for the documentation of pertinent information in your records that may
assist us in managing your medication therapy or your overall health. For
treatment purposes, such use and disclosure will take place in providing,
coordinating, or managing healthcare and its related services by one or more of
your providers, such as when your pharmacist consults with your physician or a
specialist regarding your medications, treatment, or condition.
For payment purposes, such use and disclosure will take place to obtain or
provide reimbursement for providing pharmaceutical care services, such as when
your case is reviewed to ensure that appropriate care was rendered. For
reimbursement purposes, your Protected Health Information may be disclosed to
one or several intermediaries employed by your plan sponsor including but not
limited to insurers, pharmacy benefits managers, claims administrators and
computer switching companies.
For healthcare operations purposes, such us and disclosure will take place in a
number of ways, including for quality assessment and improvement; provider
review and training; underwriting activities; reviews and compliance activities;
and planning, development, management and administration. Your information
could be used, for example, to assist in the evaluation of the quality of care
that your were provided.
We store some of your Protected Health Information in electronic computer files.
We backup our electronic records daily, and employ other precautions to
safeguard the integrity of your Protected Health Information. In spite of
these precautions it is possible but unlikely that a computer crash or other
technological failure could cause the loss of data. In addition reasonable
safeguards are employed to protect your Protected Health Information stored on
electronic media.
In addition, we may contact you to provide refill reminders, health screenings,
wellness events, inoculations, vaccinations or information about treatment
alternatives or other health-related benefits and services that may be of
interest to you. In addtion, we may disclose your health information to
your plan sponsor. In addition, we may contact you for the purpose of fund
raising activities.
We may use and disclose your Protected Health Information, without your
authorization when the pharmacy needs to contact a physician or physician's
staff and is permitted or required to do so without individual written
authorization. We may use and disclose your Protected Health Information
if we are contaced by another pharmacy who states they have your request and
consent to transfer pharmacy records to them.
From time to time we may employ the services of business associates who may
assist us in one or more tasks and who may use, change or create Protected
Health Information. Business associates are required to comply with all
the privacy regulations on your behalf.
We may disclose Protected Health Information about you without your
authorization to comply with workers compensation laws, as required by law
enforcement, legal proceedings, public health requirements, health oversight
activites and as required by law.
Other uses and disclosures will be made only with your written authorization,
and you may revoke your authorization by notifying us as described in Section B.
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| 2. |
You may ask us to restrict uses and disclosures of your Protected Health
Information to carry out treatment, payment, or healthcare operations, or to
restrict uses and disclosures to family members, relatives, friends, or other
persons identified by you who are involved in your care or payment of your care.
However, we are not required to agree to your request.
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| 3. |
You have the right to request the following with respect to your Protected
Health Information: (i) inspection and copying; (ii) amendment or correction;
(iii) an accounting of the disclosures of this information by us (we are not
required to account to you for the disclosures made for treatment, payment,
operations, disclosures to you, disclosures to your care givers, for
notifications or as otherwise excluded by law); and (iv) the right to reveive a
paper copy of this notice upon request. We may require you to pay for this
request to cover our costs of copying, labor and postage.
In addition, you may request, and we mus accommodate the request, if reasonable,
to reveive communications of Protected Health Information by alternative means
or at alternative locations. To make this request please contact, in
writing:
Quinlan's Pharmacy & Medical Supply
John Quinlan, Privacy Officer
107 N. Main Street
Wayland, NY 14572
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| 4. |
We may use your name to reference your prescriptions and pharmaceutical care
services. You may be required to sign a signature log form to acknowledge
receipt of service, to acknowledge receipt of this Notice and the disclosure of
Protected Health Information as outlined herein. This information may be
disclosed by us to other persons who ask for you or your prescriptions by name.
You may restrict or prohibit these uses and disclosures by notifying a pharmacy
representative orally or in writing of your restriction or prohibition. We
are not required to honor those requests. We are able to provide treatment
services to you even if you object to sign the acknowledgement of the receipt of
this Notice or if we decide not to honor a request regarding the information in
this document. In the event of an emergency or your incapacity, we will do
in our reasonable judgement what is consistent with your known preference, and
what we determine to be in your best interest. We will inform you of any
such uses or disclosures if uses and disclosures would require your signed
authorization under such circumstances and give you an opportunity to object as
soon as practicable.
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| 5. |
We may disclose to one of your family members, to a relative, to a close
personal friend, or to any other person identified by you, Protected Health
Information that is directly relevant to the person's involvement with your care
or payment related to your care. In addition we may use or disclose the
Protected Health Information to notify, identify, or locate a memeber of your
family, your personal representative, another person responsible for care, or
certain disaster relief agencies of your location, general condition, or death.
If you are incapacitated, there is an emergency, or you object to his use or
disclosure, we will do in our judgment what is in your best interest regarding
such disclosure and will disclose only the information that is directly relevant
to the person's involvement with your healthcare. We will also use our
judgment and experience regarding your best interest in allowing people to
pickup filled prescriptions, or other similar forms of Protected Health
Information.
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| 6. |
We reserve the right to change the terms of this Notice and to make new Notice
provisions effective for all Protected Health Information we maintain. You
may receive a copy of this Notice by contacting us as outlined by Section B or
upon the receipt of pharmacy care services.
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| 7. |
If you believe that your privacy rights have been violated, you may complain to
us at the location descirbed in Section B or to the Secretary of the Department
of Health and Human Services, Hubert H. Humphrey Building, 200 Independence
Avenue SW, Washington, DC 20201. You will not be retaliated against for
filing a complaint.
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Section B: Contacting Us
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| You may contact us for further information at: |
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Quinlan's Pharmacy & Medical Supply
John Quinlan, Privacy Officer
107 N. Main Street
Wayland, NY 14572 |