Discover OF PRIVACY PRACTICES Effective Apr 14, 2003 THIS Discover DESCRIBES HOW MEDICAL Information Virtually You lot MAY BE USED AND DISCLOSED AND HOW Y'all CAN Go ACCESS TO THIS Data. Delight REVIEW IT Carefully. As role of the federal Wellness Insurance Portability and Accountability Deed of 1996, known as HIPAA, the pharmacy has created this Observe of Privacy Practices (Notice). This Find describes the chemist's shop'due south private practices and the rights you, the individual, accept as they relate to the privacy of your Protected Health Information (PHI). Your PHI is information most y'all, or that could be used to place you, as it relates to your past and present concrete and mental wellness intendance services. The HIPAA regulations require that the chemist's shop protect the privacy of your PHI that the pharmacy has received or created. This chemist's shop will bide by the terms presented within this Notice. For any uses or disclosures that are not listed below, the pharmacy will obtain a written authority from y'all for that apply or disclosure, which you will take the right to revoke at any time, equally explained in more than detail below. The pharmacy reserves the right to change the chemist's's privacy practices and this Notice. Revisions to the Notice volition be posted in the pharmacy and upon your request, provided to you in a paper format. HOW THE Pharmacy MAY USE AND DISCLOSE YOUR PHI The post-obit is an accounting of the ways that the pharmacy is permitted, by constabulary, to use and disembalm your PHI. Uses and disclosures of PHI for Handling: Nosotros will use the PHI that nosotros receive from you to fill up your prescription and coordinate or manage your wellness care. Uses and disclosures of PHI for Payment: The chemist's shop will disclose your PHI to obtain payment or reimbursement grade insurers for your health intendance services. Uses and disclosures of PHI for Wellness Intendance Operations: The chemist's shop will utilise your PHI to conduct quality assessments, comeback activities, and evaluate the pharmacy workforce. The post-obit is an accounting of additional ways in which the chemist's is permitted or required to apply or disclose phi near you without your written authorization: Uses and disclosures as required by police: The pharmacy is required to use and disclose PHI well-nigh you as required and every bit limited by law. Uses and disclosures for public health activities: The chemist's may use or disclose PHI near you to a public wellness authority that is authorized past law to collect for the purpose of preventing, controlling disease, injury, or disability. Uses and disclosure well-nigh victims of abuse, neglect or domestic violence: The chemist's shop may use or disclose PHI nigh y'all to a government say-so if information technology is reasonably believed you are a victim of abuse, neglect or domestic violence. Uses and disclosures for health oversight activities: The pharmacy may use or disclose PHI most you to a health oversight agency for oversight activities that it is authorized by law to conduct. Disclosures for judicial and administrative proceedings: The pharmacy may disclose PHI almost you in the course of whatever judicial or administrative proceedings, provided that proper documentation is presented to the pharmacy. Disclosures for law enforcement purposes: The pharmacy may disclose PHI about yous to police force enforcement officials for authorized purposes. Uses and disclosures near the deceased: The pharmacy may disclose PHI about a deceased, or prior to, and in reasonable anticipation of an private'southward decease, to coroners, medical examiners, and funeral directors. Uses and disclosures for cadaveric organ, middle or tissue donation purposes: The pharmacy may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes. Uses and disclosures for research purposes: The pharmacy may use and disclose PHI about you for research purposes with valid waiver of authorisation canonical by an institutional review lath or a privacy board. Otherwise, the chemist's shop will request a signed authorization by the individual for all other inquiry purposes. Uses and disclosures to avert a serious threat to wellness or rubber: The pharmacy may utilise or disclose PHI about you, if it believed in proficient faith, and is consequent with whatsoever applicable law and standards of ethical carry, to avert a serious threat to health or safety. Uses and disclosures for specialized authorities functions: The pharmacy may apply or disclose PHI about you for specialized government functions including; military and veteran'south activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations. Disclosure for workers' compensation: The pharmacy may disclose PHI about you as authorized by and to the extent necessary to comply with workers' compensation laws or programs established by police force. Disclosures for disaster relief purposes: The pharmacy may disembalm PHI about y'all as authorized past law to a public or individual entity to aid in disaster relief efforts. Disclosures to business organisation associates: The chemist's shop may disclose PHI about you to the pharmacy's concern associates for services that they may provide to or for the chemist's shop. OTHER USES AND DISCLOSURES The pharmacy may contact you for the following purposes: Refill reminders: The pharmacy may contact y'all to remind you of your prescription upon such time they are ready to be refilled. Information about treatment alternatives: The chemist's shop may contact y'all to notify y'all of alternative treatments and/or products. Health related benefits or services: The pharmacy may use your PHI to notify you of benefits and services the chemist's shop provides. Fundraising: If the pharmacy participates in a fundraising activity, the pharmacy may utilize demographic PHI to send you a fundraising packet, or the pharmacy may disclose demographic PHI almost you to its business associate or an institutionally related foundation to send you a fundraising packet. No further disclosure will be immune by the business associates or an institutionally related foundation without your written authorization. FOR ALL OTHER USES AND DISCLOSURES The pharmacy volition obtain a written dominance from you for all other uses and disclosures of PHI, and the pharmacy will only use or disclose pursuant to such an authorization. In addition, you lot may revoke such an say-so in writing at whatever time. To revoke a previously authorized use or disclosure, please contact the pharmacy. YOUR HEALTH Data RIGHTS The following are a list of your rights in respect to your PHI. Asking restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of the pharmacy?s uses and disclosures of your PHI; nevertheless, the pharmacy is not required to accommodate a request. If yous wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from the chemist's and render the completed form to the pharmacy. The right to have your PHI communicated to you past alternate means or locations: You have the right to request that the pharmacy communicate confidentially with yous using an address or phone number other than your residence. However, state and federal laws crave the pharmacy to have an accurate address and abode telephone number in case of emergencies. The pharmacy will consider all reasonable requests. If you wish to request a modify in your communicating address and/or phone number, please obtain a form, Request for Alternative Arrangements for Confidential Communication, from the chemist's shop and render the completed form to the pharmacy. The right to inspect and/or obtain a copy of your PHI: Yous take the right to request access and/or obtain a copy of your PHI that is contained in the chemist's for the duration the pharmacy maintains PHI almost you. If you wish to inspect or obtain a copy of your PHI, please obtain a form, Request for Access to Records, from the chemist's and return the completed form to the pharmacy. There may be a reasonable price-based charge for photocopying documents. You will exist notified in accelerate of incurring such charges, if any. The right to ameliorate your PHI: You have the right to asking an amendment of the PHI the pharmacy maintains about y'all, if you feel that the PHI the pharmacy has maintained near you is incorrect or otherwise incomplete. Under sure circumstances we may deny your request. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involve in the initial review. You may inquire to Secretarial assistant, United States Section of Health and Human Services, or their advisable designee, to review such a denial. If y'all wish to amend your PHI files, please obtain a form, Asking for Amendment of PHI, from the pharmacy and return the completed form to the pharmacy. The right to receive and accounting of disclosures of your PHI: Yous accept the correct to receive an accounting of certain disclosures of your PHI made by the pharmacy. If yous wish to receive an accounting of disclosures of your PHI, please obtain grade, Request for Accounting of Disclosures, from the chemist's and return the completed course to the pharmacy. You should be aware; however, that such an bookkeeping excludes uses and disclosures fabricated for treatment, payment and health care operations purposes. The right to receive additional copies of the Pharmacy?s Notice of Privacy Practices: you take the right to receive additional paper copies of this Notice, upon request, fifty-fifty if you lot initially agreed to receive the Find electronically. If you with to receive a paper re-create of this notice, please ask a chemist's workforce member and they volition provide you with a copy. REVISIONS TO THE Discover OF PRIVACY PRACTICES The pharmacy reserves the correct to change and/or revise this Notice and brand the new revised version applicable to all PHI received prior to its effective date. The revised Notice will exist bachelor, upon request, to all individuals. The chemist's shop will also post the revised version of the Notice in the pharmacy. COMPLAINTS If y'all believe your privacy rights have been violated, you may file a complaint with the chemist's and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with the pharmacy, delight contact the Privacy Officer. If you wish to file a complaint with the Secretary, delight write to: The U.S. Department of Health and Human being Services Office of the Inspector Full general 200 Independence Ave, S.W. Washington, D.C. 20201 The pharmacy will not take whatever adverse action against you equally a effect of your filing of a complaint. CONTACT Information If you have any questions on the pharmacy's privacy practices or for clarification on annihilation independent within the Find, please contact:
My All-time Pharmacy
1050 Gateway Boulevard Suite 101
Boynton Beach, FL 33426
Phone: (561) 200-4245
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