THIS
NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED BY OUR
PHARMACY AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE
REVIEW IT CAREFULLY.
Protecting Medical
Information
Wall’s Medicine
Center has always protected your personal health information. We
respect your privacy and value your relationship with us.
Wall’s Medicine
Center is required by the Health Insurance Portability &
Accountability Act of 1996 (“HIPPA”) to maintain the
privacy of your Protected Health Information (PHI). PHI is
considered to be your medical records and your health information
that identifies you. This includes any information we keep, use, or
disclose in any form, whether electronically, on paper, or orally.
As required by HIPAA, we must provide this notice to you and make a
good faith effort to obtain your acknowledgement that you have
received it. This notice explains how we will use and disclose your
PHI while maintaining your privacy, explains your rights with respect
to PHI, and explains our duty to abide by the terms of the notice and
any updates that we make in the future.
Our Use Of Your
Information
Under the law we are
permitted to use and disclose your PHI without your authorization for
the purposes of treatment, payment, and health care operations:
Treatment
means providing, coordinating, or managing health care and related
services by one or more health care providers. Examples are when we
contact your physician or other health care providers to obtain
refill authorizations, ask questions about medication doses, inform
them of potential drug interactions, or to determine validity of
prescription orders. We may also use and disclose your information
when your physician, health care provider, or other pharmacy
contacts us and says that you have requested them to provide health
care services.
Payment means
such activities as obtaining payment for services, confirming health
plan coverage, and billing or collection activities. Examples are
electronically billing your insurance company or health plan at the
time we fill your prescriptions. Insurance companies or health
plans may also contact us about services we provide to you.
Health care
operations includes business aspects of running our pharmacy,
such as planning, financial analysis, and customer service. An
example is when we look at records to evaluate how well our
pharmacists and technicians provide service to you.
Our Use Of Your
Information
We may also use your
PHI without your authorization to provide you with refill reminders;
information about alternatives to medications or services you receive
through our pharmacy; or notices of health screenings, special
events, or other wellness activities we may conduct.
We may release
information about you to a family member or others who are involved
in your medical care. Examples include if a family member picks up a
prescription for you or if you gave a nursing aide that assists you
with your medications.
Whenever anyone
receives PHI on your behalf we will provide only the minimum amount
of information necessary to insure your quality of care. We may
disclose PHI about you for law enforcement purposes as required by
law or in response to a valid subpoena.
Our pharmacy may use
and disclose your PHI when necessary to reduce or prevent serious
threat to your health and safety or the health and safety of another
individual or the public.
Any other uses and
disclosures other than those provided for above (or as otherwise
permitted or required by law) will be made only with your written
authorization. You may revoke such authorization in writing and we
are required to honor and abide by that written request, except for
actions we have already taken relying on your authorization.
Your Rights
You have the following
rights with respect to your PHI, which you can exercise by presenting
a written request to the Privacy Official:
The right to
request restrictions on certain uses and disclosures, including any
group of persons or person identified by you. We are, however, not
required to agree to a restricted restriction.
The right to
reasonable requests to receive confidential communications from us
by alternative means or at alternative locations.
The right to
inspect and copy your PHI. We reserve the right to schedule this
activity and charge a reasonable fee to gather the information and
for copy expenses.
The right to amend
your PHI.
The right to
receive a list of disclosures of your PHI when you complete our
request form.
The right to
obtain a paper copy of this notice.
We are required by law
to maintain the privacy of your protected health information and to
provide you with notice of our legal duties and privacy practices
with respect to protected health information.
Effective Date of
Notice
This notice is
effective as of April 14, 2003 and we are required to abide by the
terms of the Notice of Privacy Practices currently in effect. We
reserve the right to change the terms of our Notice of Privacy
Practices and to make the new notice provisions effective for all
protected heath information that we maintain. We will post and
revised notice in our pharmacy and you may receive a written copy of
a revised notice by requesting orally or in writing.
Complaint Process
If you believe your
privacy protections have been violated, you have the right to file a
formal, written complaint with us at the address shown in the contact
information, or with the Department of Health & Human Services,
Office of Civil Rights. Our pharmacy can provide you with the
addresses of the regional office of Civil Rights for this are. We
will not retaliate against you for filing a complaint.
Contact Information
Please contact us for
more information:
Dennis P. Johnson, Privacy Official
Wall’s Medicine Center
708 S. Washington
Street
Grand Forks, ND 58201
701-746-0497
1-800-926-3658
Department of Health &
Human Services
For more information
about HIPAA or how to file a complaint you can go to the website
below:
http://www.hipaa.org/
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