Thompson
Pharmacy
NOTICE OF PRIVACY PRACTICES
EFFECTIVE APRIL 14, 2003
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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.
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As part of the federal Health Insurance Portability
and Accountability Act of 1996, known as HIPAA, the pharmacy has
created this Notice of Privacy Practices (Notice). This Notice describes
the pharmacy’s privacy practices and the rights you, the individual,
have as they relate to the privacy of your Protected Health Information
(PHI). Your PHI is information about you, or that could be used
to identify you, as it relates to your past and present physical
and mental health care services. The HIPAA regulations require that
the pharmacy protect the privacy of your PHI that the pharmacy has
received or created.
This pharmacy will abide by the terms presented within
this Notice. For any uses or disclosures that are not listed below,
the pharmacy will obtain a written authorization from you for that
use or disclosure, which you will have the right to revoke at any
time, as explained in more detail below. The pharmacy reserves
the right to change the pharmacy’s privacy practices and this Notice.
Revisions to the Notice will 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 following is an accounting of the ways that the pharmacy is
permitted, by law, to use and disclose your PHI.
Uses and disclosures of PHI for Treatment:
We will use the PHI that we receive from you to fill your prescription
and coordinate or manage your health care.
Uses and disclosures of PHI for Payment:
The pharmacy will disclose your PHI to obtain payment or reimbursement
from insurers for your health care services.
Uses and disclosures of PHI for Health Care
Operations: The pharmacy will use your PHI to conduct quality
assessments, improvement activities, and evaluate the pharmacy workforce.
The following is an accounting of additional ways in
which the pharmacy is permitted or required to use or disclose PHI
about you without your written authorization.
Uses and disclosures as required by law: The
pharmacy is required to use or disclose PHI about you as required
and as limited by law.
Uses and disclosure for Public Health Activities:
The pharmacy may use or disclose PHI about you to a public health
authority that is authorized by law to collect for the purpose of
preventing or controlling disease, injury, or disability.
Uses and disclosure about victims of abuse,
neglect or domestic violence: The pharmacy may use or disclose
PHI about you to a government authority if it 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 about 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 about you in
the course of any judicial or administrative proceedings, provided
that proper documentation is presented to the pharmacy.
Disclosures for law enforcement purposes:
The pharmacy may disclose PHI about you to law enforcement officials
for authorized purposes.
Uses and disclosures about the deceased:
The pharmacy may disclose PHI about the deceased, or prior to, and
in reasonable anticipation of an individual’s death, to coroners,
medical examiners, and funeral directors.
Uses and disclosures for cadaveric organ, eye
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 a valid waiver of authorization from the research
board. Otherwise, the pharmacy will request a signed authorization
by the individual for all other research purposes.
Uses and disclosures to avert a serious threat
to health or safety: The pharmacy may use or disclose PHI
about you, if it believed in good faith, and is consistent with
any applicable law and standards of ethical conduct, to avert a
serious threat to health or safety.
Uses and disclosures for specialized government
functions: The pharmacy may use or disclose PHI about you
for specialized government functions including; military and veterans
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 law.
Disclosures for disaster relief purposes:
The pharmacy may disclose PHI about you as authorized by law to
a public or private entity to assist in disaster relief efforts.
Disclosures to business associates:
The pharmacy may disclose PHI about you to the pharmacy’s business
associates for services that they may provide to or for the pharmacy.
OTHER USES AND DISCLOSURES
The pharmacy may contact you for the following purposes:
Refill reminders: The pharmacy may
contact you to remind you of your prescription upon such time they
are ready to be refilled.
Information about treatment alternatives:
The pharmacy may contact you to notify you 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 pharmacy provides.
Fundraising: If the pharmacy participates
in a fundraising activity, the pharmacy may use demographic PHI
to send you fundraising packet, or the pharmacy may disclose demographic
PHI about you to its business associate or an institutionally related
foundation to send you a fundraising packet. No further disclosure
will be allowed by the business associates or an institutionally
related foundation without your written authorization.
FOR ALL OTHER USES AND DISCLOSURES
The pharmacy will obtain a written authorization 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
may revoke such an authorization in writing at any time. To revoke
a previously authorized use or disclosure, please contact Angela
or Debbie.
YOUR HEALTH INFORMATION RIGHTS
The following are a list of your rights in respect to your PHI.
Request 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; however, the
pharmacy is not required to accommodate a request. If you wish to
request additional restrictions, please obtain the form, Request
for Restriction of Uses & Disclosures, from the pharmacy and
return the completed form to the pharmacy or return to Angela or
Debbie.
The right to have your PHI communicated to you
by alternate means or locations: You have the right to
request that the pharmacy communicate confidentially with you using
an address or phone number other than your residence. However, state
and federal laws require the pharmacy to have an accurate address
and home phone number in case of emergencies. The pharmacy will
consider all reasonable requests. If you wish to request a change
in your communicating address and/or phone number, please obtain
a form, Request for Alternative Arrangements for Confidential Communication,
from the pharmacy and return the completed form to the pharmacy
or return to Angela or Debbie.
The right to inspect and/or obtain a copy your
PHI: You have the right to request access and/or obtain
a copy of your PHI that is contained in the pharmacy for the duration
the pharmacy maintains PHI about you. If you wish to inspect or
obtain a copy of your PHI, please obtain a form, Request for Access
to Records, from the pharmacy and return the completed form to the
pharmacy or return to Angela or Debbie
The right to amend your PHI: You have
the right to request an amendment of the PHI the pharmacy maintains
about you, if you feel that the PHI the pharmacy has maintained
about you is incorrect or otherwise incomplete. Under certain circumstances
we may deny your request for amendment. If we do deny the request,
you will have the right to have the denial reviewed by someone we
designate who was not involved in the initial review. You may also
ask the Secretary, United States Department of Health and Human
Services, or their appropriate designee, to review such a denial.
If you wish to amend your PHI files, please obtain a form, Request
for Amendment to PHI, from the pharmacy and return the completed
form to the pharmacy or return to Angela or Debbie.
The right to receive an accounting of disclosures
of your PHI: You have the right to receive an accounting
of certain disclosures of your PHI made by the pharmacy. If you
wish to receive an accounting of disclosures of your PHI, please
obtain a form, Request for Accounting of Disclosures, from the pharmacy
and return the completed form to the pharmacy or return to Angela
or Debbie. You should be aware, however, that such an accounting
excludes uses and disclosures made for treatment, payment, or health
care operations purposes.
The right to receive additional copies of the
Pharmacy’s Notice of Privacy Practices: You have the right
to receive additional paper copies of this Notice, upon request,
even if you initially agreed to receive the Notice electronically.
If you wish to receive a paper copy of this request, please ask
a pharmacy workforce member and they will provide you with a copy.
REVISIONS TO THE NOTICE OF PRIVACY PRACTICES
The pharmacy reserves the right to change and/or revise this Notice
and make the new revised version applicable to all PHI received
prior to its effective date. The revised Notice will be available,
upon request, to all individuals. The pharmacy will also post the
revised version of the Notice in the pharmacy.
COMPLAINTS
If you believe your privacy rights have been violated, you may file
a complaint with the pharmacy and/or to the Secretary of HHS, or
their designee. If you wish to file a complaint with the pharmacy,
please contact Angela or Debbie. If you wish to file a complaint
with the Secretary, please write to:
The U.S Department of Health and Human
Services
200 Independence Ave, S.W.
Washington, D.C. 20201
The pharmacy will not take any adverse
action against you as a result of your filing of a complaint.
CONTACT INFORMATION
If you have any questions on the pharmacy’s privacy practices or
for clarification on anything contained within the Notice, please
contact:
THOMPSON PHARMACY
ANGELA WAGNER
600 EAST CHESTNUT AVENUE
ALTOONA, PA 16601
(814) 944-6139
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600
E. Chestnut Ave.