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.
The Pharmacy is required by law to maintain the privacy of Protected Health Information (PHI) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is 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 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 PHI about you.
The Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you 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 any revised Notice to you.
Your Health Information Rights
You have the following rights with respect to PHI about you:
Obtain a paper copy of the Notice upon request You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically you are still entitled to a paper copy. To obtain a paper copy, you may pick one up in person at Helena Drugs, 455 Helena Marketplace, Suite 455, Helena, AL 35080.
You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to Helena Drugs, 455 Helena Marketplace, Suite 455, Helena, AL 35080. We are not required to agree to those restrictions. Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as the Pharmacy maintains the PHI. The designated record set usually will include prescription and billing records. To inspect or copy PHI about you. You must send a written request to Helena Drugs, 455 Helena Marketplace, Suite 455, Helena, AL 35080.
We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain, limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to Helena Drugs, 455 Helena Marketplace, Suite 455, Helena, AL 35080. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement.
You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in writing to Helena Drugs, 455 Helena Marketplace, Suite 455, Helena, AL 35080. Your request must specify the time period, but may not be longer than two years. The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Request communications of PH by alternative means or at alternative locations: For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must submit a request in writing to Helena Drugs, 455 Helena Marketplace, Suite 455, Helena, AL 35080. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.
Examples of How We May Use and Disclose PHI are Available Upon Request
The following are descriptions and examples of ways we use and disclose PHI: We will use PHI for treatment payments health care, We are likely to use or disclose PHI for the following purposes:
Business associates: Communication with individuals involved in your care or payment for your care, Health-related communications. Food and Drug Administration (FAD). Worker's compensation. Public health. As required by law. Health oversight activities, Judicial and administrative proceedings.
We are permitted to use or disclose PHI about you for the following purposes:
Research, Coroners, medical examiners, and funeral directors. Organ or tissue procurement organizations, fundraising, Notification, Correctional Institution, to avert a serious threat to health or safety, Military, and veterans. National security and intelligence activities. Protective services for the President and others, Victims of abuse, neglect, or domestic violence.
Other Uses and Disclosures of PHI
The Pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided far above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action In reliance on the authorization.
For More Information or to Report a Problem
If you have questions or would like additional information about the Pharmacy's privacy practices, you may contact Helena Drugs by telephone: 205-729-5060 or in person at 455 Helena Marketplace, Suite 455, Helena, Al 35080. If you believe your privacy rights have been violated, you can file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
This Notice is effective as of April 1, 2003.