Apothecary Compounding Solutions Inc.
3909 Creekside
Loop Yakima , Washington 98902
Telephone
(509) 248-9065
R. W. Murdock, RPH
NOTICE
OF PRIVACY PRACTICES
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
to maintain the privacy of your Protected Health Information (“PHI”) and to
provide you with a notice of our legal duties and privacy practices with
respect to PHI. PHI is information about you, including basic demographic 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 about you 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 PHI we maintain. Upon request,
we will provide a 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, contact the “Privacy Officer” whose name
appears at the end of this notice.
Request a restriction on certain uses and disclosures of PHI. You have the
right to request additional restrictions on our use or disclosure of PHI about
you by sending a written request to the “Privacy Officer” whose name appears at
the end of this notice. 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
the “Privacy Officer” whose name appears at the end of this notice. We may
charge you a fee for the costs of copying, mailing, or other 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
the “Privacy Officer” whose name appears at the
end of this notice. 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 give a rebuttal to your statement.
Receive an accounting of disclosures
of PHI. 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 the “Privacy Officer”
whose name appears at the end of this notice. Your request must specify the
time period, but may not be longer than six 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 PHI 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 your request in writing to the “Privacy Officer”
whose name appears at the end of this notice. 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
The following are
descriptions and examples of ways we use and disclose PHI:
We will use PHI for
treatment. Example: Information
obtained by the pharmacist will be used to dispense prescription medications to
you. We will document in your record information related to the medications
dispensed to you and services provided to you.
We will use PHI for payment. Example: We will contact your insurer or pharmacy benefit manager to
determine whether it will pay for your prescription and the amount of your
co-payment. We will bill you or a third-party payer for the
cost of prescription medications dispensed to you. The information on or
accompanying the bill may include information that identifies you, as well as
the prescriptions you are taking.
We will use PHI for health care
operations. Example: The
Pharmacy may use information in your health record to monitor the performance
of the pharmacists providing treatment to you. This information will be used in
an effort to continually improve the quality and effectiveness of the health
care and service we provide.
We are likely to use
or disclose PHI for the following purposes:
Business associates:
There are some services
provided by us through contracts with business associates. Examples include our
software system vendor and technology provider Etreby Computer Company. When
these services are contracted for, we may disclose PHI about you to our
business associate so that they can perform the job we have asked them to do and
bill you or your third-party payer for services rendered. To
protect PHI about you, we require the business associate to appropriately
safeguard the PHI.
Communication with individuals
involved in your care or payment for your care:
Health professionals such as pharmacists, using their
professional judgment, may disclose to a family member, other relative, close
personal to friend or any person you identify, PHI relevant that person's
involvement in your care or payment related to your care.
Health-related communications: We may contact you to provide refill reminders or information about
treatment alternatives or other health-related benefits and services that may
be of interest to you.
Food and Drug
Administration (FDA): We
may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI
relative to adverse events with
respect to drugs, foods, supplements,
products and product defects, or post marketing surveillance information to
enable product recalls, repairs, or replacement.
Worker's compensation:
We may disclose PHI about
you as authorized by and as necessary to comply with laws relating to worker's
compensation or other similar programs established by law.
Public health: As required by law, we may disclose PHI about you to public health or legal
authorities charged with preventing or controlling disease, injury, or
disability.
Law enforcement: We may disclose PHI about you for law enforcement purposes as required by
law or in response to a valid subpoena or other legal process.
As required by law: We must disclose PHI about you when required do so by law.
Health oversight activities: We may disclose PHI about you to an oversight agency for activities
authorized by law. These oversight activities include audits, investigations,
and inspections, as necessary for our licensure and for the government to
monitor the health care system, government programs, and compliance with civil
rights laws.
Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about
you in response to a court or administrative order. We may
also disclose PHI about you in response to a subpoena, discovery request, or
other lawful process by someone else involved in the dispute, but only if
efforts have been made to tell you about the request or to obtain an order
protecting the requested PHI.
We are permitted to use or
disclose PHI about you for the following purposes:
Research: We may disclose PHI about you to researchers when their research has been
approved by an institutional review board that has reviewed the research
proposal and established protocols to ensure the privacy of your information.
Coroners, medical examiners, and funeral directors: We may release PHI about
you to a coroner or medical
examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death. We may
also disclose PHI to funeral directors consistent with applicable law to carry
out their duties.
Organ or tissue
procurement organizations: Consistent
with applicable law, we may disclose PHI about you to organ procurement
organizations or other entities engaged in the procurement, banking, or
transplantation of organs for the purpose of tissue donation and transplant.
Fundraising: We may contact you as part of a fundraising effort.
Notification: We may use or disclose PHI about you to notify or assist in notifying a
family member, personal representative, or another person responsible for your
care, your location, and general
condition.
Correctional institution: If you are or become an inmate of a correctional institution, we may
disclose PHI to the institution or its agents when necessary for your health or
the health and safety of others.
To avert a serious threat to health or safety:
We may use and disclose PHI about you when
necessary to prevent a serious threat to your health and safety or the health
and safety of the public or another
person.
Military and
veterans: If you are a member of the
armed forces, we may release PHI about you as required by military command
authorities. We may also release PHI about foreign military personnel to the
appropriate military authority.
National security
and intelligence activities: We
may release PHI about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We may disclose PHI about you to authorized federal official so they may
provide protection to the President, other authorized persons or foreign heads
of state or conduct special investigations.
Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as a social
service or protective services agency, if we reasonably believe you are a
victim of abuse, neglect, or domestic violence. We will only disclose this type
of information to the extent required by law, if you agree to the disclosure,
or if the disclosure is allowed by law and we believe it is necessary to
prevent serious harm to you or someone else or the law enforcement or public
official that is to receive the report represents that it is necessary and will
not be used against you.
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 for above or as otherwise permitted or
required by law. You may revoke this 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 the “Privacy Officer” whose name appears at the end
of this notice at the pharmacy address and telephone number at the top of page
1 of this notice.
If you believe your privacy
rights have been violated, you can file a complaint with the “Privacy Officer”
whose name appears at the end of this notice or with the Secretary of Health
and Human Services. There will be no retaliation for filing a complaint.
Effective Date
This Notice is effective as of April
7, 2003
Privacy Officer: Robert Murdock