​​

 

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.

 

Blount Pharmacy is required by law to maintain the privacy and security of Protected Health Information (“PHI”), to provide individuals with notice of our legal duties and privacy practices with respect to PHI, and to promptly notify affected individuals following a breach of unsecured 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.  This Notice also describes your rights with respect to PHI about you.

 

Blount Pharmacy is required to follow the duties and privacy practices described in this Notice and give you a copy of it.  We will not use or share your information other than as described in this Notice unless you tell us we can in writing.  If you tell us we can, you may change your mind at any time.  Let us know in writing if you change your mind.  We can change the terms of this Notice, and the changes will apply to all information we have about you.  Upon request, we will provide any revised Notice to you.

 

Your Rights

You have the following rights with respect to PHI about you:

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you contained in a designated record set for as long as Blount Pharmacy maintains the PHI.  The designated record set usually will include prescription and billing records.  Ask us how to do this.

• We will provide a copy or a summary of your health information, usually within 30 days of your request.  We may charge a reasonable, cost-based fee.

• You can ask us to correct health information about you that you think is incorrect or incomplete.  You may request an amendment for as long as we maintain the PHI.  You must include a reason that supports your request.  Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

  • We will say “yes” to all reasonable requests.  In the event of an emergency regarding your treatment, if we cannot reach you promptly using the alternative means or alternative location you requested, we may try to reach you by other means or at another location.

• You can ask us not to use or share certain health information for treatment, payment, or our operations.

  • We are not required to agree to your request, and we may say “no” if it would affect your care.

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.

  • We will say “yes” unless a law requires us to share that information.

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all the disclosures except for those about treatment, payment, and 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.  We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.  We will provide you with a paper copy promptly.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.

• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.S., Washington, D.C.  20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints

• We will not retaliate against you for filing a complaint.

 

Your Choices

For certain health information, you can tell us your choices about what we share.  If you have a clear preference for how we share your information in the situations described below, talk to us.  Tell us what you want us to do, and we will follow your instructions.

• In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory

  • Contact you for fundraising efforts

  • If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest.  We may also share your information when needed to lessen a serious and imminent threat to health or safety.

• In these cases, we never share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

• In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again

 

Our Uses and Disclosures

We typically use or share your health information in the following ways.

• Treat you:  We can use your health information and share it with other professionals who are treating you.

  • Example:  Information obtained by the pharmacist will be used to dispense prescription medications to you, and may be used to monitor the effectiveness, safety, and compliance of your drug therapy.  In addition, we may contact you to provide refill reminders, information about treatment alternatives, educational information about current or new therapeutic products, or information about other health-related benefits and services that may be of interest to you.

• Run our organization:  We can use and share your health information to run our practice, improve your care, and contact you when necessary.

  • Example:  we use health information about you to manage your treatment and services.

• Bill for your services:  We can use and share your health information to bill and get payment from health plans or other entities.

  • Example:  We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your copayment.  We will bill you or a third-party payor 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 are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research.  We have to meet many conditions in the law before we can share your information for these purposes.  For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

• Help with public health and safety issues:  We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reported suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

• Do research:  We can use or share your information for health research.

• Comply with the law:  We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• Respond to organ and tissue donation requests:  We can share health information about you with organ procurement organizations.

• Work with a medical examiner or funeral director:  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

• Address workers’ compensation, law enforcement, and other government requests:  We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

• Respond to lawsuits and legal actions:  We can share health information about you in response to a court or administrative order, or in response to a subpoena.

• Business associates:  There are some services provided by us through contracts with business associates.  For example, we may contract with a third party to perform Medicare Part B billing services for us.  We may disclose PHI about you to our business associate so that they can perform the job we have asked then to do and bill you or your third-party payor 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 friend or any person you identify, PHI relevant to that person’s involvement in your care or payment related to your care.

• 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.

• 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 your general condition.

• Correctional institution:  If you are or become an inmate of a correctional institution, we may disclose PHI to the institution when necessary for your health or the health and safety of others.

 

For more information see:  www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 

This Notice is effective as of January 12, 2017.

 

Texas Law Supplement

The following Texas law supplements the listed “Examples of How We May Use and Disclose PHI,” except as otherwise permitted or required by law:

We will only release your confidential record to you, your agent, or to:

(a) a practitioner or another pharmacist if, in the pharmacist’s professional judgment, the release is necessary to protect your health and well being;

(b) the pharmacy board or another state or federal agency authorized by law to receive the record;

(c) a law enforcement agency engaged in investigation of a suspected violated on the controlled substances laws, or the Comprehensive Drug Abuse Prevention and Control Act of 1970;

(d) a person employed by a state agency that licensed a practitioner, if the person is performing the person’s official duties; or an insurance carrier or other third party payor authorized by the patient to receive the information.

(e) an insurance carrier or other third party payor authorized by the patient to receive the information