724 Main Street , Rochester , IN 46975   (574) 223-2216

101 W. Rochester Street , Akron , IN   46910 (574) 893-4413

“The Professional Pharmacy with the Hometown Touch...”

 

Notice of Privacy Practices

Date of Notice:  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

 

Introduction

All of us at Webb’s Family Pharmacy value your relationship with us, and we know that respect for your privacy is the foundation of that relationship. We are committed to protecting the privacy of your protected health information (PHI) that is in our possession, and only using and disclosing your PHI as necessary to providing you with health care products and services. PHI is any information that we possess, use, and disclose that identifies you and relates to your past, current, or future physical and mental health condition or illness and the health care products and services that have been provided to you.

 

This “Notice of Privacy Practices” (Notice) has been created to help you understand our legal duties to protect your PHI and how we may use and disclose your PHI in relation to your past, present, and future health condition and its treatment. We will mainly use and disclose your PHI in relation to the health care products and services that we provide you, such as dispensing your prescriptions. Specifically, we will use and disclose your PHI as necessary to provide treatment to you, obtaining payment for health care products and services provided to you, and other health care operations and activities as described later in this Notice. This Notice also describes the legal rights that you have related to your PHI that is in our possession. We take the matters described in this Notice very seriously because of our relationship with you and the requirement that we comply with this Notice.

 

Your PHI will only be used and disclosed as described in this Notice. Should a need for use and disclosure of your PHI occur that is not described in this Notice, we will obtain your written authorization before the use and disclosure. At some future time, it may be necessary for us to revise this Notice. If such becomes necessary, we will post the revised Notice in the pharmacy and, if you request, provide a written Notice to you.

 

Ways That We May Use and Disclose Your PHI

1.  Under applicable law, we are required to protect the privacy of your individual health information (information we refer to in this notice as “Protected Health Information”).  We are also required to provide you with this notice regarding our policies and procedures regarding your Protected Health Information and to abide by the terms of this notice, as it may be updated from time to time.

 

We are permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and healthcare operations purposes.  We may obtain information to dispense prescriptions and for the documentation of pertinent information in your records that may assist us in managing your medication therapy or your overall health.  For treatment purposes, such use and disclosure will take place in providing, coordinating, or managing healthcare and its related services by one or more of your providers, such as when your pharmacist consults with your physician or a specialist regarding your medications, treatment or condition.

 

For payment purposes, such use and disclosure will take place to obtain or provide reimbursement for providing pharmaceutical care services, such as when your case is reviewed to ensure that appropriate care was rendered.  For reimbursement purposes, your Protected Health Information may be disclosed to one or several intermediaries employed by your plan sponsor including but not limited to insurers, pharmacy benefits managers, claims administrators and computer switching companies.

 

For healthcare operations purposes, such use and disclosure will take place in a number of ways, including for quality assessment and improvement, provider review and training, underwriting activities, reviews and compliance activities; planning, development, management and administration.  Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided.

 

We store some of your Protected Health Information in electronic computer files.  We backup our electronic records daily, and employ other precautions to safeguard the integrity of your Protected Health Information.  In spite of these precautions it is possible but unlikely that a computer crash or other technological failure could cause the loss of data.  In addition reasonable safeguards are employed to protect your Protected Health Information stored on electronic media.

 

In addition, we may contact you to provide refill reminders, health screenings, wellness events, inoculations, vaccinations or information about treatment alternatives or other health-related benefits and services that may be of interest to you.  In addition, we may disclose your health information to your plan sponsor.  In addition we may contact you for the purpose of fund raising activities.

 

We may use and disclose your Protected Health Information, without your authorization when the pharmacy needs to contact a physician or physician’s staff and is permitted or required to do so without individual written authorization.  We may use and disclose your Protected Health Information if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them.

 

From time to time we may employ the services of business associates who may assist us in one or more tasks and who may use, change or create Protected Health Information.  Business associates are required to comply with all the privacy regulations on your behalf.

 

We may disclose Protected Health Information about you without your authorization to comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, health oversight activities and as required by law.

 

As Permitted or Required by Law: Information about you may be used or disclosed to regulatory agencies, such as during audits, licensure or other proceedings; for administrative or judicial proceedings; to public health authorities; or to law enforcement officials, such as to comply with a court order or subpoena.

 

Other uses and disclosures will be made only with your written authorization, and you may revoke your authorization by notifying us at the address below.

 

2.  You may ask us to restrict uses and disclosures of your Protected Health Information to carry out treatment, payment, or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care.  However, we are not required to agree to your request.

 

3.  You have the right to request the following with respect to your Protected Health Information: (i) inspection and copying;  (ii) amendment or correction; (iii) an accounting of the disclosures of this information by us (we are not required to account to you for disclosures made for treatment, payment, operations, disclosures to you, disclosures to your care givers, for notifications or as otherwise excluded by law); and (iv) the right to receive a paper copy of this notice upon request.  We may require you to pay for this request to cover our costs of copying, labor and postage.

 

In addition, you may request, and we must accommodate the request, if reasonable, to receive communications of Protected Health Information by alternative means or at alternative locations.  To make this request please contact, in writing at the address below:                   

 

4.  We may use your name to reference your prescriptions and pharmaceutical care services.  You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this notice and the disclosure of Protected Health Information as outlined herein.  We may disclose this information to other persons who ask for you or your prescriptions by name.  You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative orally or in writing of your restriction or prohibition.  We are not required to honor those requests.  We are able to provide treatment services to you even if you object to sign the acknowledgment of the receipt of this notice or if we decide not to honor a request regarding the information in this document.  In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preference, and what we determine to be in your best interest.  We will inform you of any such uses or disclosures if uses and disclosures would require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable.

 

5.  We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care.  In addition we may use or disclose the Protected Health Information to notify, identify, or locate a member of your family, your personal representative, another person responsible for care, or certain disaster relief agencies of your location, general condition, or death.  If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do in our judgment what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare. We will also use our judgment and experience regarding your best interest in allowing people to pick-up filled prescriptions, or other similar forms of Protected Health Information.

 

6.  We reserve the right to change the terms of this notice and to make new notice provisions effective for all Protected Health Information we maintain.  You may receive a copy of this notice by contacting us as outlined in Section B or upon the receipt of pharmacy care services.

 

7.  If you believe that your privacy rights have been violated, you may complain to us at the location described in Section B or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building , 200 Independence Avenue SW , Washington , DC 20201 .  You will not be retaliated against for filing a complaint.

 

Contacting Us

You may contact us for further information at: Webb’s Family Pharmacy, INC, Harry Webb, Owner, 724 Main Street , Rochester , IN   46975 ; Phone 574-223-2216, Fax 574-223-3987; or Contact Us.  

 

Again, thank you for allowing us the privilege of being your pharmacy, and we look forward to continuing to be of service to you.

 

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Located in Rochester and Akron Indiana

“The Professional Pharmacy with the Hometown Touch...”  

 

 

 

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