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Notice of Privacy Practices
Effective as of 14 April 2003
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.
Recently, the Department of Health and Human Services (HHS) has enacted the Health Insurance Portability and Accountability Act (HIPAA). The law was passed to promote standardization and efficiency within the healthcare industry. It created what is known as Protected Health Information (PHI), which is any healthcare information that may specifically identify you, including demographic information, information about your past, present, or future medical conditions, including physical and mental health, or any treatment or related healthcare services. The Apothecary Shops (Apothecary) would like to make you aware of your rights and our responsibilities, as identified by HIPAA.
CLICK TO DOWNLOAD THE HIPAA AUTHORIZATION FOR DISCLOSURE FORM --->
Uses and Disclosures
Apothecary may use your PHI in the preparation of your order. This may include prescription and over-the-counter medication, as well as medical devices and educational programs. We may use your information to contact you, your representative, your physician, or your third party payor (i.e. insurance company) to prepare your order or provide services.
We collect information from you or your representative in order to accurately and beneficially provide you with care. None of your information is ever sold, either during or after your treatment with Apothecary. Occasionally, we may contact you, your representative, your healthcare provider, or your third party payor to suggest treatment options, offer reminders of therapy, find alternatives for care, or to resolve payment issues. Your physician may be contacted in order for us to clarify or discuss treatment, as well as ask for refills and changes, per your request. Your third party payor may be contacted to determine coverage or eligibility, discuss payment or reimbursement, or to gather additional information in an attempt to submit claims.
Any communication necessary to provide and maintain our high standard of care would be carried out as needed; however, it would always be executed within the limits of HIPAA and constrained to the release or collection of the minimum amount of information.
Business Associates (i.e. insurance companies, pharmacy benefits managers, etc.) of Apothecary may have access to your PHI from time to time. These companies are either covered by the laws of HIPAA or have agreed to abide by these laws through Business Associate Contracts they have signed with us. We will hold all entities with which we do business to the standards of our privacy practices and HIPAA laws. Any company wavering from these policies will be given notice of their shortcomings with an opportunity to correct their mistakes. Associations will be severed with associates who are unable to continually maintain these privacy standards.
Be assured that at all time, Apothecary will release or collect only the minimum amount of information necessary to accomplish its objective. We apply the most stringent standard of law, whether state or federal, to the protection of your PHI.
Authorizations
Orders may be placed, altered, and picked-up, and PHI may be given to or changed by someone other than yourself, with your permission. For current patients, Apothecary would apply historical standards to your care. For instance, if a spouse or care-giver has regularly attended to your orders and PHI, this would be considered the standard. To ensure seamless service, please list all persons allowed to access your information at the end of this notice.
Information may be disclosed without your consent in certain circumstances, as required by law. These include requests from the Department of Health and Human Services, state departments of insurance, law enforcement agencies, and court orders, as well as other public health, military, and judicial agencies. We will comply with all requests by authorized agencies, but will only release the information necessary to fulfill the request, as required by law. In these instances, you would be notified of any such disclosures, in accordance with the law.
It is required that a written release be obtained by Apothecary in order to use or disclose any PHI not otherwise described in this notice. You may revoke this authorization at any time with a written request.
Individual Rights
A request for access to your information may be made to our Privacy Officer during business hours. In most instances, you have the right to receive copies of your PHI. Printed copies are available for $1.00 per page. You have the right to request that any information in your record which you believe to be incorrect or incomplete be corrected or added to, once complete and accurate information is verified. You may make an amendment to your PHI at any time, although this amendment may or may not influence the content or release of your information, but it will be kept as a permanent part of your record. You may request that any correspondence with regard to your PHI be delivered to you by means other than in person. A written request must be received, acknowledging the fact that you would possibly endanger yourself or your information, before such information is delivered by alternative means.
You may request that your information not be shared with Business Associates or other HIPAA Covered Entities, such as third party payors, pharmacy benefits managers, or physicians. Also, you may request a list of all disclosures of your health information that we have made to others. We do not routinely monitor these disclosures, with some exceptions as required by law, but will accommodate the request to the best of our ability. Apothecary will consider all of the above requests, but we are not legally required to fulfill them.
Legal Duties
The Apothecary Shops have a legal duty to protect the privacy of your information, to provide and make available our Notice of Privacy Practices and legal duties, including updates and revisions, and to abide by the terms of this notice.
Complaints
Should you disagree with a decision that has been made with regard to your records, or believe that your rights have been violated, you may contact our Privacy Officer, listed below. Also, you may contact the State of Arizona Board of Pharmacy. Finally, you have the right to file a complaint with the Secretary of the Department of Health and Human Services. In accordance with Federal Regulation 160.306, your complaint must be filed in writing within 180 days of the violation, unless good cause is found to waive this time limit. The complaint must list the entity thought to be in violation and the subject of the violation, as well as describe the standards, requirements, or specifications believed to have been violated. Apothecary will not retaliate against any person who files a complaint.
Requests and Information
We are dedicated to protecting your privacy. This Notice of Privacy Practices may be updated and revised over time. For the most up to date version of this document, please visit our website at www.theapothecaryshop.com or contact our Privacy Officer. To submit requests for records or disclosures, to correct or add information to your record, or to receive more details about HIPAA and The Apothecary Shop’s privacy practices, please contact our Privacy Officer by telephone at (480) 203-0677 or by mailing your request to:
Apothecary Shops
Attn: Privacy Officer
23620 North 20th Drive
Phoenix, Arizona 85085
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