Feldman’s Pharmacy
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
UNDERSTANDING YOUR PATIENT PRESCRIPTION RECORDS:
Each time you visit a pharmacy a record of your visit is made. Typically, this record contains your name, address, phone number, date of birth, allergies to medications, drug name, drug strength and dosage, and prescription insurance information. When supplies are ordered, diagnosis and letters of medical necessity may be added to your record. Feldman’s Pharmacy is required by law to maintain the privacy of this Protected Health Information (PHI) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. This information is used for the purposes of prescription dispensing, counseling, billing and communication among any and all health professionals who may contribute to your care and for other specified purposes that are permitted or required by law. Understanding what information is retained in your records and how may be used will help you to ensure its accuracy and enable you to relate to who, when, where, and why others may be allowed to access your PHI. This understanding can also help you make more informed decisions when authorizing disclosure to others. Use ore disclosure of your health information will follow the more stringent of State and Federal Laws.
UNDERSTANDING YOUR HEALTH INFORMATION RIGHTS:
Your prescription record is the physical property of Feldman’s Pharmacy, but the content is about you, and therefore belongs to you. You have the following rights with respect to PHI about you. You may request a copy of this notice at any time. You have the right to request additional restrictions on disclosure of your PHI, but we are not required to agree to those restrictions. You have the right to inspect and copy your PHI for the previous six years by contacting our privacy official. We have the right to charge you for the cost of reproduction of your PHI. If you are denied access to your PHI, you may have the right to appeal this decision to the Secretary of Health and Human Services or his representative. You have the right to confidential communications between Feldman’s Pharmacy and yourself and to have those communications made by alternative means at alternative locations. If you feel that the PHI that we maintain about you is incomplete or incorrect, you may request that we amend it by contacting our privacy official. You have the right to receive an accounting of the disclosures we have made of your PHI for most purposes other than treatment, payment, or health care operations for a period of six years prior to the request. Other disclosures excluded are direct disclosures to yourself, family or friends involved in your care. Other than activity that already has occurred, you may revoke any further authorization to use or disclose your health information.
OUR RESPONSIBILITIES:
Feldman’s Pharmacy is required to maintain the privacy of your prescription information and to provide you with notice of our legal commitment and privacy practices with respect to the information we collect and maintain about you. Feldman’s Pharmacy is required to abide by the terms of this notice and notify you if we are unable to grant your requested restrictions or reasonable desires to communicate PHI by alternative means or to alternative locations. Other than for reasons described in this notice, Feldman’s Pharmacy agrees not to use or disclose your PHI without your authorization. We reserve the right to change our practices and to make the new provisions effective for all PHI we maintain. Should our information practices change, we will post a revised notice at store locations, and give you a revised “Notice of Privacy Practices” with your next prescription. If we maintain a web site that provides information about our customer services or benefits we will post our new policy on that site.
TO RECEIVE ADDITIONAL INFORMATION OR REPORT A PROBLEM:
For further explanation of this notice you may contact our Dorsey Hall Medical Center Privacy Official at 410.730.8200, our Columbia Medical Center Privacy Official at 410.964.8444, or our Chartwell Medical Center Privacy Official at 443-620-9990. If you believe your privacy rights have been violated, you have the right to file a complaint with Feldman’s Pharmacy by contacting Amy Adams, Les Feldman, or by contacting the Secretary of Health and Human Services of the
EXAMPLES OF HOW WE MAY USE AND DISCLOSE PHI:
TREATMENT – PHI will be used by the pharmacist to dispense medication, for cognitive services or any other patient related services provided to you, and may be shared with other health care professionals involved in your care.
PAYMENT – Your PHI will be used for payment from your insurer or pharmacy benefit manager to determine payment to our pharmacy and the amount of any co-payment. A bill may be sent directly to you or to another third party payer. The information on or accompanying the bill may include your PHI.
BUSINESS ASSOCIATES – Some or all of your PHI may be subject to disclosure through contracts for services to assist our pharmacy in providing health care. To protect your PHI, we will require these Business Associates to follow the same standards held by our pharmacy through terms detailed in a written agreement. An example of a business Associate would be our relationship with our computer system vendor.
NOTIFICATION – If necessary, we may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
COMMUNICATIONS WITH INDIVIDUALS OTHER THAN YOURSELF – We may use professional judgment to disclose to a family member, other relative, close personal friend or any other person you identify, PHI relevant to that person’s involvement in your care or payment related care.
MARKETING – We may contact you to provide refill reminders or information about treatment alternatives or other specific health-related benefits and services for you at the telephone number or address that you authorize regarding such communications. You may request that this be restricted. Feldman’s Pharmacy does not sell patient information for marketing purposes.
FOOD AND DRUG ADMINISTRATION (FDA) – Feldman’s Pharmacy is required by law to disclose health information to the FDA related to any adverse effects of food, supplements, products, and defects for surveillance to enable product recalls, repairs, or replacement to the FDA or any other Health Oversight Agency.
WORKERS COMPENSATION – We may disclose PHI to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
PUBLIC HEALTH – We may disclose PHI as required by law, about you to public health or legal authorities charged with preventing or controlling disease, injury or disability.
ORGAN, EYE AND TISSUE DONATION – We may disclose your PHI to agencies involved with organ, eye and tissue donation if you are a donor.
LAW ENFORCEMENT – We may disclose PHI for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
NOTICE OF PRIVACY PRACTICES AVAILABILITY:
This notice will be prominently posted in the pharmacy where registration occurs. Patients will be provided a hard copy at the pharmacy where service occurs. This notice will be maintained at the following web site address:
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2003.