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.
All of us at Belmont 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 provide you with health care products and services.
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 physical or mental health condition or illness and its treatment. We will mainly use and disclose your PHI in relation to the health care products and services that we provide you. 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.
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 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 home medical equipment department, and if you request, provide a written Notice to you.
Your Rights With Respect To Your PHI
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides you with the following rights related to your PHI:
- You have the right to receive this written Notice of Privacy Practices describing how we will protect your PHI and your rights related to PHI. You are entitled to request this written Notice at any time.
- You have the right to request a limitation on our use and disclosure of your PHI. All requests for limitation on the use and disclosure of your PHI must be submitted to our Privacy Officer in writing, using a form that we will provide to you.
- You have the right to review or receive photocopies of our records that contain your PHI.
- You have the right to request changes in the content of your PHI contained in our records where you believe the content is incomplete, inaccurate, or for some other reason needs to be changed. We may not be able to agree to your request if it affects the accuracy of your PHI. You have the right to submit a written statement of disagreement to our Privacy Officer. All requests for changes to your PHI in our records must be submitted to our Privacy Officer in writing, using a form that we will provide to you.
- You have the right to request that we communicate with you about your PHI in a confidential manner and only to locations (such as a post office box) or by means (such as personal cellular telephone) specified by you. All requests for confidential communications must be submitted to our Privacy Officer in writing, using a form that we will provide to you.
- You have the right to obtain an accounting of some of our disclosures of your PHI made after April 14, 2003. By an accounting, we mean a written record of these disclosures. Some of our disclosures of your PHI are not required by HIPAA to be included in the accounting. Most notable among these are disclosures for purposes of treatment, obtaining payment, and carrying out health care operations. Other disclosures of your PHI that are not required to be included in the accounting are disclosures made directly to you or that you have authorized, made to family, friends, and others who assist you with your care (caregivers) and made for other purposes allowed by HIPAA. Please consult with our Privacy Officer for more information on the disclosures not required to be included in the accounting. The period of time for which we are required to provide the accounting is the six-year period immediately prior to the date of your request for the accounting but no earlier than April 14, 2003; however, your request for an accounting can be for a shorter period of time. All requests for an accounting of our disclosures of your PHI must be submitted to our Privacy Officer in writing, using a form that we will provide to you.
You have the right to file a complaint if you believe that we have violated your rights as described above, and to not fear retaliation or adverse action by us against you for exercising your right. You can file the complaint with us directly, or with the United States Department of Health and Human Services (HHS). Please be assured that we will work with you to resolve any complaint, including providing you with the address for filing a complaint with HHS.
Ways That We May Use and Disclose Your PHI
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that this Notice tell you how we may use and disclose your PHI. These uses and disclosures are summarized below:
- Treatment – We may use and disclose PHI about you for – the provision, coordination, or management of health care and related services by one or more health care providers. As a pharmacy/home medical equipment provider, we may use and disclose your PHI as necessary to maintain a patient profile on you, your medical condition, medications, and prescription devices that you use; any allergies that you may have; and other information, such as any health insurance that you may have. Finally, we may use and disclose your PHI to you and your caregivers in our discussions with you and your caregivers about your treatment, as well as in counseling about proper use of medications.
- Payment – We will use and disclose PHI about you to others to bill and obtain reimbursement for the health care products and services that we provide to you. These activities include primarily billing you directly or someone who pays for your health care, such as a family member or health insurance company, for health care products and services that we provide to you. If required we will disclose PHI about you for purposes of audits, inspections and investigations.
- Health care operations – We may use and disclose PHI in business activities that are related to (a) the monitoring of the quality of health care products and services provided to you by us, case management, care coordination, or treatment options; (b) conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs; and (c) our pharmacy/home medical equipment management and general administrative activities.
- Business associates – In many situations, it will be necessary for us to provide your PHI to business associates so that they can carry out the activities that we need to have performed in order to provide you health care products and services. Very importantly to you, business associates are required to give us their assurance that they, like us, will protect the privacy of your PHI.
- Disclosures of your PHI – In providing health care products and services to you, we may find it necessary to communicate with businesses and individuals. Most of these disclosures will be related to providing treatment to you, and to carrying out payment and health care operations. In addition to communicating with these businesses and individuals, we may also communicate with you directly, as well as others who assist you with your health care, commonly referred to as caregivers. We will disclose your PHI to these caregivers, or appropriate others, as we believe necessary and appropriate for your health care.
- Emergencies/health personnel – We may share your PHI with a public or private agency for disaster relief purposes. We may release your PHI to a coroner or medical examiner if necessary. We may also disclose your PHI to funeral directors consistent with applicable law to carry out their duties.
Health and treatment communications – We want to assist you with maintaining your health and obtaining the most benefit from your treatment. We routinely monitor your prescription medications for appropriateness and to help you use your medication properly. For example, if our records show that a refill of your medication is due, we may contact you to remind you to obtain the refill. We may also call you or send you materials regarding products and services that we believe may be of benefit to you.
- Federal and state government agencies – We may disclose your PHI to federal and state government agencies for a variety of purposes, most of which are directed at monitoring health care quality and safety, and government programs related to health care and our compliance with laws applicable to health care. Also, we may disclose your PHI for qualification of government funded programs such as “Section 8 Housing”.
- Federal and state government health care insurance programs – If you apply for and receive benefits from federal and state health care programs, such as Medicare or Medicaid, your PHI may be disclosed to the agency granting these benefits. Your PHI may be disclosed for qualification of workers compensation. Your PHI may be disclosed for qualification of any government funded programs. Such plans have a right to conduct audits, inspections, and investigations of our activities and your activities, and where required, we will disclose your PHI for these activities.
Public health and safety – If your physical or mental health condition and illness is of a nature that federal or state law requires it to be reported, then we will disclose your PHI to the appropriate government agency in order to comply with these laws. We may also disclose your PHI to government agencies in other situations where we are required to submit reports, such as suspected domestic, child or elder abuse, or neglect.
- Law enforcement activities – Governmental agencies may engage in a number of activities designed to monitor and improve federal and state health care programs and systems, including conducting inspections and investigations of our activities and the health care products and services that we provide to our patients. At any time we are required by federal or state laws, or by court order, subpoena or other legal mandate, to disclose your PHI, we will do so as necessary.
- Legal disputes – Lawsuits and other legal disputes may involve your PHI that we possess. In the event that you are involved in a lawsuit or other legal proceeding, whether as a plaintiff or a defendant, and without regard to the basis for the lawsuit, we will disclose your PHI when required to comply with a court order, subpoena, discovery proceeding, such as a deposition, or other legal mandate served upon us.
- Disclosures for the benefit of you and others – A variety of events could occur where we would use and disclose your PHI for your benefit and to prevent or reduce the risk of harm to you. For example, if you are in a car accident and are unconscious in a hospital emergency room and the emergency room medical staff calls us with a request for your PHI, we may disclose it for the purpose of assisting in your prompt medical treatment. Finally, we may disclose your PHI where necessary to protect the health and safety of others.
Disclosures for national security and intelligence – We are legally required to disclose your PHI where necessary to national security activities and intelligence and counterintelligence activities. Any disclosure for these purposes would be made only to authorized government officials.
- Disclosures if you are in the military or a veteran – We may disclose your PHI, if you are a member of any branch of the armed services, whether on active or reserve status as required by the U.S. Military. Also, if you are a veteran, we may release your PHI. Any disclosure for these purposes would be made only to authorized government officials.
- Disclosures of a miscellaneous nature – We may be required to disclose your PHI if you are placed into the custody of a federal or state correctional system, if necessary to protect the health and safety of you and others. Health care is an area where much research is being conducted, and we may disclose your PHI for purposes of a research project. Finally, given the national need for organ donations, we may disclose your PHI to organizations that manage organ transplantation programs.
IF YOU HAVE QUESTIONS ABOUT WAYS THAT WE MAY USE AND DISCLOSE YOUR PHI AS DESCRIBED ABOVE, PLEASE CONTACT OUR PRIVACY OFFICER.
North Carolina State Law
If you receive services in North Carolina, some North Carolina State laws provide you more protection than HIPAA, and where applicable, we will follow the requirements of those State laws. The following North Carolina laws may apply to you:
Under North Carolina law, minors, with or without the consent of a parent or guardian, have the ability to consent to services for the prevention, diagnosis and treatment of certain illnesses including: venereal disease and other diseases that must be reported to the State; pregnancy; abuse of controlled substances or alcohol; and emotional disturbance. Abortion services, however, still require the consent of the parent, guardian or a grandparent with whom the minor has been living for at least six (6) months unless a court has determined that the minor should be treated as an adult. Minors may petition a court to waive this requirement for parental consent.
If you suffer from a communicable disease (for example, tuberculosis, syphilis or HIV/AIDS), information about your disease will be treated as confidential. Other than circumstances described to you in other sections of this notice, we will not release any information about your disease except as required to protect public health, prevent the spread of a disease, or at the request of the State or Local Health Director.
Uses and Disclosures Not Contained in this Notice
If a use and disclosure of your PHI is not contained in this Notice, then we will obtain your written authorization before use and disclosure. You may have the right to refuse to authorize the use and disclosure, or if you grant the authorization, to revoke the authorization at any time. If such authorization is requested, we will provide you with a form that describes the proposed use and disclosure and your rights related to the requested authorization.
Please consult our Privacy Officer if you have any questions or want more information concerning your health care and privacy rights under HIPAA or the laws of our state, or our privacy practices. Also, you should consult our Privacy Officer if you wish to file a complaint about our privacy practices or if you believe we have violated any of your rights as described in this Notice.
HIPAA requires that we give you this “Notice of Privacy Practices” and make a good faith effort to obtain your written acknowledgement that you were given this Notice. Upon giving you this Notice, you will be asked to sign a document acknowledging that you received this Notice. We appreciate your cooperation in reviewing this Notice and in giving us your written acknowledgement.
Effective Date: April 14, 2003
Again, thank you for allowing us the privilege of being your pharmacy and home medical equipment provider. We look forward to continuing to be of service to you.