SECTION A: Uses and Disclosures of Protected Health
Information
I . 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 strattera. 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 diflucan online. 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], [periodically store backups off site,] 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. [Add here
soecics on any other health related benefit offered by your pharmacy.]
In addition, we may disclose your health information to your plan
sponsor. In addition we may contact you for the purpose of fund
raising actitives.
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.
Other uses and disclosures will be made only with
your written authorization, and you may revoke your authorization
by notifying us as described in Section B.
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:
Alleon Pharmacy
7133 - 5th Avenue
Brokklyn NY 11209
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. This information may be disclosed
by us 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 infonn 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 pickup filled prescriptions, or
other similar forms of Protected Health Information.