HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAYBE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASEREVIEW IT CAREFULLY
When this Notice of Privacy Practices (“Notice”) refers to“we” or “us,” it is referring to Novi and all the pharmacists who providehealth care services and the employees of our pharmacy. We are required by lawto maintain the privacy of your protected health information (“PHI”), to followthe terms of the Notice currently in effect, to give you this Notice settingforth our legal duties and privacy practices concerning your PHI and to notifyaffected individuals following a breach of unsecured PHI. This Notice describeshow we may use and disclose your PHI. Additionally, this Notice explains therights you have with respect to your PHI, and certain obligations we must abideby in accordance with the law. We reserve the right to amend this Notice. If wemake any material revisions to this Notice, we will post a copy of the revisedNotice in the pharmacy, on our website and will offer you a copy of the revisedNotice.
I. USE AND DISCLOSURE OF YOUR PHI
We will use and disclose your PHI for treatment, payment andhealth care operations. We may also use your PHI for other purposes that arepermitted and/or required by law and pursuant to your written authorization.The following lists examples of how we may use and/or disclose your PHI. Anyother uses not described in this Notice will only be made with your explicitwritten authorization, which you may revoke at any time by providing us withwritten notice of your revocation.
A. Treatment – We may use and disclose your PHI in order toprovide you with prescription and supply services. We may disclose your PHI toother pharmacists, pharmacy technicians and health care providers that areinvolved in your care. You will receive an individual notice and have theopportunity to opt out of any subsidized treatment communications.
B. Payment – We will use and disclose your PHI in order toobtain payment for the health care services we provide to you. We may also needto disclose your PHI to receive prior approval from your health plan or todetermine if your health plan will cover a certain prescription or service.
C. Health Care Operations – We may use and disclose your PHIin connection with the management of our pharmacy. For example, this mayinclude: quality assessment and improvement, internal compliance audits, andperformance evaluations.
Additionally, we may use your PHI for our businessmanagement and general administrative activities.
D. Prescription Refill Reminders, Treatment Alternatives orHealth-Related Benefits – We may use and disclose your PHI to contact you toremind you about prescription refills, to tell you about treatment options oralternatives, or to inform you about health-related benefits or services thatmay be of interest to you.
E. Family Members, Relatives or Close Friends – Unless youobject to such disclosure, we may disclose your PHI to your family members,relatives or close personal friends, or any other persons identified by you asbeing involved in the treatment or payment for your medical care. If you arenot present to agree or object to our disclosure of your PHI to a familymember, relative or friend, we may exercise our professional judgment todetermine whether the disclosure is in your best interest. If we decide to discloseyour PHI, we will only disclose the PHI that is relevant to your treatment orpayment.
F. Other Permitted and Required Uses and Disclosures – Wemay use your PHI without obtaining your authorization and without offering youthe opportunity to agree or object as follows: as required by law, providedhowever, that the use or disclosure will be made in compliance with applicablelaw; to a public health authority that is authorized by law to collect orreceive such information, or to a foreign government agency that is acting incollaboration with a public health authority and these health activitiesgenerally include preventing or controlling disease, reporting deaths,reporting adverse effects of medications or problems with products,notification of communicable disease, and reporting abuse or neglect undercertain circumstances; to a health oversight agency for oversight activitiesauthorized by law, including audits and inspections, and civil, administrativeor criminal investigations, proceedings or actions; for judicial oradministrative proceedings purposes in response to a subpoena, court order,discovery request, etc. but only if efforts have been made to inform you aboutthe request or to obtain an order protecting the information requested; to lawenforcement to report certain injuries, comply with court orders or warrants orsimilar process, to identify a suspect, fugitive, missing person, or victi,m orto report a crime; to a coroner or medical examiner to perform dutiesauthorized by law, such as identification of a deceased person or determiningthe cause of death; to funeral directors, consistent with applicable law, asnecessary to carry out their duties; to organ procurement organizations orsimilar entities for the purpose of facilitating organ, eye or tissue donationand transplantation; for research purposes provided that certain approvals takeplace and assurances are given; to avert a serious threat to health or safety,so long as the disclosure is only to a person who is reasonably able to preventor lessen such threat; for military and veterans activities (including foreignmilitary personnel) to assure the proper execution of a military mission and todetermine eligibility for benefits; for national security and intelligenceactivities for the purpose of conducting lawful intelligence,counter-intelligence and other national security activities; for protection ofthe President and other authorized persons or foreign heads of state or toconduct authorized investigations; to a correctional institution or lawenforcement custodian if you are an inmate or under custody; and to the extentnecessary to comply with laws relating to workers’ compensation andwork-related injuries.
II. YOUR RIGHTS AS OUR PATIENT
As our patient, you have a number of rights associated withyour PHI. The following describes your specific rights.
A. You have the right to request restrictions or limitationson how we use and/or disclose your PHI, however, we do not have to agree toyour requested restriction or limitation (except for transactions you paid forin full out-of-pocket). Your written request must specify: (1) if you wouldlike to restrict or limit our use and/or disclosure; (2) what information youwant restricted or limited; and (3) to whom the restriction or limitationapplies (e.g., spouse).
If we agree to your request, it will not prevent us fromdisclosing your PHI as follows: (1) to you if you request access or anaccounting of disclosures; (2) for purposes required or permitted by law; or(3) in case of an emergency.
B. You have the right to receive confidential communicationsconcerning your PHI by alternative means or via alternative locations. Forexample, you may want to receive communications related to your prescriptionsat a different address other than your home address. If you wish to receiveconfidential communications via alternative means or locations, please submityour request in writing to the Privacy Officer and set forth the alternativemeans by which you wish to receive communications or the alternative locationat which you wish to receive such communications. We will accommodate allreasonable requests.
C. You have the right to access, inspect and obtain a copyof your PHI, including any electronic PHI; provided, however, you are notentitled to access certain PHI exempted under HIPAA. To the extent we maintainelectronic PHI, upon request we will provide you with a copy of your PHI in theformat requested. If we do not have your PHI in our possession, we will provideyou with the appropriate contact information when your request is received. Ifyou request a copy of your PHI, you will receive a response to your request ina timely fashion but may be charged a reasonable, cost-based fee to cover copycosts and postage. In some limited circumstances, we may deny your request foraccess to PHI in which case you may request for the denial to be reviewed. If accessis ultimately denied, you are entitled to a written explanation with thereason(s) for the denial.
D. You have the right to receive an accounting ofdisclosures of your PHI made by us, including disclosures to or by our businessassociate(s), for a period of six (6) years prior to the date on which yourequest an accounting of disclosures, or such lesser period as you indicate.You will receive one request annually free of charge and, thereafter, we maycharge you a reasonable, cost-based fee for each subsequent request for anaccounting of disclosures within the same twelve-month period. We will notify youof the cost for an accounting of disclosures and you may choose to withdraw ormodify your request before we charge you.
E. If you believe we have PHI about you that is incorrect orincomplete, you may make a written request to us stating the reasons to supportany requested amendment. You have the right to request an amendment to your PHIfor so long as we maintain your PHI. If we do not have your PHI in ourpossession, we will provide you with the appropriate contact information whenwe receive your request. We will respond to your request for an amendment afterwe receive your request. However, we may deny your request for amendment if,for example, we determine that the PHI you requested was not created by us oris already accurate and complete. You may respond to our denial by filing awritten statement of disagreement, but we have the right to rebut yourdisagreement. If this occurs, you have the right to request that your originalrequest, our denial, your statement of disagreement, and our rebuttal beincluded in future disclosures of your PHI.
F. You have the right at any time to obtain a paper copy ofthis Notice, even if you receive this Notice electronically. If you havereceived an electronic copy of this Notice but wish to obtain a paper copy ofthis Notice, please send your request in writing to the Privacy Officer at theaddress listed below.
G. You have the right to opt-out of fundraising and your PHIwill not be used for fundraising purposes or sold without your priorauthorization.
III. Additional Information/Questions or Complaints
A. If you need any additional information about this Noticeor wish to exercise any of your rights set forth in this Notice, please contactthe Privacy Officer at the following address: Novi 1590 Rosecrans Ave ManhattanBeach CA 90266
If you believe your privacy rights have been violated, youmay file a complaint without retaliation with the Privacy Officer of thepharmacy or with:
Secretary of the Department of Health and Human Services
200 Independence Avenue SW
Washington D.C. 20201