PharmCare Compounding Pharmacy, LLC Notice of Privacy Practices

Effective Date: September 23, 2013

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. We understand that your medical information is personal. We are committed to protecting your medical information. PharmaCare Compounding Pharmacy, LLC are required by law to maintain the privacy of your protected health information (‘PHI”), to follow th terms of this Notice, and to give you this Notice of our legal duties and privacy practices concerning your health information. We must follow the terms of the current Notice.

How PharmaCare May Use or Disclose Your Health Information

For Treatment. We may use your PHI to dispense prescriptions to you. We may disclose your PHI to treating physicians and other persons who are involved in your healthcare treatment.

For Payment. We may use and disclose your PHI so that we can bill and collect payment from you, your insurance company, or a third party. This may include conducting insurance eligibility checks with health plans, determining enrollment status, and providing information to entities that help us submit bills and collect amounts owed.

For Health Care Operations. We may use and disclose your PHI for health care operations, which include activities necessary to provide health care services and ensure you receive quality patient care.

Individuals Involved in Your Care or Payment for Your Care. We may disclose your PHI to a family member or friend who is involved in your medical care or payment for your care, provided you agree to this disclosure or we give you an opportunity to object to the disclosure. If you are unavailable or are unable to object, we will use our best judgment to decide whether this disclosure is in your best interest.

As Required by Law. We will disclose your PHI when required to do so by the federal, state or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. We may disclose your PHI for public health activities, such as those aimed at preventing or controlling disease, preventing injury, report reactions to medications or problems with products, recalling products, and reporting the abuse or neglect of children, elders and dependent adults. Any disclosure, however, would only be to someone able to help prevent the threat.

For Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities, which are necessary for the government to monitor the health care system, include audits, investigations, inspections and licensure.

For Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice) or to obtain an order protecting the information requested.

For Specialized Government Functions. We may disclose your PHI: (1) if you are a member of the armed forces, as required by military command authorities; (2) if you are inmate or in custody, to a correctional institution or law enforcement official: (3) in response to a request from law enforcement, under certain conditions; (4) for national security reasons authorized by law; (5) to authorized federal officials to protect the President, or other authorized persons or foreign heads of state.

For Worker’s Compensation. We may disclose your health information for worker’s compensation or similar programs.

For Organ and Tissure Donation. We may also disclose your PHI to organ procurement or similar organizations for purpose of donation or transplant.

For Coroners and Funeral Directors. Upon your death, we may release your PHI to a funeral home director, coroner, or medical examiner, consistent with applicable law to enable them to carry out their duties.

For Personal Representatives. We may disclose your PHI to a person legally authorized to act on your behalf, such as a parent, legal guardian, administrator or executor of your estate, or other individual authorized under applicable law.

For Marketing. With your authorization, we may use or disclose your PHI to our third-party agents, representatives, service providers and/or contractors to offer targeted marketing communications to you.

For Sale of PHI. With your authorization, we may receive remuneration, financial or otherwise, directly or indirectly in exchange for your PHI

For Business Associates. We may share your PHI with certain business associates that perform services for us. We may disclose your PHI to a business associate so that the business associate can perform the job we have asked it to do and bill you and your third-party payer for services rendered. Federal law requires us to enter into business associate contracts to safeguard your PHI as required by law and PharmaCare.

Limitations on Uses and Disclosures of Your Health Information. Except as described in this Notice, we will not use your PHI without your authorization. If you do give us authorization to use or disclose your PHI, you may cancel your authorization in writing at any time. If you cancel your authorization, this will stop any further use or disclosure for the purposes covered by your authorization, except where we have already acted on your permission. We must also follow any state law that is stricter than federal HIPPA regulations. In the event of a security breach involving your PHI, a notice will be provided to you.

You Have the Following Rights with Respect to Your Health Information in Our Records

  • You may request restrictions on the use or disclosure of your PHI for treatment, payment or health care operations, or when using or disclosing your PHI to someone who is involved in your care of the payment for your care, like a family member or friend. We are not required to agree to your request. If we agree, we will comply with your request except in certain emergency situations or as required by law.
  • You may request restrictions on certain disclosure of your PHI to your health plan for purposes of carrying our payment or health care operations regarding services paid for in full (out of pocket).
  • You may inspect and receive a paper copy of your medical records, if readily producible. Usually, this includes prescription and billing records, we may charge you for the costs of responding to your request. We may deny your request, in which case, you may request the denial be reviewed.
  • You may request we amend your health information if it is incorrect or incomplete. You must provide a reason that supports your request. We may deny your request if the health information is accurate and complete, or is not part of the health information kept by or for PharmaCare. If we deny your request, you have the right to submit a statement of disagreement regarding any item in your record you believe is incomplete or incorrect. Your request will become part of your medical record. We will attach it to your records and include it when we make a disclosure of the item or statement you believe to be incomplete or incorrect.
  • You may request an accounting of disclosures of your PHI. This is a list of the disclosures made of your health information, other than for treatment, payment or health care operations , and other exceptions allowed by law. Your request must specify a time period, which may not be longer than six years and may not include dates before April 14, 2003.
  • You may request we contact you in a certain way or at a certain location. For example, you may request we contact you only at work or at a different residence or post office box. Your written request must state how or where you wish to be contacted. We will grant reasonable requests. If you would like to exercise any of these rights, submit a written request to PharmaCare Compounding Pharmacy at 232 West Ave. Tallmadge, OH 44278. A paper copy of this Notice may be obtained from PharmaCare Compounding Pharmacy upon request.

Changes to this Notice of Privacy Practices

We reserved the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI we already have about you and any information we receive in the future. We will post a copy of the current Notice. If we change our Notice, you may obtain a copy of the revised Notice by contacting PharmaCare at 232 West Ave. Tallmadge, OH 44278.

For More Information or to Report a Problem

If you have questions about this Notice, contact PharmaCare Compounding Pharmacy at 232 West Ave. Tallmadge, OH 44278 or phone (330)-633-0714. If you believe your privacy rights have been violated, you may file a written complaint, and there will be no retaliation, with the Health &Wellness HIPAA Compliance Officer at the above address, or with the Secretary of the Dept of Health and Human Services, Office of Civil Rights.

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