Affiliated with Walsh Distribution L.L.C. and HealthcareAmerica.com
|
Affiliated with Walsh Distribution L.L.C. and HealthcareAmerica.com |
|
|
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO
US. OUR LEGAL DUTY We reserve the right to change
our privacy practices and the terms of this Notice at any time, provided such
changes are permitted by applicable law.
We reserve the right to make the changes in our privacy practices and
the new terms of our Notice effective for all health information that we
maintain, including health information we created or received before we made
the changes. Before we make a
significant change in our privacy practices, we will change this Notice and
make the new Notice available upon request. You may request a copy of our
Notice at any time. For more
information about our privacy practices, or for additional copies of this
Notice, please contact us using the information listed at the end of this
Notice. USES AND DISCLOSURES OF
HEALTH INFORMATION Treatment: We may use or
disclose your health information to a physician or other healthcare provider
providing treatment to you. Payment: We may use and
disclose your health information to obtain payment for services we provide to
you. Healthcare Operations: We may use and
disclose your health information in connection with our healthcare
operations. Healthcare operations
include quality assessment and improvement activities, reviewing the competence
or qualifications of healthcare professionals, conducting training programs,
accreditation, certification, licensing or credentialing activities. Your Authorization: In addition to
our use of your health information for treatment, payment or healthcare
operations, you may give us written authorization to use your health
information or to disclose it to anyone for any purpose. If you give us an authorization, you may
revoke it in writing at any time. Your
revocation will not affect any use or disclosures permitted by your authorization
while it was in effect. Unless you give
us a written authorization, we cannot use or disclose your health information
for any reason except those described in this Notice. To Your Family and Friends: We must
disclose your health information to you, as described in the Patient Rights
section of this Notice. We may disclose
your health information to a family member, friend or other person to the
extent necessary to help with your healthcare or with payment for your
healthcare, but only if you agree that we may do so. Persons Involved In Care: We may use or
disclose health information to notify, or assist in the notification of
(including identifying or locating) a family member, your personal
representative or another person responsible for your care, of your location,
your general condition, or death. If
you are present, then prior to use or disclosure of your health information, we
will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency
circumstances, we will disclose health information based on a determination
using our professional judgment disclosing only health information that is
directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment
and our experience with common practice to make reasonable inferences of your
best interest in allowing a person to pick up filled prescriptions, medical
supplies, or other similar forms of health information. Marketing Health-Related Services: We will not
use your health information for marketing communications without your written
authorization. Required by Law: We may use or
disclose your health information when we are required to do so by law. We may disclose your health
information to the extent necessary to avert a serious threat to your health or
safety or the health or safety of others. National Security: We may
disclose to military authorities the health information of Armed Forces
personnel under certain circumstances.
We may disclose to authorized federal officials health information
required for lawful intelligence, counterintelligence, and other national
security activities. We may disclose to
correctional institution or law enforcement official having lawful custody of
protected health information of inmate or patient under certain circumstances. Refill Reminders: We may use or
disclose your health information to provide you with refill reminders (such as
voicemail messages, postcards, or letters). Incidental Disclosures: We may
disclose PHI incidental to our provision of treatment, payment, or health care
operations. For example, in our telephone discussions with your health care
professional or conversations with you, someone passing by might overhear your
PHI. Workers’ Compensation: We may
disclose PHI about you 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. Health Oversight
Activities: We may disclose PHI about you to an oversight agency for
activities authorized by the law. These
oversight activities include audits, investigations, and inspections, as
necessary for our licensure and for the government to monitor the health care
system, government programs, and compliance with civil rights laws.
PATIENT RIGHTS Access: You have the right to look at or get copies
of your health information, with limited exceptions. You may request that we provide copies in a format other than
photocopies. We will use the format you
request unless we cannot practicably do so.
(You must make a request in writing to obtain access to your health
information. You may obtain a form to
request access by using the contact information listed at the end of this
Notice. We will charge you a reasonable
cost-based fee for expenses such as copies and staff time. You may also request access by sending us a
letter to the address at the end of this Notice. If you request copies, we will charge you $0.___ for each page,
$___ per hour for staff time to locate and copy your health information, and
postage if you want the copies mailed to you.
If you request an alternative format, we will charge a cost-based fee
for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of
your health information for a fee.
Contact us using the information listed at the end of this Notice for a
full explanation of our fee structure.) Disclosure Accounting: You have the
right to receive a list of instances in which we or our business associates
disclosed your health information for purposes, other than treatment, payment,
healthcare operations and certain other activities, for the last 6 years, but
not before April 14, 2003. If you
request this accounting more than once in a 12-month period, we may charge you
a reasonable, cost-based fee for responding to these additional requests. Restriction: You have the right to request that we place
additional restrictions on our use or disclosure of your health
information. We are not required to
agree to these additional restrictions, but if we do, we will abide by our
agreement (except in an emergency). Alternative Communication: You have the
right to request that we communicate with you about your health information by
alternative means or to alternative locations. (You must make your request in
writing.) Your request must specify the
alternative means or location, and provide satisfactory explanation how payments
will be handled under the alternative means or location you request. Amendment: You have the
right to request that we amend your health information. (Your
request must be in writing, and it must explain why the information should be
amended.) We may deny your
request under certain circumstances. Electronic Notice: If you receive
this Notice on our Web site or by electronic mail (e-mail), you are entitled to
receive this Notice in written form.
QUESTIONS AND COMPLAINTS If you are concerned that
we may have violated your privacy rights, or you disagree with a decision we
made about access to your health information or in response to a request you
made to amend or restrict the use or disclosure of your health information or
to have us communicate with you by alternative means or at alternative
locations, you may complain to us using the contact information listed at the
end of this Notice. You also may submit
a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file
your complaint with the U.S. Department of Health and Human Services upon
request. We support your right to the
privacy of your health information. We
will not retaliate in any way if you choose to file a complaint with us or with
the U.S. Department of Health and Human Services. CONTACT INFORMATION Reuss
Pharmacy Phone
361-275-3411 Attn: Privacy Officer Fax 361-275-3783 P.O. Box 270 Cuero, TX 77954 |
