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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.
DATE OF NOTICE: April
10, 2003
SECTION A: Uses
and Disclosures of Protected Health Information
- 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. 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. 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;
and 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.. In
addition, we may disclose your health information to your
plan sponsor. In addition we may contact you for the purpose
of fund raising activities.
We may use and disclose your Protected Health Information,
without your authorization when the pharmacy needs to contact
a physician or physicians 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.
- 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.
- 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:
- 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 inform
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.
- 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 persons 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 persons involvement
with your healthcare. We will also use our judgment and
experience regarding your best interest in allowing people
to pick-up filled prescriptions, or other similar forms
of Protected Health Information.
- We reserve the right to change the terms
of this Notice and to make new Notice provisions effective
for all Protected Health Information we maintain. You may
receive a copy of this Notice by contacting us as outlined
in Section B or upon the receipt of pharmacy care services.
- If you believe that your privacy rights
have been violated, you may complain to us at the location
described in Section B or to the Secretary of the Department
of Health and Human Services, Hubert H. Humphrey Building,
200 Independence Avenue SW, Washington, DC 20201. You will
not be retaliated against for filing a complaint.
Section B: Contacting
Us
You may contact us for further information at:
Wilcox Pharmacy Inc
Richard Wilcox, Privacy Officer
252 Stratton Rd., Rutland, VT 05701 (802) 775-3351
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