THRIFTY DRUG STORES, INC. d/b/a THRIFTY WHITE DRUG / WHITE DRUG / BELL PHARMACY/VALLEY DRUG/ THRIFTY NYSTROM DRUG NOTICE OF PRIVACY PRACTICES

Transcription

1 THRIFTY DRUG STORES, INC. d/b/a THRIFTY WHITE DRUG / WHITE DRUG / BELL PHARMACY/VALLEY DRUG/ THRIFTY NYSTROM DRUG NOTICE OF PRIVACY PRACTICES 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. Thrifty White Drug (the Pharmacy ) is required by law t maintain the privacy f yur Prtected Health Infrmatin ("PHI") and t prvide yu with this ntice f ur legal duties and privacy practices with respect t PHI. PHI is infrmatin abut yu that identifies yu and that relates t yur past, present r future physical r mental health r cnditin and related health care services. This Ntice f Privacy Practices ("Ntice") describes hw we may use and disclse PHI abut yu. The Ntice als describes yur rights with respect t PHI abut yu. The Pharmacy is required t fllw the terms f the Ntice that is currently in effect. We will ntify yu in the event there is a breach f any unsecured PHI abut yu. Yur Health Infrmatin Rights Under State Law Sme state laws prvide yu with greater prtectin fr yur infrmatin r greater access t yur recrds than the federal HIPAA Privacy Regulatins. The Pharmacy will abide by the laws in the state where yu btain services frm us when thse state laws prvide yu with even greater prtectin r access t yur health infrmatin than HIPAA. Nte that in certain states, sme health infrmatin abut yu, including HIV/AIDS-related infrmatin (Iwa, Mntana, Nrth Dakta), infrmatin abut sexually transmitted diseases (Mntana), substance abuse infrmatin (Iwa, Nrth Dakta) and mental health infrmatin (Iwa, Mntana, Nrth Dakta) is subject t additinal restrictins n disclsure. Hw We May Use and Disclse PHI The fllwing are descriptins and examples f ways we use and disclse yur PHI: We will use PHI fr treatment. Infrmatin btained by the Pharmacy will be used t dispense prescriptin medicatins t yu, cntact physicians and cunsel yu and ther caregivers. We will dcument infrmatin related t the medicatins dispensed t yu and services prvided t yu. We may use PHI t crdinate care with ther pharmacies and healthcare prviders. We may cntact ther health care prfessinals if we have cncerns regarding prescriptin misuse r addictin. We will use PHI fr payment. We will cntact yur insurer r pharmacy benefit manager t determine whether it will pay fr yur prescriptin and the amunt f yur c-payment. We will bill yu r a thirdparty payer fr the cst f prescriptin medicatins dispensed t yu. The billing infrmatin may include the prescriptins yu are taking. We will disclse infrmatin as needed t thers invlved in paying fr yur care t btain payment fr services prvided t yu. We will give an insurer the infrmatin necessary t perfrm their duties with yur plan spnsr. We will use PHI fr health care peratins. Health care peratins includes activities such as training, legal, auditing and cmpliance, custmer service and ther pharmacy management and administratin activities. We may use yur PHI t mnitr the perfrmance f the pharmacists prviding treatment t yu and t imprve the quality and effectiveness f the health care and service we prvide. PHI may be transferred t anther pharmacy if they are buying a stre frm us. This allws yu t have yur prescriptin histry available t yu. We are likely t use r disclse PHI fr the fllwing purpses: Business assciates: Sme services are prvided thrugh cntracts with ur business assciates. Examples include liability insurers, attrneys, cllectin agencies, pharmacy sftware and systems prviders, and data switches t relay data t yur insurer. When we wrk with business assciates, we

2 may disclse PHI abut yu s that the business assciate can perfrm the jb we have asked them t d. T prtect PHI abut yu, we require the business assciate t apprpriately safeguard the PHI. Cmmunicatin with individuals invlved in yur care r payment fr yur care: Pharmacists and ther Pharmacy emplyees, using their prfessinal judgment, may disclse PHI t a persn that has been designated by yu and/r is acting as yur agent r authrized representative, as permitted under state law. We may disclse PHI relevant t that persn's invlvement in yur care r payment related t yur care. Fr example, we may disclse PHI t a persn designated by yu t pick up yur prescriptin r t smene calling n yur behalf t ur Accunts Receivable Department. Refill reminders and health-related cmmunicatins: We may cntact yu t prvide refill reminders r infrmatin abut current medicatins r treatment alternatives, r ther health-related benefits and services that may be f interest t yu. This cmmunicatin may be via phne, mail, r ther frm f cmmunicatin. If we receive any financial remuneratin fr making such refill r medicatin cmmunicatins beynd ur csts f making the cmmunicatin, we must first btain yur written authrizatin t make such cmmunicatins. We are nt required t btain yur written authrizatin fr face-t-face cmmunicatins. Fd and Drug Administratin (FDA): We may disclse t the FDA, r persns under the jurisdictin f the FDA, PHI relative t adverse events with respect t drugs, fds, supplements, prducts and prduct defects, r pst-marketing surveillance infrmatin t enable prduct recalls, repairs, r replacement. Wrker's cmpensatin: We may disclse PHI abut yu as authrized by and as necessary t cmply with state laws relating t wrker's cmpensatin r similar prgrams. Iwa law allws release f all infrmatin cncerning an emplyee s physical r mental cnditin relative t the claim t any party making r defending a claim a claim fr benefits. Minnesta law permits disclsure, withut cnsent, f infrmatin related t a wrkers cmpensatin claim t thse parties that are invlved in the claim. Mntana law prvides that s lng as a patient is claiming wrkers cmpensatin r ccupatinal disease benefits, a signed claim fr thse benefits authrizes disclsure t the insurer f infrmatin relating t the patient s cnditin. Nrth Dakta law prvides that filing a wrkers cmpensatin claim cnstitutes cnsent t the use f medical infrmatin by the state wrkers cmpensatin bureau, in any prceeding by the bureau r t which the bureau is a party. Suth Dakta law requires medical practitiners t make reprts as required by the state Department f Labr. Medical infrmatin must be made available n demand t an emplyer, emplyee, insurer, r the Department f Labr fr purpses f a wrkers cmpensatin claim. Wiscnsin law allws disclsure f infrmatin regarding a wrk-related injury t yur emplyer, yur emplyer s wrkers cmpensatin insurer, r the Department f Wrkfrce Develpment. Public health: As required by law, we may disclse PHI abut yu t public health r legal authrities charged with preventing r cntrlling disease, injury, r disability. Law enfrcement: We will disclse PHI abut yu fr law enfrcement purpses as required r permitted by law, including disclsures t an inspectr r investigatr whse duty it is t enfrce the laws relating t drugs, and wh is engaged in a specific investigatin invlving a designated persn r drug, r fr reprting suspected crimes such as child abuse. 2

3 Minnesta and Wiscnsin laws generally d nt allw the release f infrmatin frm a persn s health recrd withut a valid curt rder r warrant, unless specifically required r authrized by law. Iwa law generally requires yur cnsent r a curt rder t release infrmatin fr law enfrcement purpses, unless therwise authrized r required by law. As required by law: We must disclse PHI abut yu when required t d s by law. Health versight activities: We may disclse PHI abut yu t an versight agency fr activities authrized by law. These versight activities include audits, investigatins, and inspectins, as necessary fr ur licensure and fr the gvernment t mnitr the health care system, gvernment prgrams, and cmpliance with civil rights laws. Minnesta and Wiscnsin laws require that mst patient-identifying infrmatin (such as name and address) be remved (when pssible) frm mst disclsures fr health versight activities, unless yu have prvided written cnsent fr access t yur prtected health infrmatin. Wiscnsin law allws private-pay patients that are nt nursing hme residents t deny access f this type by annually submitting t the Pharmacy a written request n a frm prvided by the state Department f Health. Judicial and administrative prceedings: We may disclse PHI abut yu in respnse t a valid curt r administrative rder. We may als disclse in respnse t certain types f subpenas, discvery requests, r ther lawful prcess. We may disclse in the cntext f civil litigatin when yu have put yur cnditin at issue in the litigatin. r warrant r grand jury subpena. Minnesta law requires a valid curt rder, administrative rder, warrant, statutry authrity, r yur written cnsent. Wiscnsin law requires a valid curt rder, statutry authrity, r yur written cnsent. We are als permitted t use r disclse PHI abut yu fr the fllwing purpses: Research: We may disclse PHI abut yu t researchers when their research has been apprved by an institutinal review bard r a privacy bard that has reviewed the research prpsal and established prtcls t ensure the privacy f yur infrmatin, r with yur written authrizatin. Minnesta law generally requires a written cnsent befre we can disclse any medical infrmatin abut yu fr medical research t an utside researcher. We will btain yur cnsent r refusal t participate in any research study, r we will make a gd faith effrt t btain yur cnsent r refusal, prir t releasing any identifiable infrmatin abut yu fr research purpses. Crners, medical examiners, and funeral directrs: We may release PHI abut yu t a crner r medical examiner. This may be necessary, fr example, t identify a deceased persn r determine the cause f death. We may als disclse PHI t funeral directrs cnsistent with applicable law t carry ut their duties. Organ r tissue prcurement rganizatins: Cnsistent with applicable law, we may disclse PHI abut yu t rgan prcurement rganizatins r ther entities engaged in the prcurement, banking, r transplantatin f rgans fr the purpse f tissue dnatin and transplant. Fundraising: Pharmacy, r ne f its business assciates, may use certain infrmatin abut yu (including basic demgraphic infrmatin, dates that yu received care frm Pharmacy, utcme infrmatin and insurance status) t let yu knw abut fundraising pprtunities fr Pharmacy r its fundatin. Yu have the right t pt ut f receiving such fundraising cmmunicatins, and each 3

4 cmmunicatin yu receive will include an pprtunity t pt ut f future fundraising cmmunicatins. Alternatively, yu may ntify the Privacy Officer t pt ut f receiving all fundraising cmmunicatins. Crrectinal institutin: If yu are r becme an inmate f a crrectinal institutin, we may disclse PHI t the institutin r its agents when necessary fr yur health r the health and safety f thers. In mst situatins, Minnesta law requires us t get yur written cnsent prir t making such disclsures. Minnesta law des allw certain persns acting n yur behalf (as yur agent ) t have access t yur prescriptin infrmatin. When the crrectinal institutin acts as yur agent, we will prvide the crrectinal institutin with yur prescriptin infrmatin. In mst situatins, Iwa law will requires us t get yur written cnsent prir t making such disclsures. Iwa law des allw disclsures t yur authrized agent and as determined by the pharmacist in his r her prfessinal judgment t thse he r she believes are entitled t the infrmatin. When the crrectinal institutin acts as yur authrized agent, r when the pharmacist determines in his r her prfessinal judgment that the crrectinal institutin is entitled t the infrmatin, we will prvide the crrectinal institutin with yur prescriptin infrmatin. T avert a serius threat t health r safety: We may use and disclse PHI abut yu when necessary t prevent a serius threat t yur health and safety r the health and safety f the public r anther persn, but generally will d s nly with yur written cnsent unless we are authrized r required by law t make the disclsure. Fr example, we will disclse the infrmatin in situatins where state law prvides that the pharmacist has a duty t warn abut a specific threat r danger. Military and veterans: If yu are a member f the armed frces, we will release PHI abut yu as required by military cmmand authrities if required t d s by law. We may als release PHI abut freign military persnnel t the apprpriate military authrity, if required t d s by law. If release is nt required r permitted by law, we will btain yur cnsent prir t making such disclsures. Minnesta, Wiscnsin and Iwa law generally d nt permit this type f disclsure withut written cnsent r unless therwise required by federal law. Natinal security and intelligence activities: We may release PHI abut yu t authrized federal fficials fr intelligence, cunterintelligence, and ther natinal security activities authrized by law. Minnesta, Wiscnsin and Iwa law generally d nt permit this type f disclsure withut written cnsent, r unless therwise required by federal law. Prtective services fr the President and thers: We may disclse PHI abut yu t authrized federal fficial s they may prvide prtectin t the President, ther authrized persns r freign heads f state r cnduct special investigatins. Minnesta, Wiscnsin and Iwa law generally d nt permit this type f disclsure withut written cnsent, r unless therwise required by federal law. Victims f abuse, neglect, r dmestic vilence: We may disclse PHI abut yu t a gvernment authrity, such as a scial service agency, if we reasnably believe yu are a victim f abuse, neglect, r dmestic vilence. We will nly disclse this type f infrmatin t the extent required by law, if yu cnsent t the disclsure, r if the disclsure is allwed by law and we believe it is necessary t prevent serius harm t yu r smene else r the law enfrcement r public fficial that is t receive the reprt represents that it is necessary and will nt be used against yu. Other Uses and Disclsures f PHI We are required t btain a written authrizatin frm yu fr mst uses and disclsures f psychtherapy ntes, uses and disclsures f PHI fr marketing purpses and disclsures that cnstitute a sale f PHI. The Pharmacy 4

5 will btain yur written authrizatin befre using r disclsing PHI abut yu fr purpses ther than thse prvided fr abve (r as therwise permitted r required by law). If yu prvide us with this written authrizatin t use r disclse medical infrmatin abut yu, yu may revke that authrizatin, in writing, at any time. If yu revke yur authrizatin, we will n lnger use r disclse medical infrmatin abut yu fr the reasns cvered by yur written authrizatin, except t the extent we have already relied n yur authrizatin. We are unable t take back any disclsures we have already made with yur permissin, and we are required t retain ur recrds f the care that we prvided t yu. Yur Health Infrmatin Rights Under HIPAA Yu have the fllwing rights with respect t PHI abut yu: Obtain a paper cpy f the Ntice upn request. Yu may request a cpy f the Ntice at any time. Even if yu have agreed t receive the Ntice electrnically, yu are still entitled t a paper cpy. T btain a paper cpy, cntact yur nearest Thrifty White Drug lcatin. Request a restrictin n certain uses and disclsures f PHI. Yu have the right t request additinal restrictins n ur use r disclsure f yur PHI by sending a written request t the Privacy Officer. If yu pay ut-f-pcket in full fr an item r service, then yu may request that we nt disclse infrmatin t yur health plan pertaining slely t such item r service. We are required t agree with such a request. Hwever, we are nt required t agree t any ther request. If we d agree, we will cmply with yur request unless the infrmatin is needed t prvide yu emergency treatment r yu request that we remve the restrictin. In Minnesta, if yu request a restrictin n the infrmatin we disclse t a health maintenance rganizatin ( HMO ) the law may prhibit us frm accepting payment frm yu abve the cst-sharing amunt fr the item r service that is the subject f the requested restrictin. T request restrictins, yu must make yur request in writing t: Privacy Officer, Thrifty White Drug, 6055 Nathan Lane N, Suite 200, Plymuth, MN In yur request, yu must tell us (1) what infrmatin yu want t limit; (2) whether yu want t limit ur use, disclsure, r bth; and (3) t whm yu want the limits t apply. Inspect and btain a cpy f PHI. Yu have the right t access and cpy PHI abut yu cntained in a designated recrd set fr as lng as the Pharmacy maintains the PHI. The designated recrd set usually includes prescriptin and billing recrds. T inspect r cpy PHI abut yu, yu must send a written request t the Pharmacy where yu had prescriptins filled. We may charge yu a fee fr the csts f cpying, mailing and supplies that are necessary t fulfill yur request, t the extent permitted by applicable state and federal law. If we maintain yur health infrmatin electrnically as part f a designated recrd set, yu have the right t receive a cpy f yur health infrmatin in electrnic frmat upn yur request. Yu may als direct us t transmit yur health infrmatin (whether in hard cpy r electrnic frm) directly t an entity r persn clearly and specifically designated by yu in writing. We may deny yur request t inspect and cpy in certain limited circumstances. If yu are denied access t PHI abut yu, yu may request that the denial be reviewed. Nte: individuals ver the age f 18 must request a cpy f their wn recrds, and spuses are nt able t btain the recrds f the ther spuse withut the authrizatin f the spuse wh is the subject f the recrds. State laws allw minrs t keep sme recrds cnfidential frm parents r guardians in certain cases. In mst f these cases, minrs are respnsible fr payment fr the services and prducts related t thse recrds. If a minr chses t use his r her parents insurance r payment infrmatin, the Pharmacy cannt assure that the recrds will be kept cnfidential. In additin, we are permitted in sme cases t infrm the parent f legal guardian f the minr patient f any treatment given r needed where, in the judgment f the pharmacist, failure t infrm the parent r guardian wuld seriusly jepardize the health f the minr patient. Minrs must ntify the Pharmacy in writing in situatins where the minr believes the infrmatin shuld be kept cnfidential s that the Pharmacy can make a determinatin abut whether the infrmatin must be shared with a parent r guardian. In Mntana, yu must be prvided the requested infrmatin within 10 days. 5

6 Request an amendment f PHI. If yu feel that PHI we maintain abut yu is incmplete r incrrect, yu may request that we amend it. Yu may request an amendment fr as lng as we maintain the PHI. T request an amendment, yu must send a written request t the pharmacy where yu btained the infrmatin. Yu must include a reasn that supprts yur request. In certain cases, we may deny yur request fr amendment. If we deny yur request fr amendment, yu have the right t file a statement f disagreement with the decisin and we may give a rebuttal t yur statement. In Mntana, yur amendment request must be acted upn within 10 days f yur request. Receive an accunting f disclsures f PHI. Yu have the right t receive an accunting f the disclsures we have made f PHI abut yu fr mst purpses ther than treatment, payment, r health care peratins. The accunting will exclude certain disclsures, such as disclsures made directly t yu, disclsures yu authrize, disclsures t friends r family members invlved in yur care that are permitted by state and federal law, disclsures fr ntificatin purpses and certain disclsures t the State Bard f Pharmacy r ther regulatry agencies. T request an accunting, yu must submit a request in writing t Privacy Officer, Thrifty White Drug, 6055 Nathan Lane N, Suite 200, Plymuth, MN Yur request must specify the time perid, but may nt be lnger than six years frm the date f the request. The first accunting yu request within a 12 mnth perid will be prvided free f charge, but yu may be charged fr the cst f prviding additinal accuntings. We will ntify yu f the cst invlved and yu may chse t withdraw r mdify yur request at that time. Request cmmunicatins f PHI by alternative means r at alternative lcatins. Fr instance, yu may request that we cntact yu abut medical matters nly in writing r at a different residence r pst ffice bx. T request cnfidential cmmunicatin f PHI abut yu, yu must submit a request in writing t the pharmacy where yu have yur prescriptins filled. Yur request must state hw r where yu wuld like t be cntacted. We will accmmdate all reasnable requests, althugh we are permitted t require yu t prvide infrmatin abut hw payment will be handled. Fr Mre Infrmatin r t Reprt a Prblem If yu have questins r wuld like additinal infrmatin abut the Pharmacy's privacy practices, yu may cntact the Privacy Officer, Thrifty White Drug, 6055 Nathan Lane N, Suite 200, Plymuth, MN The e- mail address is privacyffice@thriftywhite.cm. If yu believe yur privacy rights have been vilated, yu can file a cmplaint by writing t: Privacy Officer, Thrifty White Drug, 6055 Nathan Lane N, Suite 200, Plymuth, MN Yu may als file a cmplaint with the Secretary f Health and Human Services. There will be n retaliatin against yu fr filing a cmplaint. Effective Date This Ntice is effective as f September 23, We reserve the right t change ur practices and this Ntice and t make the new Ntice effective fr all PHI we maintain. Upn request, we will prvide a revised Ntice t yu, and we will pst a revised ntice at each Thrifty White Drug lcatin. 6