Phone: (214) 521-9991 Fax: (214) 521-1649 6901 Preston Road at Grassmere Dallas, Texas 75205 |
HIPAA NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can gain access to this information. Please review it carefully. - This notice does not apply to health information that does not identify you or anyone else. Our Responsibilities We are required by applicable federal and state law to maintain the privacy of your protected health information. "Protected Health Information" (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices that are described in this notice while it is in effect. This notice is effective April 14, 2003, and will remain in effect until we replace it. We reserve the right to change our privacy practice 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 PHI that we maintain, including PHI 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. For more information about the 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 Protected Health Information We use and disclose PHI about you for treatment, payment and health care operations. Following are examples of the types of uses and disclosures that we are permitted to make. Treatment: We may use or disclose your PHI to physician or other health care provider providing treatment to you. We may use or disclose your PHI to a health care provider so that we can make prior authorization decisions under your benefit plan. Payment: We may use and disclose your PHI to get benefit payments for the health care services provided to you. We may disclose your PHI to another health plan, to a health care provider, or other entity subject to the federal Privacy Rules for their payment purposes. Payment activities may include processing claims, determining eligibility or coverage for claims. Health Care Operations: We may use and disclose your PHI in connection with our healthcare operations, and disclose PHI to business associates with whom we have written agreements containing terms to protect the privacy of your PHI. Your Privacy Rights The Law gives you the right to:
The law requires us to protect the privacy of health information that identifies you. It also requires us to give you a Notice of its legal duties and privacy practices.
How We Use Medical Information That Identifies You 1. Payment We may use or disclose health information about you to pay or collect payment for your health care. 2. Health care operations We may use or disclose health information about you for health care operations. Health care operation includes:
3. Family member, other relative, or close personal friend We may disclose health information about you to a family member, other relative or close personal friend when:
Our company may not disclose health information about you to family members, relativies, or friends without your written permission or the written permission of your guardian. 4. Government programs providing public benefits We may disclose health information about you to another government agency offering public benefits if:
5. Health oversight activities We may sometimes use or disclose health information about you for health oversight activities. Health oversight activities include looking into:
Our company may disclose health information for oversight activities only to another health oversight agency. A health oversight agency must be a governmental agency or someone acting on behalf of a government agency. 6. Public Health We may disclose health information about you to:
7. Victims of abuse, neglect, or domestic violence If we believe you are the victim or abuse, neglect, or domestic violence, we may sometimes disclose health information about you to a government agency that receives reports of abuse, neglect or domestic violence if:
8. Serious threat to health or safety We may use or disclose health information about you if it believes the use or disclosure is needed:
9. For other law enforcement purposes We may disclose health information about you to a law enforcement official for the following law enforcement purposes:
10. For judicial or administrative proceedings We may disclose health information about you in responce to:
11. As required by law We must use or disclose health information about you when a law requires the use or disclosure. 12. Contractors We may disclose health information about you to one of its contractors if the contractor:
13. Secretary of Health and Human Services We must disclose health information about you to the Secretary of Health and Human Services when the Secretary wants it to enforce privacy protections. 14. Research We may use or disclose health information about you for research if a research board approves the use. The board will ensure that your privacy is protected when your information is used in research. Your health infomation may also be used:
15. Other uses and disclosures We may use or disclose health information about you:
Questions and Complaints if you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice. If you are concerned that we may have violated your privacy rights, you may complain to us using the contact information listed at the end of this notice. You also may submit a writen complaint to the U.S. Department of Health and Human Services; see information at its web site: htt://www.hhs.gov/. If you request, we will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We support your right to the privacy of your PHI. 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 HIPAA Privacy Officer at: Preston Road Pharmacy 6901 Preston Road Dallas, Texas 75205 214-521-9991 Jonathan Lipe |
