Privacy Policy
Keene Pharmacy
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. If you have any questions about this Notice
please contact our Privacy Contact who is Louis Caldwell, RPh. This notice
of Privacy Practices describes how we may use and disclose you protected
health information to carry out treatment, payment or health care operations
and for other purposes that are permitted or required by law. It also
describes your rights to access and control your protected health
information. “Protected health information” 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 required to abide by the terms of this
Notice of Privacy Practices. We may change the terms of our notice, at any
time. The new notice will be effective for all protected health information
that we maintain at that time. Upon your request, we will provide you with
any revised Notice of Privacy Practices by accessing our website at
www.keenepharmacy.com, calling the pharmacy and requesting a revised copy be
sent to you in the mail or asking for one at the time of your next visit. 1.
Uses and Disclosures of Protected Health Information Uses and Disclosures of
Protected Health Information Based Upon Your Written Consent You will be
asked by your pharmacist to sign a consent form. Once you have consented to
use and disclosure of your protected health information for treatment,
payment and health care operations by signing the consent form, your
pharmacist will use or disclose your protected health information as
described in this Section 1. Your protected health information may be used
and disclosed by your pharmacist, our pharmacy staff and others outside of
our pharmacy that are involved in your care and treatment for the purpose of
providing health care services to you. Your protected health information may
also be used and disclosed to pay your health care bills and to support the
operation of the pharmacy. Following are examples of the types of uses and
disclosures of your protected health care information that the pharmacy is
permitted to make once you have signed our consent form. These examples are
not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made by our pharmacy once you have provided consent.
Treatment: We will use and disclose your protected health information to
provide, coordinate, or manage your health care and any related services.
This includes the coordination or management of your health care with a
third party that has already obtained your permission to have access to your
protected health information. For example, we would disclose protected
health information to physicians who may be treating you when we have the
necessary permission from you to disclose your protected health information.
For example, your protected health information may be provided to a
physician to whom you have been referred to ensure that the physician has
the necessary information to diagnose or treat you. In addition, we may
disclose your protected health information from time-to-time to another
pharmacy or health care provider (e.g., a specialist or laboratory) who, at
the request of your Physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your physician.
Payment: Your protected health information will be used, as needed, to
obtain payment for your health care services. This may include certain
activities that your health insurance plan may undertake before it approves
or pays for health care services, such as; making a determination of
eligibility or coverage for insurance benefits, reviewing services provided
to you for medical necessity, and undertaking utilization review activities.
For example, obtaining approval for a prescription may require that your
relevant protected health information be disclosed to the health play to
obtain approval for the prescription. Healthcare Operations: We may use or
disclose, as-needed, your protected health information in order to support
the business activities of your pharmacy. These activities include, but are
not limited to, quality assessment activities, employee review activities,
licensing, marketing and conducting or arranging for other business
activities. For example, we may ask your name and your physician’s name when
you deliver a prescription to be filled. We may also call you by name when
your prescription is ready. We may use or disclose your protected health
information, as necessary, to contact you to remind you of a prescription
that has not been picked up. We will share your protected health information
with third party “business associates” that perform various activities
(e.g., billing services) for the pharmacy. Whenever an arrangement between
our pharmacy and a business associate involves the use or disclosure of your
protected health information, we will have a written contract that contains
terms that will protect the privacy of your protected health information. We
may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other
health-related benefits and services that may be of interest to you. We may
also use and disclose your protected health information for other marketing
activities. For example, your name and address may be used to send you a
newsletter about our pharmacy and the services we offer. We may also send
you information about products or services that we believe may be beneficial
to you. You may contract our Privacy Contact to request that these materials
not be sent to you. Uses and Disclosures of Protected Health Information
Based Upon Your Written Authorization Other uses and disclosures of your
protected health information will be made only with your written
authorization, unless otherwise permitted or required by law as described
below. You may revoke this authorization, at any time, in writing, except to
the extent that your pharmacist or the pharmacy has taken an action in
reliance on the use or disclosure indicated in the authorization. Other
Permitted and Required Uses and Disclosures That May Be Made With Your
Consent, Authorization or Opportunity to Object We may use and disclose your
protected health information in the following instances. You have the
opportunity to agree or object to the use or disclosure of the protected
health information. If you are not present or able to agree or object to the
use or disclosure of the protected health information, then your pharmacist
may, using professional judgment, determine whether the disclosure is in
your best interest. In this case, only the protected health information that
is relevant to your health care will be disclosed. Others Involved in Your
Healthcare: Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your protected
health information that directly relates to that person’s involvement in
your health care. If you are unable to agree or object to such a disclosure,
we may disclose such information as necessary if we determine that it is in
your best interest based on our professional judgment. We may use or
disclose your protected health information your protected health information
to an authorized public or private entity to assist in disaster relief
efforts and to coordinate uses and disclosures to family or other
individuals involved in your health care. Emergencies: We may use or
disclose your protected health information in an emergency treatment
situation. If this happens, your pharmacist shall try to obtain your consent
as soon as reasonably practicable after the delivery of treatment. If your
pharmacist is required by law to treat you and has attempted to obtain your
consent but is unable to obtain your consent, he or she may still use or
disclose your protected health information to treat you. Communication
Barriers: We may use and disclose your protected health information if your
pharmacist attempts to obtain consent from you but is unable to do so due to
substantial communication barriers and the pharmacist determines, using
professional judgment, that you intend to consent to use or disclosure under
the circumstances. Other Permitted and Required Uses and Disclosures That
May Be Made Without Your Consent, Authorization or Opportunity to Object We
may use or disclose your protected health information in the following
situations without your consent or authorization. These situations include:
Required By Law: We may use or disclose your protected health information to
the extent that the use or disclosure is required by law. The use or
disclosure will be made in compliance with the law and will be limited to
the relevant requirements of the law. You will be notified, as required by
law, of any such uses or disclosures. Public Health: We may disclose your
protected health information for public health activities and purposes to a
public authority that is permitted by law to collect or receive the
information. The disclosure will be made for the purpose of controlling
disease, injury or disability. We may also disclose your protected health
information, if directed by the public health authority, to a foreign
government agency that is collaborating with the public health authority.
Health Oversight: We may disclose protected health information to a health
oversight agency for activities authorized by law, such as audits,
investigations, and inspections. Oversight agencies seeking this information
include government agencies that oversee the health care system, government
benefit programs, other government regulatory programs and civil rights
laws. Abuse Or Neglect: We may disclose your protected health information to
a public health authority that is authorized by law to receive reports of
child abuse or neglect. In addition, we may disclose your protected health
information if we believe that you have been a victim of abuse, neglect or
domestic violence to the government entity or agency authorized to receive
such information. In this case, the disclosure will be made consistent with
the requirements of applicable federal and state laws. Food and Drug
Administration: We may disclose your protected health information to a
person or company required by the Food and Drug Administration to report
adverse events, product defects or problems, biologic product deviations,
track products; to enable product recalls; to make repairs or replacements,
or to conduct post marketing surveillance, as required. Legal Proceedings:
We may disclose protected health information in the course of any judicial
or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly
authorized), in certain conditions in response to a subpoena, discovery
request or other lawful process. Law Enforcement: We may also disclose
protected health information, so long as applicable legal requirements are
met, for law enforcement purposes. These law enforcement purposes include
(1) legal processes and otherwise required by law, (2) limited information
requests for identification and location purposes, (3) pertaining to victims
of a crime, (4) suspicion that death has occurred as a result of criminal
conduct, (5) in the event that a crime occurs on the premises of the
pharmacy and (6) medical emergency (not on the pharmacy‘s premises) and it
is likely that a crime has occurred. Criminal Activity: Consistent with
applicable federal and state laws, we may disclose your protected health
information, if we believe that the use or disclosure is necessary to
prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. We may also disclose protected health information if
it is necessary for law enforcement authorities to identify or apprehend an
individual. Workers’ Compensation: Your protected health information may be
disclosed by us as authorized to comply with workers’ compensation laws and
other similar legally-established programs. Inmate: We may use or disclose
your protected health information if you are an inmate of a correctional
facility and your pharmacy created or received your protected health
information in the course of providing care to you. Required Uses and
Disclosures: Under the law, we must make disclosures to you and when
required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section
164.500 et. Seq. 2. Your Rights Following is a statement of your rights with
respect to your protected health information and a brief description of how
you may exercise these rights. You have the right to inspect and copy your
protected health information. This means you may inspect and obtain a copy
of protected health information about you that is contained in a designated
record set for as long as we maintain the protected health information. A
“designated record set” contains prescription and billing records and any
other records that your pharmacy uses for making decisions about you. Under
federal law, however, you may not inspect or copy the following records:
information compiles in reasonable anticipation of, or use in, a civil,
criminal, or administrative action or proceeding, and protected health
information that is subject to law that prohibits access to protected health
information. Depending on the circumstances, a decision to deny access may
be reviewable. In some circumstances, you may have a right to have this
decision reviewed. Please contact our Privacy Contact if you have questions
about access to your medical record. You have the right to request a
restriction of your protected health information. This means you may ask us
not to use or disclose any part of your protected health information for the
purposes of treatment, payment or healthcare operations. You may also
request that any part of your protected health information not be disclosed
to family members or friends who may be involved in your care or for
notification purposes as described in this Notice of Privacy Practices. Your
request must state the specific restriction requested and to whom you want
the restriction to apply. Your pharmacist is not required to agree to a
restriction that you may request. If the pharmacist believes it is in your
best interest to permit use and disclosure of your protected health
information, your protected health information will not be restricted. If
your pharmacist does agree to the requested restriction, we may not use or
disclose your protected health information in violation of that restriction
unless it is needed to provide emergency treatment. With this in mind,
please discuss any restriction you wish to request with your pharmacist. You
may request a restriction by contacting the Pharmacist. You have the right
to request to receive confidential communications from us by alternative
means or at an alternative location. We will accommodate reasonable
requests. We may also condition this accommodation by asking you for
information as to how payment will be handled or specification of an
alternative address or other method of contact. We will not request an
explanation from you as to the basis for the request. Please make this
request in writing to our Privacy Contact. You may have the right to have
your pharmacist amend your protected health information. This means you may
request an amendment of protected health information. In certain cases, we
may deny your request for an amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement with us
and we may prepare a rebuttal to your statement and will provide you with a
copy of any such rebuttal. Please contact our Privacy Contact to determine
if you have questions about amending your medical record. You have the right
to receive an accounting of certain disclosures we have made, if any, of
your protected health information. This right applies to disclosures for
purposes other than treatment, payment or healthcare operations as described
in this Notice of Privacy Practices. It excludes disclosures we may have
made to you, to family members or friends involved in your care, or for
notification purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 14, 2003. You may
request a shorter timeframe. The right to receive this information is
subject to certain exceptions, restrictions and limitations. You have the
right to obtain a paper copy of this notice from us, upon request, even if
you have agreed to accept this notice electronically. 3. Complaints You may
complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a
complaint with us by notifying our Privacy Contact of your complaint. We
will not retaliate against you for filing a complaint. You may contact our
Privacy Contact, at 817-295-3341 or the Pharmacist for further information
about the complain process. This notice was published and becomes effective
on 4/14/03.