NOTICE OF PRIVACY PRACTICES
Effective April 14th, 2003
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.
Our Legal Duty:
We are required by applicable federal and state law to maintain the privacy of your health
information. We are also required to give you this Notice about our privacy practices that
are described in this Notice while it is in effect.
How we safeguard your Protected Health Information (PHI):
This notice of Privacy Practices (Notices) explains how your pharmacy uses and discloses you
PHI and the rights that you, as a patient, have to access that information and to keep it
private. We are required by law to protect the privacy of your PHI and to provide you with
this Notice. We are also required to follow the privacy practices that are described in
this Notice, which takes effect on April 14th, 2003. If a State Law provides you with
greater protection for your information or greater access to your records than the Federal
Law, we will abide by the State Law.
We reserve the right to change our privacy practices and the terms of this Notice at any
time, and to have those changes be effective for all information that we have, including PHI
we created or received before the effective date of the new Notice. If we make a significant
change in our privacy practices, we will make the new Notice available to you at the pharmacy.
How we use and disclose your PHI:
The following categories describe different ways that we use and disclose your PHI:
Treatment:
We may use or disclose your PHI to provide you with medical treatment or health-related
services. We may use your information to coordinate care with other pharmacies and
healthcare providers, including concerns we may have regarding suspected prescription misuse
or addiction. Other examples are filling your prescription or speaking to your physician
regarding your prescription, other medications you are taking, diagnosis, and medical condition.
Payment:
We may use and disclose your PHI in order to receive payment for the drugs you receive. For
example, we must to give information about your prescriptions to your health plan to obtain
payment.
Health Care Operations:
We may use and disclose PHI about you for our health care operations, which are activities
necessary to operate our pharmacy to ensure that you and all of our patients receive quality
care.
Business Associates:
There are some services provided by us through contracts with business associates. Then these
services are contracted for, we may disclose your PHI to our business associate's so that they
can perform the job we have asked them to do and bill you or your third party payer for services
rendered. To protect your PHI, we require the business associate to appropriately safeguard the
information.
Communications with Individuals Involved in your Care or Payment for your Care:
Heath professionals such as pharmacists, using their professional judgement, may disclose to
your family members, friends and persons you indicate are involved in your care, PHI that is
directly relevant to their involvement in your care or payment for your care.
Communications about Products and Services:
We may use and disclose your PHI to tell you about or recommend possible treatment options
or alternatives, or to tell you about health-related benefits or services that may be of
interest to you. We may communicate with you face-to-face regarding any products or services.
Required by Law:
We may use or disclose your healthcare information when we are required to do so by law.
Your Rights
Access:
Each person over the age of 18 has the right to review and obtain a copy of his or her PHI
contained in a designated record set, with limited exceptions. The designated record set
usually will include prescription and billing records. Parents of minor children may also
request the records of their minor children. We may require you to send a written request
to the Privacy Officer. If you request copies, we may charge you a fee to cover the costs
of copying, mailing and other supplies. We may deny your request to review and copy in
certain limited circumstances. If we deny your request, you may be entitled to a review of
that denial. Some state laws allow minors to keep some records confidential from parents or
guardians in certain cases. If a minor chooses to use his or her parents' insurance or payment
information, we cannot assure that the records will be kept confidential. The pharmacist may
make a determination about whether the information must be shared with a parent or guardian
if in the judgement of the pharmacist failure to inform the parent or guardian would seriously
jeopardize the health of the minor patient.
Amendment:
If you feel that your PHI incorrect or incomplete, you have the right to request that we
amend it. We require you to send a written request to the Privacy Officer. You must
include a reason to support your request. We may deny your request if we did not create
the information you want amended or for certain other reasons. You may respond with a
statement of disagreement to be included in your records.
Accounting of Disclosures:
You have the right to receive a list of disclosures we have made of you PHI. This right does
not apply to disclosures for treatment, payment, health care operations, and certain other
purposes. We require you to send a written request to the Privacy Officer. Your request must
specify the time period, but my not be longer than six years from the date of this request and
must not go back further that April 14th, 2003.
Restriction Requests:
You have the right to request that we place a restriction on our use of disclosure of you PHI
for treatment, payment, and health care operations. We are not required to agree to these
restrictions, but if we do, we will abide by our agreement, (except in an emergency). We require
you to send a written request to the Privacy Officer.
Your Authorization:
We may use and disclose your health information in connection with our 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 authorization you may revoke it at any time. Your revocation
will not affect any use of disclosures permitted by your authorization while it was in effect.
Unless you give us a written authorization, we cannot 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 do so.
Others Acting on Your Behalf:
Someone who has the legal right to act on your behalf may also exercise these rights.
Copy of this Notice:
You are entitled to receive a printed copy of this notice at any time. Please contact us using
the information listed above.
For More Information or the Report a Problem:
You may submit complaints or refer questions concerning the use of your PHI to:
Soderlund Village Drug
Chris Daniels, R.Ph., HIPPA Privacy Officer
Bill Soderlund, R.Ph., Security Officer
201 South 3rd Street
P.O. Box 498
Saint Peter, MN 56082
507-931-4410 or 800-603-8196
You may also submit a written complaint to the
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
We support your right to protect the privacy of your medical information and we will not
retaliate if you choose to file a complaint.
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