NOTICE OF PRIVACY PRACTICES FOR MALHEUR DRUG, 198 A STREET, VALE, OR 97918 (514)473-3333 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. The pharmacy is required by law to maintain the privacy of Protected Health Information (PHI) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is 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. This Notice of Privacy Practices (Notice) describes how we may use and disclose PHI to carry-out treatment, payment, or health care operations or other specified purposes that are permitted or required by law. This Notice also describes your rights with respect to PHI about you. The Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you. YOUR HEALTH INFORMATION RIGHTS 1. Obtain a paper copy of the Notice upon request. 2. Request a restriction on certain uses and disclosures of PHI. 3. Inspect and obtain a copy of PHI. 4. Receive an accounting of disclosures of PHI. 5. Request communications of PHI by alternative means or at an alternative location. Please submit all requests in writing to the Privacy Officer. We reserve the right to deny any request. A fee may apply for copies and mailing costs. EXAMPLES OF HOW WE MAY USE AND DISCLOSE PHI 1. Treatment: For example, information obtained by the pharmacist will be used to dispense prescription medications to you. We will document all information related to the medications dispensed and services provided to you. 2. Payment: For example, we will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your copayment. The information on or accompanying the bill may include information that identifies you, as well as the prescription you are taking. 3. Health Care Operations: For example, the Pharmacy may use information in your health record to monitor the performance of the pharmacist providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide. We are likely to use or disclose PHI for the following purposes: Business associates, Communication with individuals involved in your care or payment for your care, Health-related communications, Food and Drug Administration (FDA), Worker�s Compensation, Public health, Law enforcement, As required by law, Health oversight activities, and Judicial and administrative proceedings. We are permitted to use or disclose PHI about you for the following purposes: Research, Coroners, Medical examiners, Funeral directors, Organ or tissue procurement organizations, Fundraising, Notification, Correctional institutions, To avert a serious threat to health or safety, Military and veterans, National security and intelligence activities, Protective services for the President and others, and Victims of abuse, neglect, or domestic violence. The pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided in this Notice. You may revoke an authorization in writing at any time. If you have a dispute with the Pharmacy regarding a disclosure or use of your PHI, you may contact the Privacy Officer or the Secretary of Health and Human Services. For more information, contact the Privacy Officer at 198 A Street, Vale, OR 97918. This Notice is effective June 15, 2004.