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HIPAA Notice of Privacy Practice

NOTICE OF PRIVACY PRACTICES (Effective 4/14/03) 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. ANYONE MAY OBTAIN A PAPER COPY OF OUR PRIVACY PRACTICE NOTICE UPON REQUEST. “PROTECTED HEALTH INFORMATION” (PHI) is the information that may identify you by past, present and future mental/physical health or conditions and associated health care services to them. We are required by law to maintain the privacy of your PHI, to provide you notice of our legal duties and privacy practices with respect to PHI and to follow the terms of this Notice. We will not disclose or use your PHI without your written authorization, except as stated in this notice, as to use of the PHI to carry out Health Care operations, treatment or payment and for other purposes that are permitted or required by law. You have the right to revoke a written authorization at any time with a written request. It is our intention to use the minimum necessary amount of PHI to accomplish the following tasks: USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION TREATMENT: An example would be to use PHI to dispense your prescriptions or to disclose information to other health care professionals related to your treatment. We may converse with your physician’s office about your PHI as privately as possible as the pharmacy layout permits. We cannot guarantee that PHI will not be overheard by other patients in the immediate area. PAYMENT: We may use and disclose PHI so that your pharmacy services may be billed to an insurance company, other third parties or workers compensation as necessary. HEALTH CARE OPERATIONS: We may use and disclose PHI as necessary for our health care operations; to your physicians’ office or in other activities relating to compliance, auditing, business management or for purposes to improve the quality and effectiveness of the care and services provided to you. BUSINESS ASSOCIATES: Some of your PHI may be disclosed through contracts with outside persons or organizations. We require these Business Associates to follow the same standards of practice in regards to the privacy of your information. COMMUNICATION WITH FAMILY: Using our best judgment, a family member; caregiver or close personal friend, identified by you, may be given information regarding treatment, care or payment. OTHER USES AND DISCLOSURES of your PHI without your authorization. * Purposes required by law or in response to court order, subpoena or to authorized state or federal agents, including the FDA, FBI, or DEA. * Public health regarding the prevention and control of disease, injury, disability or public health investigations. * Health oversight activities for any law authorized activities to monitor the health care system, for inspections, investigations, audits and licensure. * Disclosure to proper authorities if we suspect abuse, neglect, or domestic violence or to avert a serious threat to health or safety. * For purposes permitted by law for research, organ or tissue donation, to coroners, medical examiners, funeral directors, workers compensation, military or other national security activities. RIGHTS YOU HAVE ACCESS YOUR PHI: You may have the right to inspect and copy your health information as long as the pharmacy maintains it. Your information usually will include your prescriptions records and profile. To inspect or copy this information you must submit a written request. We may charge you a fee for copying, mailing or other supplies as necessary. RESTRICTIONS ON YOUR PHI: You have the right to request restrictions on certain uses and disclosures of your PHI for any purpose other than treatment, payment or health care operations. The pharmacy is not required to agree to a restriction that you request, but we will accommodate reasonable requests when appropriate. AMENDMENTS TO YOUR PHI: You have the right to request that your PHI be amended or corrected. To request an amendment, you must submit a written request, signed by you or your representative and must state the reason for this request. We are not obligated to make all requested amendments but will give each request careful consideration. ACCOUNTING FOR DISCLOSURES: After April 14, 2003, you have the right to receive an accounting of certain disclosures above and beyond treatment, payment and health care operations. To request an accounting, you must submit a time period, no longer than 6 years. The first request in any 12 month period is free; however, additional requests will have associated fees. RIGHT FOR CONFIDENTIAL COMMUNICATION: You may request communication of your PHI by alternative means or at alternative locations. Please submit a written request, including how and where to be contacted. All reasonable requests will be accommodated. FURTHER INFORMATION The pharmacy will obtain written authorization before using or disclosing any PHI other than noted above. You have the right to revoke this written authorization with a written notice. FOR MORE INFORMATION, TO REPORT A PROBLEM OR COMPLAINT: Please contact the pharmacist on duty at the pharmacy if you have a question or would like additional information about Pharmacy Privacy Practices. You may file a complaint with us or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. We will provide a resolution and response to your complaint. CHANGES TO THIS NOTICE OF PRIVACY PRACTICE: We reserve the right to change this notice. Any revised notice will be posted in the pharmacy. Upon request, we will provide a revised notice to you.

Store Location & Directions

108 North Mitchell
Cadillac, MI, 49601
(231) 775-8200

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Pharmacy Hours

Mon - Fri: 9:00am - 7:00pm;Sat: 9:00am - 6:00pm;Sun: 10:00am - 4:00pm;

Store Hours

Mon - Fri: 9:00am - 7:00pm;Sat: 9:00am - 6:00pm;Sun: 10:00am - 4:00pm;
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