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HIPAA Notice of Privacy Practice
Bluegrass Pharmacy/Bluegrass LTC NOTICE OF PRIVACY PRACTICES Effective April 14, 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. If you have any questions about this notice, please contact Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer, April Rager at 1128 North Main, Madisonville, KY 42431. This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. It described how we may use or disclose your protected information; with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation. ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE You will be asked to provide a signed acknowledgment of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment, and healthcare operations when necessary. WHO WILL FOLLOW THIS NOTICE This notice describes Bluegrass Pharmacy/Bluegrass LTC?s practices regarding your protected health information. OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION ?Protected Health Information? is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future physical or mental health or condition and related health care services. Bluegrass Pharmacy/Bluegrass LTC is required by law to do the following: 1. Make sure that your protected health information is kept private. 2. Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information. 3. Follow the terms of the notice currently in effect. 4. Communicate any changes in the notice to you. We reserve the right to change this notice. Its effective date is at the top of the page and at the bottom of the last page. We reserve the right to make the revised or change notice effective for health information we already have about you as well as any information we receive in the future. You may obtain a Notice of Privacy Practices by calling Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer and requesting a copy be mailed to you, or asking for a copy at your next appointment. HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION Following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive. Required Uses and Disclosures By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information. 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. For example, we would disclose your protected health information as necessary to a Bluegrass Pharmacy/Bluegrass LTC contractor who provides care to you. We may disclose your protected health information from time-to-time to a physician, or health care provider (a specialist, pharmacist, or laboratory), who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions. In emergencies, we will use and disclose your protected health information to provide the treatment you require. Payment In order for an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis and the treatment provided to you. This requires that we pass this information to an insurer in order to receive payment for your medical bills. For example, we will submit to your insurer your name, date of birth, address, social security number, diagnosis and treatment received to receive payment for services you receive. Health Care Operations 1. We may need your diagnosis, treatment, and outcome information in order to improve the quality or cost of care we deliver. For example, we may review patient charts to determine the most effective, cost efficient treatment for a specific diagnosis. We may also look at your medical information and decide that another treatment or new service we offer might interest you. 2. We will share your protected health information with third-party ?business associates? who will perform various activities (billing, transcription services) for Bluegrass Pharmacy/Bluegrass LTC. The business associates will also be required to protect your health information. 3. 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 might interest you. We may also send you information about products or services that we believe may benefit you. Incidental Disclosures We may use or disclose your protected health information by incident to a use or disclosure permitted by HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information. Required or Permitted by Law We may use or disclose your protected health information if law or regulation requires the use or disclosure. Sometimes we are required to report some of your health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example: we may have to report abuse, neglect, domestic violence or certain physical injuries or respond to a court order. Public Health 1. We may disclose your protected health information to a public health authority that is permitted by law to collect or receive the information. The disclosure may be necessary for the following: 2. Prevent or control disease, injury or disability. 3. Report births and deaths 4. Report child abuse or neglect. 5. Information of concern to the Food and Drug Administration. 6. Report reactions to medications or problems with products. 7. Notify a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition. 8. Notify the appropriate authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. 9. We may also have to report to your employer certain work-related illnesses and injuries so that your workplace can be monitored for safety. For example, should you develop a contagious disease, such as measles or tuberculosis, we may need to notify the proper officials. Communicable Diseases We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition. Health Oversight We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other regulatory programs, and civil rights 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 do the following: 1. Track products 2. Enable product recalls 3. Make repairs or replacements 4. Conduct post-marketing surveillance as required Legal proceedings We may disclose protected health information during any judicial pr administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process. Military, National Security, Incarcerated/Law Enforcement Custody If you are involved with the military, national security, or intelligence activities, you are in the custody of law enforcement officials or an inmate in a correctional institution; we may release your health information to the proper authorities so they may carry out their duties under the law. We may disclose protected health information including the following: 1. Responses to legal proceedings 2. Information requests for identification and location 3. Circumstances pertaining to victims of a crime 4. Deaths suspected from criminal conduct 5. Medical emergencies believed to result from criminal conduct Coroners, Funeral Directors, and Organ Donations We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaver organ, eye, or tissue donations. Research We may disclose your protected health information to researchers when authorized by law, for example, if their research has been approved by an institutional review board that has received the research proposal and established protocols to ensure the privacy of your protected health information. Criminal Activity Under applicable Federal and state laws, we may disclose your protected health information if we believe its 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 We may disclose your protected health information to comply with workers? compensation laws and other similar legally established programs. Disclosures by the Health Plan Health plans may also disclose your protected health information. Examples of these disclosures include verifying your eligibility for health and for enrollment in various health plans and coordinating benefits for those who have other health insurance or are eligible for other benefit programs. Parental Access Some state laws concerning minors permit or require disclose of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the state where the treatment is provided and will make disclosures following such laws. Disclosures Required by HIPAA Privacy Rule We are required to disclose protected health information to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose protected health information to you upon your request to access protected health information or for an accounting or certain disclosures of protected health information about you. Incidental Disclosures We may use or disclose protected health information incident to a use or disclosure permitted by HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information. Limited Data Set Disclosures We may use or disclose a limited data set (protected health information that has certain identifying information removed) for the purposes of research, public health, or health care operations. This information may only be disclosed for research, public health, or health care operations purposes. The person receiving this information must sign an agreement to protect the information. USES AND DISCLOSURES OF PROTECTED INFORMATION REQUIRING YOUR PERMISSION In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required: Individuals Involved in Your Health Care 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 the information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose Protected Health Information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose 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 and other individuals involved in your health care. Except for the situations listed above, we must obtain your written authorization for any other release of your health information. An authorization is different from consent; the primary difference is that unlike with consents, a provider must treat you even if you do not wish to sign an authorization form. If you sign an authorization form, you may withdraw your authorization at any time, as long as the withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer. YOUR RIGHT REGARDING YOUR HEALTH INFORMATION You may exercise the following rights by submitting a written request or electronic message to Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer, April Rager at 1128 North Main, Madisonville, KY 42431. Depending on your request, you may also have rights under the Privacy Act of 1974. Please be aware that Bluegrass Pharmacy/Bluegrass LTC may deny your request; however, you may seek a review of the denial. Right to Inspect and Copy With few exceptions, you may inspect and obtain a copy of your protected health information that is contained in a ?designated record set? for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that Bluegrass Pharmacy/Bluegrass LTC uses for making decisions about you. We may charge a fee for a copy of your health information. Right to Request Restrictions You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. Your request must be made in writing Bluegrass Pharmacy/Bluegrass LTC Privacy Officer where you wish the restriction instituted. In your request, you must tell us 1. What information you want restricted; 2. Whether you want to restrict the use, disclosure or both; 3. To whom you want the disclosure to apply, for example, disclosures to your spouse, family or friends; and 4. An expiration date. If Bluegrass Pharmacy/Bluegrass LTC believes that the restriction is not in the best interest of either party, or Bluegrass Pharmacy/Bluegrass LTC cannot reasonably accommodate the request, Bluegrass Pharmacy/Bluegrass LTC is not required to agree. If the restriction is mutually agreed upon, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment. You may revoke a previous restriction at any time, in writing. Right to Request Confidential Communication You may request that we communicate with you using alternative means or at alternative location. We will not ask you for the reason for your request. We will accommodate reasonable requests, when possible. Right to Request Amendment If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment we are not required to agree to the amendment. You may be asked to make this request in writing and give a reason as to why the information should be changes. However, if we did not create the health information, that you believe to be incorrect, or if we disagree with you and believe your health information is correct we may deny your request. If you receive certain medical devices: For example, life supporting devices used outside our facility, you may refuse to release your name, address, telephone number, social security number or other identifying information for purposes of tracking the medical device. Right to an Accounting of Disclosures You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. The disclosures must have been made after April 14, 2003, and no more than 6 years from the date of the request. This list must include the date of each disclosure, who received the information, a brief description of the health information disclosed, and why the disclosure was made. We must comply with your request for a list within 60 days, unless you agree to a 30-day extension, and we may not charge you for the first list, unless you request such list more than once per year. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this notice. Right to Obtain a Copy of this Notice You may obtain a paper copy of this notice from Bluegrass Pharmacy/Bluegrass LTC. FEDERAL PRIVACY LAWS Bluegrass Pharmacy/Bluegrass LTC Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply including the Freedom of Information Act, the Privacy Act and the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. These laws have not been superseded and have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information. COMPLAINTS If you believe these privacy rights have been violated, you may file a complaint with your Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer, or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint. CONTACT INFORMATION Bluegrass Pharmacy/Bluegrass LTC Address: 1128 North Main, Madisonville, KY 42431 Privacy Officer: April Rager Telephone: 800-821-5053 This notice is effective in its entirety as of April 14, 2003.

About Us

Welcome to Bluegrass Pharmacy. As your local Good Neighbor Pharmacy, we offer quality products at affordable prices, while providing the personalized attention and customer service you expect from a local business. As your neighbors, we live, work and play in the same community as you and your family. We’re the local business owners you see in the neighborhood, at the school play, and volunteering at the local charity. We believe it is our responsibility to take care of our community and our neighbors, and it’s one we take very seriously. We thrive on the opportunity to serve you and your family to the best of our abilities because your business and your health are very important to us. Get to know your neighbor – we’re here to help.

    HIPAA Notice of Privacy Practice
    Bluegrass Pharmacy/Bluegrass LTC NOTICE OF PRIVACY PRACTICES Effective April 14, 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. If you have any questions about this notice, please contact Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer, April Rager at 1128 North Main, Madisonville, KY 42431. This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. It described how we may use or disclose your protected information; with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation. ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE You will be asked to provide a signed acknowledgment of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment, and healthcare operations when necessary. WHO WILL FOLLOW THIS NOTICE This notice describes Bluegrass Pharmacy/Bluegrass LTC?s practices regarding your protected health information. OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION ?Protected Health Information? is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future physical or mental health or condition and related health care services. Bluegrass Pharmacy/Bluegrass LTC is required by law to do the following: 1. Make sure that your protected health information is kept private. 2. Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information. 3. Follow the terms of the notice currently in effect. 4. Communicate any changes in the notice to you. We reserve the right to change this notice. Its effective date is at the top of the page and at the bottom of the last page. We reserve the right to make the revised or change notice effective for health information we already have about you as well as any information we receive in the future. You may obtain a Notice of Privacy Practices by calling Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer and requesting a copy be mailed to you, or asking for a copy at your next appointment. HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION Following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive. Required Uses and Disclosures By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information. 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. For example, we would disclose your protected health information as necessary to a Bluegrass Pharmacy/Bluegrass LTC contractor who provides care to you. We may disclose your protected health information from time-to-time to a physician, or health care provider (a specialist, pharmacist, or laboratory), who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions. In emergencies, we will use and disclose your protected health information to provide the treatment you require. Payment In order for an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis and the treatment provided to you. This requires that we pass this information to an insurer in order to receive payment for your medical bills. For example, we will submit to your insurer your name, date of birth, address, social security number, diagnosis and treatment received to receive payment for services you receive. Health Care Operations 1. We may need your diagnosis, treatment, and outcome information in order to improve the quality or cost of care we deliver. For example, we may review patient charts to determine the most effective, cost efficient treatment for a specific diagnosis. We may also look at your medical information and decide that another treatment or new service we offer might interest you. 2. We will share your protected health information with third-party ?business associates? who will perform various activities (billing, transcription services) for Bluegrass Pharmacy/Bluegrass LTC. The business associates will also be required to protect your health information. 3. 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 might interest you. We may also send you information about products or services that we believe may benefit you. Incidental Disclosures We may use or disclose your protected health information by incident to a use or disclosure permitted by HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information. Required or Permitted by Law We may use or disclose your protected health information if law or regulation requires the use or disclosure. Sometimes we are required to report some of your health information to legal authorities, such as law enforcement officials, court officials, or government agencies. For example: we may have to report abuse, neglect, domestic violence or certain physical injuries or respond to a court order. Public Health 1. We may disclose your protected health information to a public health authority that is permitted by law to collect or receive the information. The disclosure may be necessary for the following: 2. Prevent or control disease, injury or disability. 3. Report births and deaths 4. Report child abuse or neglect. 5. Information of concern to the Food and Drug Administration. 6. Report reactions to medications or problems with products. 7. Notify a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition. 8. Notify the appropriate authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. 9. We may also have to report to your employer certain work-related illnesses and injuries so that your workplace can be monitored for safety. For example, should you develop a contagious disease, such as measles or tuberculosis, we may need to notify the proper officials. Communicable Diseases We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition. Health Oversight We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other regulatory programs, and civil rights 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 do the following: 1. Track products 2. Enable product recalls 3. Make repairs or replacements 4. Conduct post-marketing surveillance as required Legal proceedings We may disclose protected health information during any judicial pr administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process. Military, National Security, Incarcerated/Law Enforcement Custody If you are involved with the military, national security, or intelligence activities, you are in the custody of law enforcement officials or an inmate in a correctional institution; we may release your health information to the proper authorities so they may carry out their duties under the law. We may disclose protected health information including the following: 1. Responses to legal proceedings 2. Information requests for identification and location 3. Circumstances pertaining to victims of a crime 4. Deaths suspected from criminal conduct 5. Medical emergencies believed to result from criminal conduct Coroners, Funeral Directors, and Organ Donations We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaver organ, eye, or tissue donations. Research We may disclose your protected health information to researchers when authorized by law, for example, if their research has been approved by an institutional review board that has received the research proposal and established protocols to ensure the privacy of your protected health information. Criminal Activity Under applicable Federal and state laws, we may disclose your protected health information if we believe its 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 We may disclose your protected health information to comply with workers? compensation laws and other similar legally established programs. Disclosures by the Health Plan Health plans may also disclose your protected health information. Examples of these disclosures include verifying your eligibility for health and for enrollment in various health plans and coordinating benefits for those who have other health insurance or are eligible for other benefit programs. Parental Access Some state laws concerning minors permit or require disclose of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the state where the treatment is provided and will make disclosures following such laws. Disclosures Required by HIPAA Privacy Rule We are required to disclose protected health information to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose protected health information to you upon your request to access protected health information or for an accounting or certain disclosures of protected health information about you. Incidental Disclosures We may use or disclose protected health information incident to a use or disclosure permitted by HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information. Limited Data Set Disclosures We may use or disclose a limited data set (protected health information that has certain identifying information removed) for the purposes of research, public health, or health care operations. This information may only be disclosed for research, public health, or health care operations purposes. The person receiving this information must sign an agreement to protect the information. USES AND DISCLOSURES OF PROTECTED INFORMATION REQUIRING YOUR PERMISSION In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required: Individuals Involved in Your Health Care 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 the information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose Protected Health Information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose 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 and other individuals involved in your health care. Except for the situations listed above, we must obtain your written authorization for any other release of your health information. An authorization is different from consent; the primary difference is that unlike with consents, a provider must treat you even if you do not wish to sign an authorization form. If you sign an authorization form, you may withdraw your authorization at any time, as long as the withdrawal is in writing. If you wish to withdraw your authorization, please submit your written withdrawal to Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer. YOUR RIGHT REGARDING YOUR HEALTH INFORMATION You may exercise the following rights by submitting a written request or electronic message to Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer, April Rager at 1128 North Main, Madisonville, KY 42431. Depending on your request, you may also have rights under the Privacy Act of 1974. Please be aware that Bluegrass Pharmacy/Bluegrass LTC may deny your request; however, you may seek a review of the denial. Right to Inspect and Copy With few exceptions, you may inspect and obtain a copy of your protected health information that is contained in a ?designated record set? for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that Bluegrass Pharmacy/Bluegrass LTC uses for making decisions about you. We may charge a fee for a copy of your health information. Right to Request Restrictions You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. Your request must be made in writing Bluegrass Pharmacy/Bluegrass LTC Privacy Officer where you wish the restriction instituted. In your request, you must tell us 1. What information you want restricted; 2. Whether you want to restrict the use, disclosure or both; 3. To whom you want the disclosure to apply, for example, disclosures to your spouse, family or friends; and 4. An expiration date. If Bluegrass Pharmacy/Bluegrass LTC believes that the restriction is not in the best interest of either party, or Bluegrass Pharmacy/Bluegrass LTC cannot reasonably accommodate the request, Bluegrass Pharmacy/Bluegrass LTC is not required to agree. If the restriction is mutually agreed upon, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment. You may revoke a previous restriction at any time, in writing. Right to Request Confidential Communication You may request that we communicate with you using alternative means or at alternative location. We will not ask you for the reason for your request. We will accommodate reasonable requests, when possible. Right to Request Amendment If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment we are not required to agree to the amendment. You may be asked to make this request in writing and give a reason as to why the information should be changes. However, if we did not create the health information, that you believe to be incorrect, or if we disagree with you and believe your health information is correct we may deny your request. If you receive certain medical devices: For example, life supporting devices used outside our facility, you may refuse to release your name, address, telephone number, social security number or other identifying information for purposes of tracking the medical device. Right to an Accounting of Disclosures You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice of Privacy Practices. The disclosures must have been made after April 14, 2003, and no more than 6 years from the date of the request. This list must include the date of each disclosure, who received the information, a brief description of the health information disclosed, and why the disclosure was made. We must comply with your request for a list within 60 days, unless you agree to a 30-day extension, and we may not charge you for the first list, unless you request such list more than once per year. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this notice. Right to Obtain a Copy of this Notice You may obtain a paper copy of this notice from Bluegrass Pharmacy/Bluegrass LTC. FEDERAL PRIVACY LAWS Bluegrass Pharmacy/Bluegrass LTC Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply including the Freedom of Information Act, the Privacy Act and the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. These laws have not been superseded and have been taken into consideration in developing our policies and this notice of how we will use and disclose your protected health information. COMPLAINTS If you believe these privacy rights have been violated, you may file a complaint with your Bluegrass Pharmacy/Bluegrass LTC HIPAA Officer, or the Department of Health and Human Services. No retaliation will occur against you for filing a complaint. CONTACT INFORMATION Bluegrass Pharmacy/Bluegrass LTC Address: 1128 North Main, Madisonville, KY 42431 Privacy Officer: April Rager Telephone: 800-821-5053 This notice is effective in its entirety as of April 14, 2003.
       
       
       
       
       

    HIPAA Notice of Privacy Practice

    JOSEPH PHARMACY 216 WEST 72ND STREET NEW YORK, NY 10023 TEL (212) 875-1718 FAX (212) 875-0921 E-Mail: JOSEPHPHARMACY@YAHOO.COM OR WWW.JOSEPHPHARMACY.COM 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. JOSEPH 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 and for other specified purposes that are permitted or required by law. The Notice also describes your rights and with respect to PHI about you. JOSEPH PHARMACY is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, expect as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you. Your Health Information Rights You have the following rights with respect to PHI about you: *Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact the Privacy Officer at (212) 875-1718 or e-mail request to JOSEPHPHARMACY@YAHOO.COM. *Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use and disclosure of PHI about you by sending a written request to the Privacy Officer or e-mailing the request to JOSEPHPHARMACY@YAHOO.COM. We are not required to agree to those restrictions. *Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as JOSEPH PHARMACY maintains the PHI. The 'designated record set' usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to the Privacy Officer or e-mail it to JOSEPHPHARMACY@YAHOO.COM. We may charge you a fee for the cost of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed. *Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to the Privacy Officer or e-mail it to: JOSEPHPHARMACY@YAHOO.COM. In addition, you must include a reason that supports your request. 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 the decision, and we give you a rebuttal to your statement. *Receive an accounting of disclosure of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude disclosures we have made directly to you, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in to the Privacy Officer or e-mail it to JOSEPHPHARMACY@YAHOO.COM. Your request must specify the time period, but may not be longer than six years. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time. *Request communications of PHI by alternative means or at alternative locations. For instance, you may request we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must submit a request in writing to the Privacy Officer or e-mail it to JOSEPHPHARMACY@YAHOO.COM. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests. *Revoke your consent to use or disclose PHI. You may revoke consent in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that that we have already taken action in reliance on the consent. We may refuse to continue to treat a customer that revokes his or her consent. Example of How We May Use and Disclose PHI The following categories describe and provide examples of different ways we use and disclose PHI about you. We will use PHI for treatment. Example: Information obtained by the pharmacist will be used to dispense prescription medications to you. We will document in your record information related to the medications dispensed to you and services provided to you. We will use PHI for payment. Example: We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment. We will bill you or third-party payer for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking. We will use PHI for health care operations. Example: JOSEPH PHARMACY may use information in your health record to monitor the performance of the pharmacists 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: There are some services provided by us through contracts with business associates. Examples include the analysis of prescription costs and their trends for groups and sub- groups of patient populations. When these services are contracted for, we may disclose PHI about you to our business associates 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 PHI about you, we require the business associate to appropriately safeguard the PHI. Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you can identify, PHI relevant to that person's involvement in your care or payment related to your care. Personal communications: We may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements. Worker's compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker's compensation or similar programs established by law. Public Health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury or disability. Law enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process. Health Oversight activities: We must disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws. Judicial and administrative proceedings: If you are involved in a lawsuit or dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI. We are permitted to use and disclose PHI about you for the following purposes: Research: We may disclose PHI about you to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information has approved their research. Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties. Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. Fundraising: We may contact you as part of a fundraising effort. Notification: We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and your general condition. Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others. To avert a serious threat to health and safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Military or veterans: If you are a member of the armed forces, we may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. National Security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Protective services for the President and others: We may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Victims of abuse, neglect, or domestic violent: We may disclose PHI about you to a government authority, such as a social service, or protective service agency. If we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure of if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you. Other Uses and Disclosures of PHI JOSEPH PHARMACY will obtain your written authorization before using or disclosing the PHI about you for purposes other than those provided above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. For More Information or to Report a Problem If you have questions or would like additional information about Joseph Pharmacy's privacy practices, you may contact our privacy officer. If you believe your privacy right have been violated, you can file a complaint with our HIPAA privacy officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. Effective Date

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    (270) 825-2775

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    Mon - Fri: 9:00am - 6:00pm;Sat: 9:00am -3:00pm;Sun: Closed;

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    MEDILANE DRUG CORP 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. LEGAL DUTY We are required by 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, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This notice takes effect April 14, 2003 and will remain in effect until we replace it. You may request a copy of our Privacy Practice Notice at any time. For more information or additional copies of this Notice, please contact us at the telephone number listed in the Company Information section at the top of this Notice. If and when permitted by applicable law, we have the right to change our privacy practices; if we do so, we will notify you in writing of these changes. USE AND DISCLOSURES OF HEALTH INFORMATION We are permitted by law, to use and disclose health information about you for reasons concerning treatment, payment, and healthcare operations. Examples: Treatment: We may disclose your health information to a physician or healthcare provider that is providing treatment or other healthcare services to you. Payment: We may use and disclose your health information to obtain payment for services that we provide to you. Operations: We may use and disclose your health information in connection with our healthcare operations, which include administration and planning and other tasks that help us improve that quality. Family and Friends: We may disclose your health information to a family member, relative or a friend that has been identified by you while you are present. If you are not present, professional judgment will be utilized to determine whether a disclosure is required or in your best interest. We will only disclose information that is believed to be relevant to the person's involvement with your healthcare of payment related to your health care. We may also disclose your health information in order to notify such persons of your location, general condition or death. As required by law: We must disclose your health information when required to do so by law. Victims of Abuse or Neglect: We may disclose your health information to authorities if reasonable belief is that you are a possible victim of abuse, neglect or domestic violence. We may disclose information to the extent necessary to avert additional serious threat to your health or safety or the health or safety of others. Public Health Activities: We may disclose your health information to public health authorities for the purpose of preventing or controlling disease or preventing injury; to report information to a health oversight agency that is responsible for ensuring compliance with governmental rules and regulations, such as Medicare and Medicaid. National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counter intelligence, and other national security activities. Appointment Reminders: We may contact you to provide you with appointment reminders, such as voice messages; including essential information such as time, location, and the name of the company/provider. Workers' Compensation: We may use or disclose your health information to the extent necessary to comply with state laws relating to workers' compensation. Disclosures Requiring your Authorization: For any reasons other than those listed in this notice, we may only use or disclose your health information with your written authorization. You authorization must also be obtained prior to using your health information for any marketing activity. YOUR RIGHTS TO YOUR PERSONAL HEALTH INFORMATION Access to Record: You may have access to your health information, with limited exceptions. Request must be made in writing, utilizing our Records Access Request Form. We may charge a reasonable fee to compensate for time and materials. Revocation of your Authorization: You make revoke your authorization to disclose your health information at any time. Request must be made in writing, using our Authorization Revocation form. Restriction of Information: You may request that we place restrictions on our use or disclosure of your health information. You must make you request in writing by sending us a letter that specifies the type of information to be restricted and to whom the information is to be restricted from. Requests should be sent directly to the address listed in the heading of this Notice. We will consider all requests: however are not required to agree to the request. We will respond to all such requests in writing. Disclosure Accounting: You may request a list of instances in which we (or our business associates) disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. You must make your request in writing by sending us a letter that specifies the type of information and the time period involved. Requests should be sent directly to the address listed in the heading of this Notice. If you request this information more than once in a 12-month period, we may charge you a reasonable fee to compensate for our time and materials. Alternative Communication: You may request that we communicate with you about your health information by alternative means or to an alternative location. You must make your request in writing by sending a letter that specifies the alternative means of location and provide satisfactory explanation how payments will be handled under the alternative means or location you have requested. Requests should be sent directly to the address listed in the header of this Notice. Amendment: You have the right to request that we amend your health information. You must make your request in writing by sending a letter that explains why the information should be amended. Requests should be sent directly to the address listed in the header of this Notice. We will comply to your request unless we believe that the information to be amended is accurate and complete. Right to Receive Paper Copy of this Notice: Upon request, you may obtain a paper copy of this notice. QUESTIONS OR COMPLAINTS If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we have made about a request for access to your health information, a request you have made to amend or restrict the use or disclosure of your health information or a request you have made for us to communication with your by alternative means or locations, you may complain to us using the contact information listed in the header of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to the U.S. Department of Health and Human Services upon request. If you have any questions, concerns, or complaints about this Notice, please contact us.