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.
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.