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HIPAA Notice of Privacy Practice
NOTICE OF PRIVACY PRACTICES This Notice is effective on April 14, 2003 Booneville Pharmacy of Ms. Inc WE ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU We are required by law to protect the privacy of medical information about you and that identifies you. This medical information may be information about health care we provide to you or payment for health care provided to you. It may also be information about your past, present, or future medical condition. We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical information in the manner that we have described in this Notice. We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all medical information that we maintain. If we make changes to the Notice, we will: ? Post the new Notice in our waiting area ? Have copies of the new Notice available upon request (you may always contact our Privacy Officer at ****662-728-1951**** to obtain a copy of the current Notice) The rest of this Notice will: ? Discuss how we may use and disclose medical information about you ? Explain your rights with respect to medical information about you ? Describe how and where you may file a privacy-related complaint If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact our Privacy Office at ****662-728-1951****. WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCE We use and disclose medical information about patients everyday. This section of our Notice explains in some detail how we may use and disclose medical information about you in order to provide health care, obtain payment for that health care, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose medical information about you. For more information about any of these uses or disclosures, or about any of our privacy policies, procedures or practices, contact our Privacy Officer at ****662-728-1951****. 1. Treatment We may use and disclose medical information about you to provide health care treatment to you. In other words, we may use and disclose medical information about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. Example: Jane is a patient at the pharmacy. The pharmacist may use medical information about Jane talking to her doctor about a medication that was prescribed to her. 2. Payment We may use and disclose medical information about you to obtain payment for health care services that you received. This means that we may use medical information about you to arrange for payment (such as preparing bills and managing accounts). We also may disclose medical information about you to others (such as insurers, collection agencies, and consumer reporting agencies). In some instances, we may disclose medical information about you to an insurance plan before you receive certain health care services because, for example, we may want to know whether the insurance plan will pay for a particular service. Example: Jane is a patient at the pharmacy and she has private insurance. She came in the pharmacy to fill a prescription for Cymbalta. The pharmacist called her insurance to inquire why the medication was not covered under her insurance. 3. Healthcare Operations We may use and disclose medical information about you in performing a variety of business activities that we call ?health care operations.? These ?health care operations? activities allow us to, for example, improve the quality of care and reduce health care costs. For example, we may use or disclose medical information about you in performing the following activities: ? Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you. ? Providing training programs for students, trainees, health care providers or non-health care professionals to help them practice or improve their skills. ? Cooperating with outside organizations that evaluate, certify or license health care providers, staff or facilities in a particular field or specialty. ? Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients. ? Improving health care and lowering costs for groups of people who have similar health problems and helping manage and coordinate the care for these groups of people. ? Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and private organizations. ? Planning for our organization?s future operations. ? Resolving grievances within our organization. ? Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes. ? Working with others (such as lawyers, accountants and others providers) who assist us to comply with this Notice and other applicable laws. Example: Jane was diagnosed with diabetes. The pharmacy used Jane?s medical information- as well as medical information from all of the other patients diagnosed with diabetes- to develop an educational program to help patients recognize the early symptoms of diabetes. (Note: The educational program would not identify any specific patient without their permission). 4. Persons Involved in Your Care We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care and the information is relevant to your care. If the patient is a minor, we may disclose medical information about the minor to a parent, guardian or other person responsible for the minor except in limited circumstances. For more information on the privacy of minors? information, contact our Privacy Officer at ****662-728-1951****. We may also use or disclose medical information about you to a relative, another person involved in your care or possibly a disaster relief organization (such as the Red Cross) if we need to notify someone about your location or condition. You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the patient is a minor. If the patient is a minor, we may or may not be able to agree to your request. Example: Jane?s husband regularly comes to the pharmacy with Jane to pick up her medication. When the pharmacist is discussing a new medication with Jane, Jane invites her husband to come into the private area. The pharmacist discusses the new medication with Jane and Jane?s husband. 5. Required by Law We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require us to use and disclose medical information. For example, state law required us to report suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with all other applicable laws. 6. National Priority Uses and Disclosures When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as ?national priorities.? In other words, the government has determined that under certain circumstances (described below), it is so important to disclose medical information that it is acceptable to disclose medical information without the individual?s permission. We will only disclose medical information about you in the following circumstances when we are permitted to do so by law. For more information on these types of disclosures, contact our Privacy Officer at ****662-729-1951****. ? Threat to health or safety: We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety. ? Public health activities: We may use or disclose medical information about you for public health activities. Public health activities require the use of medical information for various activities, including, but not limited to, activities related to investigating disease, reporting child abuse and neglect, monitoring drugs or device regulated by the Food and Drug Administration, and monitoring work-related illnesses or injuries. ? Abuse, neglect or domestic violence: We may disclose medical information about you to government authority (such as the Department of Social Services) if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic violence. ? Health oversight activities: We may disclose medical information about you to a health oversight agency- which is basically an agency responsible for overseeing the health care system or certain government programs. For example, a government agency may request information from us while they are investigating possible insurance fraud. ? Court proceedings: We may disclose information about you to a court or an officer of the court (such as an attorney). For example, we would disclose medical information about you to a court if a judge orders us to do so. ? Law enforcement: We may disclose medical information about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or identify a missing person. ? Coroners and others: We may disclose medical information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye and tissue transplants. ? Worker?s compensation: We may disclose medical information about you in order to comply with worker?s compensation laws. ? Research organizations: We may use and disclose medical information about you to research organizations if the organization has satisfied certain conditions about protecting the privacy of medical information. ? Certain government functions: We may use or disclose medical information about you for certain government functions, including but not limited to military and veterans? activities and national security and intelligence activities. We may also use and disclose information about you to a correctional institutions in some circumstances. 7. Authorization Other than the uses and disclosures described above (#1-6), we will not use or disclose medical information about you without the ?authorization?- or signed permission- of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask us to disclose medical information and we will ask you to sign an authorization form. If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization or fill out an Authorization Revocation Form. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action. YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights. If you would like to know more about your rights, please contact our Privacy Officer at ****662-728-1951**** 1. Right to a Copy of This Notice You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting area. If you would like to have a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer. 2. Right of Access to Inspect and Copy You have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form. Access Request Forms are available from our Privacy Officer. We may deny your request in certain circumstances. If we dent your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person. If you would like a copy of the information, we will charge you a fee to cover the costs of the copy. ****10 DOLLAR ONE TIME CHARGE**** We may be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for more information on these services and any possible additional fees. 3. Right to Have Medical Information Amended You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing and explain why you would like us to amend the information. You may either write us a letter requesting an amendment or fill out an Amendment Request Form. Amendment Request Forms are available from our Privacy Officer. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future. 4. Right to an Accounting of Disclosures We Have Made You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive an accounting, you may send us a letter requesting an accounting, fill out an Accounting Request Form, or contact our Privacy Officer. Accounting Request Forms are available from our Privacy Officer. The accounting will not include several types of disclosures, including disclosures for treatment, payment or health care operations. It will also not include disclosures made prior to April 14, 2003. If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting. ***10 DOLLAR ONE TIME CHARGE**** 5. Right to Request Restrictions on Uses and Disclosures You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and health care operations. We are not required to agree to your request. If we do agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation. 6. Right to Request an Alternative Method of Contact You have the right to request to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to your work address rather than to your home address. We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative Contact Request Form. Alternative Contact Request Forms are available from our Privacy Officer. YOU MAY FIL E A COMPLAINT ABOUT OUR PRIVACY PRACTICES If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any way if you file a complaint. To file a written complaint with the health department, you may bring your complaint to the department or you may mail it to the following address: BOONEVILLE PHARMACY OF MS. INC 206 NORTH SECOND ST BOONEVILLE, MS 38829 To file a complaint with the federal government, you may send your complaint to the following address: The U.S. Department of Health and Human Services 200 Independence Avenue, S. W. Washington, D.C. 20201 Telephone: 202-619-0257 Toll Free: 1-877-696-6775 Notice of Privacy Practices Policy Introduction Booneville Pharmacy Of Ms. Inc has adopted this Notice of Privacy Practices Policy to comply with our responsibility to protect individually identifiable health information and the system components that such data resides in under the Health Insurance Portability and Accountability Act of 1996 (?HIPAA?), the security and privacy regulations implementing HIPAA, other federal and state laws protecting confidentiality of health information, professional ethics, and accreditation requirements. This Notice of Privacy Practices Policy governs the creation, posting, and distribution of the Notice of Privacy Practices required under HIPAA. All personnel of Booneville Pharmacy Of Ms. Inc must comply with this policy. Demonstrated competence in the requirements of this policy is an important part of every employee?s responsibilities. Assumptions This Notice of Privacy Practices Policy is based on the following assumptions: 1. HIPAA?s Privacy Rule requires most covered entities to provide individuals with adequate notice of the uses and disclosures of protected health information that may be made by the covered entity, and of the individual?s rights and the covered entity?s responsibilities with respect to protected health information. The Rule delineates specific requirements for the content of the Notice, as well as for provision of the Notice. 2. The requirements for providing Notice to individuals vary based on type of covered entity and method of service delivery. A covered health care provider that has a direct treatment relationship with an individual must provide the Notice no later than the date of first service delivery and, if the provider maintains a physical service delivery site, must post the Notice in a clear and prominent location and have it available upon request for individuals to take with them. 3. If the first service delivery to an individual is electronic, the covered provider must furnish electronic Notice automatically and contemporaneously in response to the individual?s first request for service. In addition, if a covered entity maintains a web site, the Notice must be available electronically through the web site. 4. HIPAA requires that a covered health care provider with a direct treatment relationship with an individual make a good faith effort to obtain the individual?s written acknowledgment of receipt of the Notice of Privacy Practices. 5. Under HIPAA, if an individual refuses to sign or otherwise fails to provide an acknowledgment, a covered health care provider is required to document its good faith efforts to obtain the acknowledgment and the reason why the acknowledgment was not obtained. Failure by a covered entity to obtain an individual?s acknowledgement, assuming it otherwise documented its good faith effort, is not a violation of this Rule. Policy Booneville Pharmacy Of Ms. Inc shall create a Notice of Privacy Practices (?Notice?) that meets the requirements of HIPAA. This Notice will be post prominently in Booneville Pharmacy Of Ms. Inc?s waiting area(s) for inspection by patients and others. The requirement to post the Notice ?prominently? shall be met by either: 1. Placing a copy of the Notice on the waiting area(s) wall(s) for all to view. 2. Enclosing the Notice in a book or binder, which shall be placed in the patient waiting area(s), and shall be clearly marked ?Notice of Privacy Practices.? Booneville Pharmacy Of Ms. Inc?s Privacy Officer shall be responsible for creating, posting, and distributing the Notice of Privacy Practices. Booneville Pharmacy Of Ms. Inc shall provide the Notice of Privacy Practices in printed, hardcopy form to all patients no later than the date of first service delivery. The Privacy Officer or other employees shall make a reasonable effort to obtain from each patient a signature of acknowledgment that the patient has received a copy of the Notice. If a patient refuses to sign an Acknowledgment of Receipt, the refusal shall be noted on the Acknowledgment From by the employee. Whether signed by the patient or the employee (if the patient refused), the Acknowledgment Form shall be placed in the patient?s file. If the first service delivery to an individual is electronic, Booneville Pharmacy Of Ms. Inc shall furnish electronic Notice automatically in response to the individual?s first request for service. In addition, if Booneville Pharmacy Of Ms. Inc maintains a web site, the Notice shall be available electronically through the website. Booneville Pharmacy Of Ms. Inc?s Privacy Officer shall update the Notice of Privacy Practices whenever Booneville Pharmacy Of Ms. Inc makes substantive changes to its policies on requests, uses, and disclosures of protected health information. Compliance and Enforcement The Privacy Officer and all supervisors are responsible for enforcing this policy. Employees who violate this policy are subject to discipline up to and including termination in accordance with Booneville Pharmacy Of Ms. Inc?s Sanction Policy.

About Us

Welcome to Booneville Community 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
    NOTICE OF PRIVACY PRACTICES This Notice is effective on April 14, 2003 Booneville Pharmacy of Ms. Inc WE ARE REQUIRED BY LAW TO PROTECT MEDICAL INFORMATION ABOUT YOU We are required by law to protect the privacy of medical information about you and that identifies you. This medical information may be information about health care we provide to you or payment for health care provided to you. It may also be information about your past, present, or future medical condition. We are also required by law to provide you with this Notice of Privacy Practices explaining our legal duties and privacy practices with respect to medical information. We are legally required to follow the terms of this Notice. In other words, we are only allowed to use and disclose medical information in the manner that we have described in this Notice. We may change the terms of this Notice in the future. We reserve the right to make changes and to make the new Notice effective for all medical information that we maintain. If we make changes to the Notice, we will: ? Post the new Notice in our waiting area ? Have copies of the new Notice available upon request (you may always contact our Privacy Officer at ****662-728-1951**** to obtain a copy of the current Notice) The rest of this Notice will: ? Discuss how we may use and disclose medical information about you ? Explain your rights with respect to medical information about you ? Describe how and where you may file a privacy-related complaint If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact our Privacy Office at ****662-728-1951****. WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCE We use and disclose medical information about patients everyday. This section of our Notice explains in some detail how we may use and disclose medical information about you in order to provide health care, obtain payment for that health care, and operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or disclose medical information about you. For more information about any of these uses or disclosures, or about any of our privacy policies, procedures or practices, contact our Privacy Officer at ****662-728-1951****. 1. Treatment We may use and disclose medical information about you to provide health care treatment to you. In other words, we may use and disclose medical information about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. Example: Jane is a patient at the pharmacy. The pharmacist may use medical information about Jane talking to her doctor about a medication that was prescribed to her. 2. Payment We may use and disclose medical information about you to obtain payment for health care services that you received. This means that we may use medical information about you to arrange for payment (such as preparing bills and managing accounts). We also may disclose medical information about you to others (such as insurers, collection agencies, and consumer reporting agencies). In some instances, we may disclose medical information about you to an insurance plan before you receive certain health care services because, for example, we may want to know whether the insurance plan will pay for a particular service. Example: Jane is a patient at the pharmacy and she has private insurance. She came in the pharmacy to fill a prescription for Cymbalta. The pharmacist called her insurance to inquire why the medication was not covered under her insurance. 3. Healthcare Operations We may use and disclose medical information about you in performing a variety of business activities that we call ?health care operations.? These ?health care operations? activities allow us to, for example, improve the quality of care and reduce health care costs. For example, we may use or disclose medical information about you in performing the following activities: ? Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you. ? Providing training programs for students, trainees, health care providers or non-health care professionals to help them practice or improve their skills. ? Cooperating with outside organizations that evaluate, certify or license health care providers, staff or facilities in a particular field or specialty. ? Reviewing and improving the quality, efficiency and cost of care that we provide to you and our other patients. ? Improving health care and lowering costs for groups of people who have similar health problems and helping manage and coordinate the care for these groups of people. ? Cooperating with outside organizations that assess the quality of the care others and we provide, including government agencies and private organizations. ? Planning for our organization?s future operations. ? Resolving grievances within our organization. ? Reviewing our activities and using or disclosing medical information in the event that control of our organization significantly changes. ? Working with others (such as lawyers, accountants and others providers) who assist us to comply with this Notice and other applicable laws. Example: Jane was diagnosed with diabetes. The pharmacy used Jane?s medical information- as well as medical information from all of the other patients diagnosed with diabetes- to develop an educational program to help patients recognize the early symptoms of diabetes. (Note: The educational program would not identify any specific patient without their permission). 4. Persons Involved in Your Care We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care and the information is relevant to your care. If the patient is a minor, we may disclose medical information about the minor to a parent, guardian or other person responsible for the minor except in limited circumstances. For more information on the privacy of minors? information, contact our Privacy Officer at ****662-728-1951****. We may also use or disclose medical information about you to a relative, another person involved in your care or possibly a disaster relief organization (such as the Red Cross) if we need to notify someone about your location or condition. You may ask us at any time not to disclose medical information about you to persons involved in your care. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the patient is a minor. If the patient is a minor, we may or may not be able to agree to your request. Example: Jane?s husband regularly comes to the pharmacy with Jane to pick up her medication. When the pharmacist is discussing a new medication with Jane, Jane invites her husband to come into the private area. The pharmacist discusses the new medication with Jane and Jane?s husband. 5. Required by Law We will use and disclose medical information about you whenever we are required by law to do so. There are many state and federal laws that require us to use and disclose medical information. For example, state law required us to report suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and with all other applicable laws. 6. National Priority Uses and Disclosures When permitted by law, we may use or disclose medical information about you without your permission for various activities that are recognized as ?national priorities.? In other words, the government has determined that under certain circumstances (described below), it is so important to disclose medical information that it is acceptable to disclose medical information without the individual?s permission. We will only disclose medical information about you in the following circumstances when we are permitted to do so by law. For more information on these types of disclosures, contact our Privacy Officer at ****662-729-1951****. ? Threat to health or safety: We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety. ? Public health activities: We may use or disclose medical information about you for public health activities. Public health activities require the use of medical information for various activities, including, but not limited to, activities related to investigating disease, reporting child abuse and neglect, monitoring drugs or device regulated by the Food and Drug Administration, and monitoring work-related illnesses or injuries. ? Abuse, neglect or domestic violence: We may disclose medical information about you to government authority (such as the Department of Social Services) if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic violence. ? Health oversight activities: We may disclose medical information about you to a health oversight agency- which is basically an agency responsible for overseeing the health care system or certain government programs. For example, a government agency may request information from us while they are investigating possible insurance fraud. ? Court proceedings: We may disclose information about you to a court or an officer of the court (such as an attorney). For example, we would disclose medical information about you to a court if a judge orders us to do so. ? Law enforcement: We may disclose medical information about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or identify a missing person. ? Coroners and others: We may disclose medical information about you to a coroner, medical examiner, or funeral director or to organizations that help with organ, eye and tissue transplants. ? Worker?s compensation: We may disclose medical information about you in order to comply with worker?s compensation laws. ? Research organizations: We may use and disclose medical information about you to research organizations if the organization has satisfied certain conditions about protecting the privacy of medical information. ? Certain government functions: We may use or disclose medical information about you for certain government functions, including but not limited to military and veterans? activities and national security and intelligence activities. We may also use and disclose information about you to a correctional institutions in some circumstances. 7. Authorization Other than the uses and disclosures described above (#1-6), we will not use or disclose medical information about you without the ?authorization?- or signed permission- of you or your personal representative. In some instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. In other instances, you may contact us to ask us to disclose medical information and we will ask you to sign an authorization form. If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you may write us a letter revoking your authorization or fill out an Authorization Revocation Form. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action. YOU HAVE RIGHTS WITH RESPECT TO MEDICAL INFORMATION ABOUT YOU You have several rights with respect to medical information about you. This section of the Notice will briefly mention each of these rights. If you would like to know more about your rights, please contact our Privacy Officer at ****662-728-1951**** 1. Right to a Copy of This Notice You have a right to have a paper copy of our Notice of Privacy Practices at any time. In addition, a copy of this Notice will always be posted in our waiting area. If you would like to have a copy of our Notice, ask the receptionist for a copy or contact our Privacy Officer. 2. Right of Access to Inspect and Copy You have the right to inspect (which means see or review) and receive a copy of medical information about you that we maintain in certain groups of records. If you would like to inspect or receive a copy of medical information about you, you must provide us with a request in writing. You may write us a letter requesting access or fill out an Access Request Form. Access Request Forms are available from our Privacy Officer. We may deny your request in certain circumstances. If we dent your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person. If you would like a copy of the information, we will charge you a fee to cover the costs of the copy. ****10 DOLLAR ONE TIME CHARGE**** We may be able to provide you with a summary or explanation of the information. Contact our Privacy Officer for more information on these services and any possible additional fees. 3. Right to Have Medical Information Amended You have the right to have us amend (which means correct or supplement) medical information about you that we maintain in certain groups of records. If you believe that we have information that is either inaccurate or incomplete, we may amend the information to indicate the problem and notify others who have copies of the inaccurate or incomplete information. If you would like us to amend information, you must provide us with a request in writing and explain why you would like us to amend the information. You may either write us a letter requesting an amendment or fill out an Amendment Request Form. Amendment Request Forms are available from our Privacy Officer. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. You will have the opportunity to send us a statement explaining why you disagree with our decision to deny your amendment request and we will share your statement whenever we disclose the information in the future. 4. Right to an Accounting of Disclosures We Have Made You have the right to receive an accounting (which means a detailed listing) of disclosures that we have made for the previous six (6) years. If you would like to receive an accounting, you may send us a letter requesting an accounting, fill out an Accounting Request Form, or contact our Privacy Officer. Accounting Request Forms are available from our Privacy Officer. The accounting will not include several types of disclosures, including disclosures for treatment, payment or health care operations. It will also not include disclosures made prior to April 14, 2003. If you request an accounting more than once every twelve (12) months, we may charge you a fee to cover the costs of preparing the accounting. ***10 DOLLAR ONE TIME CHARGE**** 5. Right to Request Restrictions on Uses and Disclosures You have the right to request that we limit the use and disclosure of medical information about you for treatment, payment and health care operations. We are not required to agree to your request. If we do agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation. 6. Right to Request an Alternative Method of Contact You have the right to request to be contacted at a different location or by a different method. For example, you may prefer to have all written information mailed to your work address rather than to your home address. We will agree to any reasonable request for alternative methods of contact. If you would like to request an alternative method of contact, you must provide us with a request in writing. You may write us a letter or fill out an Alternative Contact Request Form. Alternative Contact Request Forms are available from our Privacy Officer. YOU MAY FIL E A COMPLAINT ABOUT OUR PRIVACY PRACTICES If you believe that your privacy rights have been violated or if you are dissatisfied with our privacy policies or procedures, you may file a complaint either with us or with the federal government. We will not take any action against you or change our treatment of you in any way if you file a complaint. To file a written complaint with the health department, you may bring your complaint to the department or you may mail it to the following address: BOONEVILLE PHARMACY OF MS. INC 206 NORTH SECOND ST BOONEVILLE, MS 38829 To file a complaint with the federal government, you may send your complaint to the following address: The U.S. Department of Health and Human Services 200 Independence Avenue, S. W. Washington, D.C. 20201 Telephone: 202-619-0257 Toll Free: 1-877-696-6775 Notice of Privacy Practices Policy Introduction Booneville Pharmacy Of Ms. Inc has adopted this Notice of Privacy Practices Policy to comply with our responsibility to protect individually identifiable health information and the system components that such data resides in under the Health Insurance Portability and Accountability Act of 1996 (?HIPAA?), the security and privacy regulations implementing HIPAA, other federal and state laws protecting confidentiality of health information, professional ethics, and accreditation requirements. This Notice of Privacy Practices Policy governs the creation, posting, and distribution of the Notice of Privacy Practices required under HIPAA. All personnel of Booneville Pharmacy Of Ms. Inc must comply with this policy. Demonstrated competence in the requirements of this policy is an important part of every employee?s responsibilities. Assumptions This Notice of Privacy Practices Policy is based on the following assumptions: 1. HIPAA?s Privacy Rule requires most covered entities to provide individuals with adequate notice of the uses and disclosures of protected health information that may be made by the covered entity, and of the individual?s rights and the covered entity?s responsibilities with respect to protected health information. The Rule delineates specific requirements for the content of the Notice, as well as for provision of the Notice. 2. The requirements for providing Notice to individuals vary based on type of covered entity and method of service delivery. A covered health care provider that has a direct treatment relationship with an individual must provide the Notice no later than the date of first service delivery and, if the provider maintains a physical service delivery site, must post the Notice in a clear and prominent location and have it available upon request for individuals to take with them. 3. If the first service delivery to an individual is electronic, the covered provider must furnish electronic Notice automatically and contemporaneously in response to the individual?s first request for service. In addition, if a covered entity maintains a web site, the Notice must be available electronically through the web site. 4. HIPAA requires that a covered health care provider with a direct treatment relationship with an individual make a good faith effort to obtain the individual?s written acknowledgment of receipt of the Notice of Privacy Practices. 5. Under HIPAA, if an individual refuses to sign or otherwise fails to provide an acknowledgment, a covered health care provider is required to document its good faith efforts to obtain the acknowledgment and the reason why the acknowledgment was not obtained. Failure by a covered entity to obtain an individual?s acknowledgement, assuming it otherwise documented its good faith effort, is not a violation of this Rule. Policy Booneville Pharmacy Of Ms. Inc shall create a Notice of Privacy Practices (?Notice?) that meets the requirements of HIPAA. This Notice will be post prominently in Booneville Pharmacy Of Ms. Inc?s waiting area(s) for inspection by patients and others. The requirement to post the Notice ?prominently? shall be met by either: 1. Placing a copy of the Notice on the waiting area(s) wall(s) for all to view. 2. Enclosing the Notice in a book or binder, which shall be placed in the patient waiting area(s), and shall be clearly marked ?Notice of Privacy Practices.? Booneville Pharmacy Of Ms. Inc?s Privacy Officer shall be responsible for creating, posting, and distributing the Notice of Privacy Practices. Booneville Pharmacy Of Ms. Inc shall provide the Notice of Privacy Practices in printed, hardcopy form to all patients no later than the date of first service delivery. The Privacy Officer or other employees shall make a reasonable effort to obtain from each patient a signature of acknowledgment that the patient has received a copy of the Notice. If a patient refuses to sign an Acknowledgment of Receipt, the refusal shall be noted on the Acknowledgment From by the employee. Whether signed by the patient or the employee (if the patient refused), the Acknowledgment Form shall be placed in the patient?s file. If the first service delivery to an individual is electronic, Booneville Pharmacy Of Ms. Inc shall furnish electronic Notice automatically in response to the individual?s first request for service. In addition, if Booneville Pharmacy Of Ms. Inc maintains a web site, the Notice shall be available electronically through the website. Booneville Pharmacy Of Ms. Inc?s Privacy Officer shall update the Notice of Privacy Practices whenever Booneville Pharmacy Of Ms. Inc makes substantive changes to its policies on requests, uses, and disclosures of protected health information. Compliance and Enforcement The Privacy Officer and all supervisors are responsible for enforcing this policy. Employees who violate this policy are subject to discipline up to and including termination in accordance with Booneville Pharmacy Of Ms. Inc?s Sanction Policy.
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    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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    206 North Second Street
    Booneville, MS, 38829
    (662) 728-1951

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    Pharmacy Hours

    Mon - Fri: 9:00am - 6:00pm;Sat: 9:00am - 12:00pm;Sun: Closed;

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    Mon - Fri: 9:00am - 6:00pm;Sat: 9:00am - 12:00pm;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.