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HIPAA Notice of Privacy Practice
Davies Drugs, Inc. Davies Pharmacy, Inc. Notice of Privacy Practices THlS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU HAM ACCESS TO THlS INFORMATION. PLEASE REVIEW IT CAREFULLY. THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE PRODUCED AND MAINTAINED BY DAVIES DRUGS, INC. AND DAVlES PHARMACY, INC., WHETHER MADE BY DAVlES DRUGS, INC., DAVIES PHARMACY, INC. OR A BUSINESS ASSOCIATE. Effective April 14, 2003, the federal government requires all health care providers to formally comply with The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Health care providers must inform patients in writing of their privacy practices, a patient's rights under law and the restrictions that protect patient information from being disclosed. Davies Drugs, Inc. and Davies Pharmacy, Inc. are commanded by law to preserve the privacy of Protected Health lnformation (PHI). PHI is past, present or future mental or physical health related care, service and condition information that might identify you. This Notice of Privacy Practices ('Notice") explains how we may use and disclose PHI to administer treatment, payment, health care facilitation and other particular purposes that are allowable or required by law. This Notice explains your rights with regard to your PHI. Davies is commanded to follow the provisions of this Notice. Davies will not use or disclose your PHI without your written permission, except as explained or authorized by this Notice. We preserve the right to change our privacy practices and this Notice and to make the new Notice operative for all PHI we maintain. We will provide any amended Notice to you upon request. The respect and protection of your PHI has always been a priority at Davies. We are committed to protecting your confidential PHI and will disclose your PHI to a person other than you or your personal representative, only when permitted by law. This protection extends to any PHI that is oral, written, or electronic (example: prescriptions transmitted by facsimile), modem or other electronic device. The following categorized examples describe how Davies uses and discloses your Protected Health Information to best provide for your medical care and/or as allowed or mandated by law. These categories include examples for description purposes. Please note that not every use or disclosure in a category will be Iisted: Treatment. We may use your PHI to administer and provide for the treatment, pharmaceuticals (including medicines) and services you receive. For instance, we may disclose your PHI to other third party health care agents involved in the coordination of your treatment. At times, we may disclose your PHI to another physician or specialist who becomes involved in your treatment at the request of your physician. Additionally, we may contact you regarding compliance programs like refill reminders, drug/product recommendations or therapeutic substitutions, counseling and drug utilization review (DUR), disease state management, knowledge, counseling and literature about benefits that might interest you, and/or product recalls when we feel the information is essential to your care. This contact includes the mailing or delivery of information to the address you designate and/or leaving messages on your residence answering machine or at the phone number you designate. Payment We might use your PHI for payment related purposes. For instance, we may contact your insurer, benefit manager or other health care payer to ascertain whether it will pay for your treatment, pharmaceuticals and/or services and the amount of your co-pay or other related payment obligation. We will bill you or a third-party payer for the cost of the treatment pharmaceuticals and/or services dispensed to you. Payment may involve reports to credit bureaus, collection agencies and/or to our attorneys for collection if necessary. The information listed on or supplementing your bill might include information that identifies you as well as the treatment, pharmaceuticals and/or service you are provided. Health Care Operations/Facilitations We might use your PHI for particular facilitative, administrative and quality affirmation and marketing endeavors. For instance, we might use information in your health file to supervise the performance of the pharmacists providing treatment counseling, products and services to you or for the training of pharmacy interns. This information will be utilized toward the consistent continuance of quality improvement of and effectiveness of the health care we offer. Facilitations include calling your name in our store when your order is ready and asking you or your messenger to sign our numbered receipt log. Additionally, we contract with certain outside business associates to provide specialized health services, products, counseling, and literature because we feel their personal service and knowledge is beneficial to our patients. We may disclose information in your health file to business associates if they need the information to provide products or services to us and will agree to accept and uphold particular HlPAA rules with regard to the protection of PHI. When required, you will be asked to sign a separate consent form, before these services and products can be made available to you. Davies is permitted to use or disclose your PHI in the following instances or as mandated by law: To communicate with individuals responsible for or involved in your care or responsible for or involved in payment for your care. We might disclose to a family member, other relative, close personal friend, personal representative, or any other person you identify, PHI directly relevant to that person's participation in your care or payment related to your care. For instance, if we can reasonably infer that you agree, we may provide pharmaceuticals and related information to your caregiver on your behalf. Additionally, we will give your pharmacy order to the personal adult messenger who asks for it. Should delivery be requested, we will leave your order with an adult at your residence or the address you designate. Notification. We might use or disclose your PHI to notify or assist in notifying a family member, personal representative or another person responsible for your care regarding your location and general condition. For instance, in the event of a natural disaster or emergency situation. As Mandated by Law. We will disclose your PHI when mandated to do so by federal, state or local law. Health Oversight Pursuits. We might disclose your PHI to an oversight agency for pursuits authorized by law. These oversight pursuits include audits, inspections, investigations, and credentialing as is necessary for licensure and for the government to supervise the health care system, government programs, and compliance with civil rights laws. Law Enforcement. We might disclose your PHI for law enforcement reasons when required by law or in answer to a subpoena, warrant or other court order. Judicial and Administrative Proceedings. We might disclose your PHI in answer to a court or administrative order if you are implicated in a lawsuit or dispute. Additionally, we might disclose particular health information about you in answer to a subpoena, discovery request, or other lawful process brought about by someone else implicated in the dispute, however only if attempts have been made, either by the requesting participant or us, to inform you about the request or to acquire an order protecting the information requested. Correctional Institution. Should you be or become an inmate of a correctional institution, we might disclose to the institution or its agents your PHI as deemed necessary for your health and safety and the health and safety of other individuals. Victim of Abuse or Neglect If we reasonably believe you are a victim of abuse or neglect, we might disclose PHI about you to a government authority. We will only disclose this sort of information to the degree required by law, if you are in agreement to the disclosure, or if the disclosure is permitted by law and we believe disclosure is essential to prevent serious harm to you or someone else. Worker's Compensation. We might disclose your PHI to the degree authorized by and to the degree required to obey laws regarding worker's compensation or additional programs recognized by law. Military and Veterans. Should you be or become a member of the armed forces, we might disclose PHI about you as required by military directed authorities. Additionally, we might disclose PHI about foreign military personnel to military authorities where deemed appropriate. Coroners, Medical Examiners, and Funeral Directors. We might disclose your PHI to a coroner or medical examiner. For instance, disclosure may be deemed necessary for the purposes of identification or to determine cause of death. Administrator or Executor: Upon your death, we might disclose your PHI to an administrator, executor or other individual so authorized under state law. Although we may not engage in the activities, we are permitted to use or disclose your PHI without your permission under federal or applicable state law for purposes of the following: Food and Drug Administration (FDA). We might disclose to the FDA or individuals under the authority of the FDA, PHI related to harmful action with reverence to drugs, foods, products, product deficiencies, supplements or post-marketing investigation information to facilitate product recalls, repairs, or replacement. Research. Your PHI might be disclosed to researchers whose research proposals have been approved by a privacy board or an institutional review board and who additionally, have established procedures and rules to guarantee the privacy of your PHI. Organ or Tissue Procurement Organizations. In keeping with applicable law, we might disclose your PHI to organ procurement organizations or other agencies appointed in the procurement, banking, or transplantation of organs for the intention of tissue donation and transplant Public Heath. Where mandated by law, we might disclose your PHI to public health or legal institutions responsible for the prevention and/or control of disease Including communicable diseases, disability, or injury. To Prevent a Serious Threat to Health or Safety. We might use and/or disclose your PHI when essential to avert a serious threat to your health and safety or the health and safety of the public or another individual. National Security, Intelligence Interests, and Protective Services for the President and Others. We might disclose PHI about you to federal authorities for intelligence, counterintelligence, protection for the President, and/or additional national security interests as mandated by law. Other Uses and Disclosures of PHI. We will acquire your written approval before using or disclosing your PHI for reasons other than those presented above (or as otherwise allowed or mandated by law). You may retract your approval in writing at any time. Upon receipt of your written retraction, we will cease using and/or disclosing your PHI to the degree that we have already taken action in reliance on the approval. Incidental Disclosures Davies will make reasonable endeavors to prevent incidental disclosures of your protected health information. An example of an incidental disclosure would be a disclosure that may be accidentally viewed overhead or accidentally heard in passing by other individuals in our common areas, including but not limited to include sign-in sheets. Although Davies makes every effort to minimize incidental disclosures, it is recommended that you request a more private, office consultation when you deem it necessary. If you are a minor, we may disclose your PHI to your parents or legal guardians when we are permitted or required to do so under federal and applicable state law. Should you be a minor who has lawfully given consent for treatment and you desire for Davies to regard you as an adult for purposes of access to and disclosure of records associated with such treatment please inform a Pharmacist or our Privacy Office. With regard to your Patient Health Information, you have the following rights: The right to obtain a paper copy of the Notice upon request. A paper copy of our most current Notice is available to you at any time, upon your request. Although a copy of our Notice may be available to you electronically, you are nonnetheless entitled to receive a paper copy. You may obtain a paper copy directly from any of our pharmacies. Upon written or oral request a paper copy of our Notice will be mailed to you. The right to view and obtain a copy of your PHI. In most instances, you have the right to view and obtain a copy of the PHI we preserve and protect about you. To view or obtain a copy of your PHI, you must send a written request to our Privacy Office. We have the right to charge you a fee for the costs of copying, mailing and any supplies essential to comply with your request. We have the right to deny your request to view and/or obtain a copy of your PHI in certain limited situations. The right to receive an accounting of the disclosures we have made of your PHI. You have the right to obtain an accounting of the disclosures we have made of your PHI after April 14, 2003,?.disclosures made for most reasons other than treatment, payment or health care facilitations. Your right to obtain an accounting is exposed to certain exceptions, limitations and or restrictions. To obtain an accounting, you must render your request in writing to our Privacy Office. Your request must specify a time period for the accounting not longer than six (6) years and may not include dates prior to April 14,2003. The right to request a restriction on particular uses and disclosures of your PHI. You have the right to ask for additional restrictions on our use or disclosure of your PHI by submitting a written request to our Privacy Office. We are not obligated to agree to your restrictions. We cannot agree to restrictions related to uses or disclosures that are mandated by law, or which are essential to administer our business. The right to request communications of your PHI by alternate means or at different venues. You have the right to ask that we contact you at a different address or post office box. To request confidential communication of your PHI and/or different methods regarding how and where we may contact you, you must submit a written, detailed request to our Privacy Office. We will accommodate all reasonable requests. The right to request a revision of your PHI. Should you believe the PHI we preserve about you is incomplete or inaccurate, you may request that we revise it. To ask for a revision of your PHI, you must submit a written request to our Privacy Office. Your written request must include a reason to support a revision. In particular instances, we may decline your request for a revision. The right to more information or to report a complaint. Should you have additional questions or would like more information about Davies privacy practices, you may contact our Privacy Officer at Davies Pharmacy, 2915 West Tuscarawas Street Canton, Ohio 44708 or telephone our Privacy Officer at 330- 454-5151. If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. You will not be penalized for filing a Complaint. How to obtain forms for submitting written requests with regard to your PHI: You may obtain forms for submitting the written requests described above at any pharmacy location or by contacting our Privacy Officer at Davies Pharmacy, 2915 West Tuscamwar Street, Canton, Ohio 44708 or telephone our Privacy Officer at 330-454-5151. All PHI requests must include: patients full name, date of birth, and current address and phone number l applicable. Ohio Law... Disclosure Defined: Unless we have obtained your written consent, we will only disclose your pharmacy records to: You; the prescriber who issued your prescription or medication order; certified/licensed health care personnel who are responsible for your care; a member, inspector, agent or investigator of the state board of pharmacy or any federal, state, county, or municipal officer whose duty is to enforce the laws of this state or the United States relating to drugs and who is engaged in a specific investigation involving a designated person or drug; an agent of the state medical board when enforcing the statutes governing physicians and limited practitioners; an agency of government charged with the responsibility of providing medical care for you, upon a written request by an authorized representative of the agency requesting such information; an agent of a medical insurance company who provides prescription insurance coverage to you, upon authorization and proof of insurance by you or proof of payment by the insurance company for those medications whose information is requested; an agent who contracts with the pharmacy as a 'business associate" in accordance with the regulations promulgated by the secretary of the United States department of health and human services pursuant to the federal standards for privacy of individually identifiable health information; or in emergency situations, when it is in your best interest. Effective Date: This Notice is effective as of 4/14/2003

About Us

Welcome to Davies Drugs, Inc. 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
    Davies Drugs, Inc. Davies Pharmacy, Inc. Notice of Privacy Practices THlS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU HAM ACCESS TO THlS INFORMATION. PLEASE REVIEW IT CAREFULLY. THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE PRODUCED AND MAINTAINED BY DAVIES DRUGS, INC. AND DAVlES PHARMACY, INC., WHETHER MADE BY DAVlES DRUGS, INC., DAVIES PHARMACY, INC. OR A BUSINESS ASSOCIATE. Effective April 14, 2003, the federal government requires all health care providers to formally comply with The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Health care providers must inform patients in writing of their privacy practices, a patient's rights under law and the restrictions that protect patient information from being disclosed. Davies Drugs, Inc. and Davies Pharmacy, Inc. are commanded by law to preserve the privacy of Protected Health lnformation (PHI). PHI is past, present or future mental or physical health related care, service and condition information that might identify you. This Notice of Privacy Practices ('Notice") explains how we may use and disclose PHI to administer treatment, payment, health care facilitation and other particular purposes that are allowable or required by law. This Notice explains your rights with regard to your PHI. Davies is commanded to follow the provisions of this Notice. Davies will not use or disclose your PHI without your written permission, except as explained or authorized by this Notice. We preserve the right to change our privacy practices and this Notice and to make the new Notice operative for all PHI we maintain. We will provide any amended Notice to you upon request. The respect and protection of your PHI has always been a priority at Davies. We are committed to protecting your confidential PHI and will disclose your PHI to a person other than you or your personal representative, only when permitted by law. This protection extends to any PHI that is oral, written, or electronic (example: prescriptions transmitted by facsimile), modem or other electronic device. The following categorized examples describe how Davies uses and discloses your Protected Health Information to best provide for your medical care and/or as allowed or mandated by law. These categories include examples for description purposes. Please note that not every use or disclosure in a category will be Iisted: Treatment. We may use your PHI to administer and provide for the treatment, pharmaceuticals (including medicines) and services you receive. For instance, we may disclose your PHI to other third party health care agents involved in the coordination of your treatment. At times, we may disclose your PHI to another physician or specialist who becomes involved in your treatment at the request of your physician. Additionally, we may contact you regarding compliance programs like refill reminders, drug/product recommendations or therapeutic substitutions, counseling and drug utilization review (DUR), disease state management, knowledge, counseling and literature about benefits that might interest you, and/or product recalls when we feel the information is essential to your care. This contact includes the mailing or delivery of information to the address you designate and/or leaving messages on your residence answering machine or at the phone number you designate. Payment We might use your PHI for payment related purposes. For instance, we may contact your insurer, benefit manager or other health care payer to ascertain whether it will pay for your treatment, pharmaceuticals and/or services and the amount of your co-pay or other related payment obligation. We will bill you or a third-party payer for the cost of the treatment pharmaceuticals and/or services dispensed to you. Payment may involve reports to credit bureaus, collection agencies and/or to our attorneys for collection if necessary. The information listed on or supplementing your bill might include information that identifies you as well as the treatment, pharmaceuticals and/or service you are provided. Health Care Operations/Facilitations We might use your PHI for particular facilitative, administrative and quality affirmation and marketing endeavors. For instance, we might use information in your health file to supervise the performance of the pharmacists providing treatment counseling, products and services to you or for the training of pharmacy interns. This information will be utilized toward the consistent continuance of quality improvement of and effectiveness of the health care we offer. Facilitations include calling your name in our store when your order is ready and asking you or your messenger to sign our numbered receipt log. Additionally, we contract with certain outside business associates to provide specialized health services, products, counseling, and literature because we feel their personal service and knowledge is beneficial to our patients. We may disclose information in your health file to business associates if they need the information to provide products or services to us and will agree to accept and uphold particular HlPAA rules with regard to the protection of PHI. When required, you will be asked to sign a separate consent form, before these services and products can be made available to you. Davies is permitted to use or disclose your PHI in the following instances or as mandated by law: To communicate with individuals responsible for or involved in your care or responsible for or involved in payment for your care. We might disclose to a family member, other relative, close personal friend, personal representative, or any other person you identify, PHI directly relevant to that person's participation in your care or payment related to your care. For instance, if we can reasonably infer that you agree, we may provide pharmaceuticals and related information to your caregiver on your behalf. Additionally, we will give your pharmacy order to the personal adult messenger who asks for it. Should delivery be requested, we will leave your order with an adult at your residence or the address you designate. Notification. We might use or disclose your PHI to notify or assist in notifying a family member, personal representative or another person responsible for your care regarding your location and general condition. For instance, in the event of a natural disaster or emergency situation. As Mandated by Law. We will disclose your PHI when mandated to do so by federal, state or local law. Health Oversight Pursuits. We might disclose your PHI to an oversight agency for pursuits authorized by law. These oversight pursuits include audits, inspections, investigations, and credentialing as is necessary for licensure and for the government to supervise the health care system, government programs, and compliance with civil rights laws. Law Enforcement. We might disclose your PHI for law enforcement reasons when required by law or in answer to a subpoena, warrant or other court order. Judicial and Administrative Proceedings. We might disclose your PHI in answer to a court or administrative order if you are implicated in a lawsuit or dispute. Additionally, we might disclose particular health information about you in answer to a subpoena, discovery request, or other lawful process brought about by someone else implicated in the dispute, however only if attempts have been made, either by the requesting participant or us, to inform you about the request or to acquire an order protecting the information requested. Correctional Institution. Should you be or become an inmate of a correctional institution, we might disclose to the institution or its agents your PHI as deemed necessary for your health and safety and the health and safety of other individuals. Victim of Abuse or Neglect If we reasonably believe you are a victim of abuse or neglect, we might disclose PHI about you to a government authority. We will only disclose this sort of information to the degree required by law, if you are in agreement to the disclosure, or if the disclosure is permitted by law and we believe disclosure is essential to prevent serious harm to you or someone else. Worker's Compensation. We might disclose your PHI to the degree authorized by and to the degree required to obey laws regarding worker's compensation or additional programs recognized by law. Military and Veterans. Should you be or become a member of the armed forces, we might disclose PHI about you as required by military directed authorities. Additionally, we might disclose PHI about foreign military personnel to military authorities where deemed appropriate. Coroners, Medical Examiners, and Funeral Directors. We might disclose your PHI to a coroner or medical examiner. For instance, disclosure may be deemed necessary for the purposes of identification or to determine cause of death. Administrator or Executor: Upon your death, we might disclose your PHI to an administrator, executor or other individual so authorized under state law. Although we may not engage in the activities, we are permitted to use or disclose your PHI without your permission under federal or applicable state law for purposes of the following: Food and Drug Administration (FDA). We might disclose to the FDA or individuals under the authority of the FDA, PHI related to harmful action with reverence to drugs, foods, products, product deficiencies, supplements or post-marketing investigation information to facilitate product recalls, repairs, or replacement. Research. Your PHI might be disclosed to researchers whose research proposals have been approved by a privacy board or an institutional review board and who additionally, have established procedures and rules to guarantee the privacy of your PHI. Organ or Tissue Procurement Organizations. In keeping with applicable law, we might disclose your PHI to organ procurement organizations or other agencies appointed in the procurement, banking, or transplantation of organs for the intention of tissue donation and transplant Public Heath. Where mandated by law, we might disclose your PHI to public health or legal institutions responsible for the prevention and/or control of disease Including communicable diseases, disability, or injury. To Prevent a Serious Threat to Health or Safety. We might use and/or disclose your PHI when essential to avert a serious threat to your health and safety or the health and safety of the public or another individual. National Security, Intelligence Interests, and Protective Services for the President and Others. We might disclose PHI about you to federal authorities for intelligence, counterintelligence, protection for the President, and/or additional national security interests as mandated by law. Other Uses and Disclosures of PHI. We will acquire your written approval before using or disclosing your PHI for reasons other than those presented above (or as otherwise allowed or mandated by law). You may retract your approval in writing at any time. Upon receipt of your written retraction, we will cease using and/or disclosing your PHI to the degree that we have already taken action in reliance on the approval. Incidental Disclosures Davies will make reasonable endeavors to prevent incidental disclosures of your protected health information. An example of an incidental disclosure would be a disclosure that may be accidentally viewed overhead or accidentally heard in passing by other individuals in our common areas, including but not limited to include sign-in sheets. Although Davies makes every effort to minimize incidental disclosures, it is recommended that you request a more private, office consultation when you deem it necessary. If you are a minor, we may disclose your PHI to your parents or legal guardians when we are permitted or required to do so under federal and applicable state law. Should you be a minor who has lawfully given consent for treatment and you desire for Davies to regard you as an adult for purposes of access to and disclosure of records associated with such treatment please inform a Pharmacist or our Privacy Office. With regard to your Patient Health Information, you have the following rights: The right to obtain a paper copy of the Notice upon request. A paper copy of our most current Notice is available to you at any time, upon your request. Although a copy of our Notice may be available to you electronically, you are nonnetheless entitled to receive a paper copy. You may obtain a paper copy directly from any of our pharmacies. Upon written or oral request a paper copy of our Notice will be mailed to you. The right to view and obtain a copy of your PHI. In most instances, you have the right to view and obtain a copy of the PHI we preserve and protect about you. To view or obtain a copy of your PHI, you must send a written request to our Privacy Office. We have the right to charge you a fee for the costs of copying, mailing and any supplies essential to comply with your request. We have the right to deny your request to view and/or obtain a copy of your PHI in certain limited situations. The right to receive an accounting of the disclosures we have made of your PHI. You have the right to obtain an accounting of the disclosures we have made of your PHI after April 14, 2003,?.disclosures made for most reasons other than treatment, payment or health care facilitations. Your right to obtain an accounting is exposed to certain exceptions, limitations and or restrictions. To obtain an accounting, you must render your request in writing to our Privacy Office. Your request must specify a time period for the accounting not longer than six (6) years and may not include dates prior to April 14,2003. The right to request a restriction on particular uses and disclosures of your PHI. You have the right to ask for additional restrictions on our use or disclosure of your PHI by submitting a written request to our Privacy Office. We are not obligated to agree to your restrictions. We cannot agree to restrictions related to uses or disclosures that are mandated by law, or which are essential to administer our business. The right to request communications of your PHI by alternate means or at different venues. You have the right to ask that we contact you at a different address or post office box. To request confidential communication of your PHI and/or different methods regarding how and where we may contact you, you must submit a written, detailed request to our Privacy Office. We will accommodate all reasonable requests. The right to request a revision of your PHI. Should you believe the PHI we preserve about you is incomplete or inaccurate, you may request that we revise it. To ask for a revision of your PHI, you must submit a written request to our Privacy Office. Your written request must include a reason to support a revision. In particular instances, we may decline your request for a revision. The right to more information or to report a complaint. Should you have additional questions or would like more information about Davies privacy practices, you may contact our Privacy Officer at Davies Pharmacy, 2915 West Tuscarawas Street Canton, Ohio 44708 or telephone our Privacy Officer at 330- 454-5151. If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. You will not be penalized for filing a Complaint. How to obtain forms for submitting written requests with regard to your PHI: You may obtain forms for submitting the written requests described above at any pharmacy location or by contacting our Privacy Officer at Davies Pharmacy, 2915 West Tuscamwar Street, Canton, Ohio 44708 or telephone our Privacy Officer at 330-454-5151. All PHI requests must include: patients full name, date of birth, and current address and phone number l applicable. Ohio Law... Disclosure Defined: Unless we have obtained your written consent, we will only disclose your pharmacy records to: You; the prescriber who issued your prescription or medication order; certified/licensed health care personnel who are responsible for your care; a member, inspector, agent or investigator of the state board of pharmacy or any federal, state, county, or municipal officer whose duty is to enforce the laws of this state or the United States relating to drugs and who is engaged in a specific investigation involving a designated person or drug; an agent of the state medical board when enforcing the statutes governing physicians and limited practitioners; an agency of government charged with the responsibility of providing medical care for you, upon a written request by an authorized representative of the agency requesting such information; an agent of a medical insurance company who provides prescription insurance coverage to you, upon authorization and proof of insurance by you or proof of payment by the insurance company for those medications whose information is requested; an agent who contracts with the pharmacy as a 'business associate" in accordance with the regulations promulgated by the secretary of the United States department of health and human services pursuant to the federal standards for privacy of individually identifiable health information; or in emergency situations, when it is in your best interest. Effective Date: This Notice is effective as of 4/14/2003
       
       
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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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    North Canton, OH, 44720
    (330) 305-9075

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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.