NOTICE OF PRIVACY PRACTICES RIVER OAK PHARMACEUTICAL CARE, INC. River Oak Pharmacy PO BOX 1683 1800-D WEST F STREET OAKDALE, CA 95361 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. River Oak 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 with respect to PHI about you. River Oak Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this notice. We reserve the right to change our practice 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. River Oak Pharmacy is independently owned by River Oak Pharmaceutical Care, Inc. and operates as an independent pharmacy. 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, Ken Cosner, at River Oak Pharmacy, PO Box 1683. Oakdale, CA 95361. Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on use or disclosure of PHI about you by sending a written request to the Privacy Officer at River Oak Pharmacy. 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 River Oak Pharmacy maintains the PHI. The designated record set usually will include prescription and billing records. To inspect a copy PHI about you, you must send a written request to the Privacy Officer at River Oak Pharmacy. We may charge you a fee for the costs of copying, mailing supplies that are necessary to fulfill your request. We may deny you 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 at River Oak Pharmacy. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement. Receive an accounting to disclosures 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 certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends of 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 writing to the Privacy Officer at River Oak Pharmacy. Your request must specify the time period, but may not be longer than six years. The fist accounting you request within a 12 month period will be provided free of charge, but you may be charged for the 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 that 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 at River Oak Pharmacy. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests. EXAMPLES OF HOW WE MAY USE AND DISCLOSE PHI The following are descriptions and examples of ways we use and disclose PHI. We will use PHI for treatment. 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. We will contact your insurer of pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment. We will bill you or a 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. The 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. When these services are contracted for, we may disclose PHI about you to our business associates so that they can perform the job we?ve asked them to do and bill you or a third party payor for the 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 identify, PHI relevant to that person?s involvement in your care or payment related to your care. Health-related communications: We may contact you to provide refill reminders of 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, food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repair, or replacement. Workers? Compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to workers? 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. As required by law: We must disclose PHI about you when required to do so by law. Health Oversight Activities: We may 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 law. 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 a dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requesting PHI. We are permitted to use or disclose PHI about you for the following purposes: Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information. 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. 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 or safety: We may use and disclose PHI about you when necessary to prevent serious threat to your health and safety or the health and safety of the public or another person. Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority. 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 violence: 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, or if the disclosure is allowed by law. 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 The Pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of 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 the Pharmacy?s privacy practices, you may contact the Privacy Officer, Ken Cosner, at River Oak Pharmacy, PO Box 1683. Oakdale, CA 95361. If you believe your privacy rights have been violated, you can file a complaint with the pharmacist or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. EFFECTIVE DATE This Notice is effective as of April 14, 2003 California State Law Supplement The following restrictions also may apply to pharmacies located in the state of California: Disclosure (CMIA): California law limits the disclosure of your medical information in ways that would otherwise be permitted under federal law. In the situations described below, the pharmacy will disclose your medical information as follows: (a) The information may be disclosed to providers of health care, health care service plans, contractors or other health care professionals or facilities for purposes of diagnosis or treatment of the patient. This includes, in an emergency situation the communication of patient information by radio transmission or other means between licensed emergency medical treatment at the scene of an emergency, or in an emergency medical transport vehicle, and licensed emergency medical personnel at a health facility. (b) The information may be disclosed to an insurer, employer, health care service plan, hospital service plan, employee benefit plan, government authority, contractor or any other person or entity responsible for paying for health care services rendered to the patient to the extent necessary to allow responsibility for payment to be determined and payment to be made. If the patient is, by reason of a comatose or other medical disabling medical condition, unable to consent to the disclosure of medical information and no other arrangement have been made to pay for the health care services being rendered to the patient, that patient?s eligibility for, and to obtain, payment under a governmental program for health care services provided to the patient. The information may also be disclosed to another provider of health care or health care service plan as necessary to assist the other provider or health care service plan in obtaining payment for health care services rendered by that provider of health care or health care service plan to the patient. (c) The information may be disclosed to any person or entity that provides billing, claims management, medical data processing, or other administrative services for providers of health care or health care service plans or for any of the persons or entities specified above. However, no information so disclosed may be further disclosed by the recipient in any way that would be violative of California laws governing the use and disclosure of medical information without authorization from the patient; (d) The information may be disclosed to organized committees and agents of professional societies or of medical staff of licensed hospitals, licensed health care service plans, professional standards review organizations, independent medical review organizations and their selected reviewers, utilization and quality control peer review organizations, contractor?s or persons or organization insuring, responsible for, or defending professional liability that a provider may incur, if the committees agents, health care service plans, organizations, reviewers, contractors or persons engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges; (e) A provider of health care or health service plan that has created medical information as a result of employment-related health care services to an employee conducted at the specific prior written request and expense of the employer may disclose to employee?s employer that: i. Is relevant in a lawsuit, arbitration, grievance, or other claim or challenge to which the employer and the employee are parties and in which the patient has placed in issue his or her medical history, mental or physical condition, or treatment, provided that information may only be used or disclosed in connection with that proceeding; ii. Describes functional limitations of the patient that may entitle the patient to leave from work for medical reasons or limit the patient?s fitness to perform his or her present employment, provided that no statement of medical cause is included in the information disclosed; (f) Unless the provider of health care service plan is notified in writing of an agreement by the sponsor, insurer, or administrator to the contrary, the information may be disclosed to a sponsor, insurer, or administrator of a group of individual insured or uninsured plan or policy that the patient seeks coverage by or benefits from, if the information was created by the provider of health care or health care service plan as the result of services conducted at the specific prior written request and expense of the sponsor, insurer, or administrator for the purpose of evaluating the application for coverage or benefits; (g) The information may be disclosed to a health care service plan by providers of health care that contract with the health care service plan and may be transferred among providers of health care that contract with the health care service plan, for the purpose of administering the health care service plan. Medical information may not otherwise be disclosed by a health care service plan except in accordance with the provisions of this part; (h) The information may be disclosed to an insurance institution, agent or support organization of medical information is the insurance institution, agent, or support organization has complied with all requirements for obtaining the information pursuant to the requirements of the California Insurance Code Provisions; (i) The information may be disclosed to an organ procurement organization or a tissue bank processing the tissue of a decedent for transplantation into the body of another person, but only with respect to the donating decedent for the purpose of aiding the transplant; (j) The information may be disclosed to a third party for purposes of encoding, encrypting, or otherwise anonymizing data. However, no information may be further disclosed by the recipient in any way that would be unauthorized manipulation of coded or encrypted medical information that reveals individually identifiable medical information; (k) For purposes of disease management programs and services, information may be disclosed to any entity contracting with a health care service plan or the health care service plan?s contractors to monitor or administer care of enrollees for a covered benefit, provided that the disease management organization that complies fully with the physician authorization requirements, provided that the health care service plan or its contractor provides or has provided a description of the disease management services to a treating physician or to the health care service plan?s or contractor?s network of physicians.
Welcome to River Oak 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.