Protecting Your Privacy Roller Pharmacy is committed to ensuring the privacy and confidentiality of our customer?s Protected Health Information (PHI) and fully supports the provisions of the Privacy Rule Of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 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. This Notice of Privacy Practices describes how Roller Pharmacy may collect, use and disclose your protected health information, and your rights concerning your protected health information. Protected health information is information about you or your dependents, including demographic information, that can reasonably be used to identify you and that relates to your past, present or future physical or mental health or condition, the provision of health care service to you or our payment for that care. We are required to safeguard your protected health information and to provide you with this notice about our legal duties and privacy practices. We must follow the privacy practices described in this notice while it is in effect. This notice takes effect April 14, 2003 and will remain in effect until we replace or modify it. WHAT IS PROTECTED HEALTH INFORMATION (PHI)? Whether based on our long-standing confidentiality policy or pertinent law, Roller Pharmacy, safeguards the privacy of your protected health information (?PHI?). PHI is information that alone, or in conjunction with other data that we collect from or about you, would allow you to be identified. For example, medical information used to help customers get needed care, or information about payments for services you have received, as well as descriptive information about those services, is PHI. HOW WE MAY USE AND DISCLOSE YOUR PHI In order to provide coverage for treatment and pay for those services, we need to use and disclose your PHI in a number of different ways. Roller Pharmacy staff is trained in the appropriate handling of your PH and execute their specific responsibilities using only that information required for their role. Roller Pharmacy maintains and enforces policies governing the use of PHI by workforce members to ensure their proper handling. Procedures to afford these internal protections against mishandling of PHI throughout the workforce include provisions pertinent to physical and technical safeguards taken in order to protect verbal, written and electronic PHI from being mishandled by workforce members as they execute their responsibilities. The following are examples of the types of uses and disclosures of your PHI that we are permitted to make without your authorization: FOR PAYMENT Roller Pharmacy will use and disclose your PHI to administer your health benefits policy or contract, which may involve the determination of eligibility; claims payment; utilization review activities; medical necessity review; coordination of benefits and responding to complaints, appeals, and external review requests. Examples include: * Using PHI in order to pay claims that have been submitted to us by physicians and hospitals for payment * Transmitting PHI to a third party to facilitate administration of a Flexible Spending Account, a Healthy Savings Account, a Health reimbursement account, or a dental benefits plan, in you have one * Additional PHI of dependents may be shared with subscriber when administering a family membership contract ( the current status of co-payments and deducible amounts for dependents) FOR HEALTH CARE OPERATIONS Roller Pharmacy may use and disclose your PHI for operational purposes. For example, your PGI may be disclosed to staff members within Roller Pharmacy, such as medical-management, risk- management or quality-improvement personnel, and others to: * Assess the quality of care and outcomes in your cases and similar cases * Learn how to improve our services and facilities through the use of internal and external surveys * Determine how to continuously improve the quality and effectiveness of health care services our members receive * Evaluate the performance of our staff, for example, to review our member service representatives? call documentation In addition, your PHI may be used for the following purposes, each of which is also considered health care operations: * Sharing of data used for enrollment, disenrollment, and premium billing, as well as summary renewal data with your Plan Sponsor (your employer and/or their representatives, if you are enrolled through an employer) * Other information beyond what is listed may be shared only after Roller Pharmacy receives appropriate certification that the PHI will not be used by your employer for employment decisions or other non-intended purposes) * If you have a primary care physician who manages your care, we may furnish his or her name to your Plan Sponsor in order to permit your Sponsor to evaluate the effects of changes to the network available to you * Quality assessment and improvement activities, such as peer review and credentialing of our affiliated providers. * Accreditation by independent organizations such as the National Committee for Quality Assurance. * Performance measurement and outcomes assessment, health claims analysis and health services research * Preventive health, early detection, disease management, case management and coordination of care programs, including sending preventive health service reminders * Underwriting, rate making and determining cost sharing amounts, as well as administration of reassurance policies. * Risk management, auditing and detection of unlawful conduct * Transfer of policies or contracts from and to other insurers, health plans or third party administrators. * Facilitation of any potential sale, transfer, merger, or consolidation of all or part of a ?covered entity? like HPHC, with another covered entity, and due diligence related to that activity * Other general administrative activities, including data and information systems management, customer service and collecting premiums. FOR TREATMENT Roller Pharmacy may disclose your PHI to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it in connection with your treatment. For example, for your safety, we may provide a list of medications you?ve received through Roller Pharmacy to emergency room clinicians treating you in an effort to minimize the potential for adverse drug interactions. This information will only be furnished to emergency room clinicians with your consent, unless you are unable to provide consent. We may also disclose your PHI to health care providers in connection with preventative health initiatives, early detection programs, and disease management programs. For example, Roller Pharmacy may disclose information to a physician involved in your care that includes a list of medications you?ve filled at Roller Pharmacy( this will alert those physicians treating you to those medications prescribed for you by others and will help minimize potential adverse drug interaction). Roller Pharmacy may also disclose information to your primary care physician to suggest a disease management or wellness programs that could improve your health. At times, Roller Pharmacy may contract with other organizations to provide services on our behalf. As these services are performed, PHI is accessed or disclosed. In these cases, Roller Pharmacy will enter into an agreement explicitly outlining the requirements associated with the protection, use and disclosure of your PHI. Examples of such ?business associates? include behavioral health management companies and pharmacy benefit managers. Other permitted or required uses and disclosures of PHI that do not require your authorization include the following: * Parents as personal representatives of minors: In most cases, your minor child?s PHI may be disclosed to you. However, we may be required by law to deny a parent?s access to a minor?s PHI for certain diagnoses or treatment such as sexually transmitted diseases, family planning services, etc. * Worker?s compensation: Your PHI may be used and disclosed in order to comply with laws and regulations related to Workers? Compensation. * Public Health Activities: Your PHI may be used or disclose for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury or disability, tracking of prescription drug or medical device programs, or for other health oversight activities. This can include expanded public health activities data collection by state government-mandated or sponsored consortiums or public health authorities. * Research: Roller Pharmacy may use your PHI for research purposes when our Human Subjects Committee has reviewed the research proposal and approved the research based on established protocols to ensure the privacy of your PHI. * Legal proceedings: You PHI may be disclosed in the course of any legal proceeding, in response to an order of a court or an administrative tribunal and, in certain cases, in response to a subpoena, discovery request, or any other legal process. * If you are enrolled in a group health plan: If you are enrolled in Roller Pharmacy through your work or through a family member?s policy, you are enrolled in a ?Group health plan.? If your employer has established procedures to safeguard your PHI as required by federal law, and the Group Health Plan elects to receive PHI from Roller Pharmacy, we may disclose this information to your sponsoring employer and/or their representative, including, if requested by your Group Health Plan, data describing specific treatments and medications. Talk to your subscriber?s sponsoring employer to get more details. * Health oversight: Your PHI may be disclosed to a government agency authorized to oversee the health care system or government programs or its contractors, (the US Department of Health and Human Services (HHS), a state insurance department or the US department of Labor), for activities authorized by law, such as audits, examinations, investigations, inspections and licensure activities. Although we do not anticipate the following situations will occur frequently, we are required by law to notify you of these additional potential uses and disclosures which can occur without your written authorization * As required by law: Roller Pharmacy may use and disclose information about you as required by law. For example, Roller Pharmacy may disclose information for the following reasons: to report information related to victims of abuse, neglect or domestic violence; to assist law enforcement officials in performing their duties. * Government functions: Your PHI may be disclosed to prevent serious threat to your health or safety or that of any person pursuant to applicable law. We may also disclose your protected health information to authorized federal officials for nation security purposes. In addition, under applicable conditions, we may disclose your PHI if you are, or were a member of the Armed Forces, for those activities deemed necessary by appropriate military authorities. * Inmates: If you are an inmate, your PHI may be disclosed to a correctional institution or a law enforcement official having lawful custody, if the provision of such information is necessary to provide you with health care, protect your health and safety, and that of others, or maintain the safety and security of the correctional institution. * Decedents: PHI may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties. * Organ/tissue donation: Your PHI may be used or disclosed to organ procurement organizations to facilitate cadaveric organ, eye or/tissue donation/ transplantation purposes only subsequent to your prior authorization. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION Uses and disclosures of PHI other than those listed in the previous section will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke such an authorization, at any time in writing, except to the extent that we have already taken action based on a previously executed authorization. If a written authorization is obtained from you, your PHI may be disclosed to your personal representative, a person (an adult or emancipated minor) that Roller Pharmacy recognizes as having the authority to act on behalf of another individual in making decisions related to health care. A form to designate your personal representative is at the end of this document. Many members ask us to disclose their PHI to third parties for reasons not described in this notice. For example, elderly members often ask to make their records available to family members or caregivers. To authorize us to disclose any of your PHI to a person or organization for reasons other than those describe in our notice, you may request in writing and we will be glad to assist you. You may revoke the authorization at any time by sending a letter to our Member Services Department. It is important for you to note that once you give us authorization to release your health information, the PHI that we release is out of our control. Roller Pharmacy is unable to safeguard such PHI from redisclosure by the person(s) that you have authorized us to release it to. Finally, Roller Pharmacy will not use your PHI to offer you services or products unrelated to your health care coverage or your health status without your authorization. YOUR RIGHTS REGARDING YOUR PHI The following are your rights with respect to your PHI RIGHT TO ACCESS AND RECEIVE COPIES OF YOUR PHI You have the right to receive a copy of your PHI. We may ask you to request access to copies of your records in writing and to provide us with specific information we need to fulfill your request. We reserve the right to charge a reasonable fee for the cost of producing and mailing the copies of such information. There are certain cases in which we are not permitted to fulfill your request to access or receive your PHI. You may not inspect or copy: * Information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding: * Psychotherapy notes that may be submitted to Roller Pharmacy incidental to a member complaint or appeal. (Roller Pharmacy never requests these confidential notes) * PHI that is subject to the Clinical Laboratory Improvements Amendments of 1988; * Information created or obtained by Roller Pharmacy in the course of research that includes treatment. Access to these records may be temporarily suspended for as long as the research is in progress; * PHI that was obtained from someone other than a health care provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information. RIGHT TO AMEND YOUR PHI If you believe that your protected health information is incorrect or incomplete, you have the right to ask us to amend it. All requests for amendment must be in writing. In certain cases, we may deny your request. For example, we may deny a request if we did not create the information, as is often the case for medical information that is generated by a provider and stored in our records, or if we believe the current information is correct. All denials will be made in writing. You may respond by filing a written statement of disagreement with Roller Pharmacy and we would have the right to rebut that statement. If you believe someone has received an un-amended PHI from us, you should inform us at the time of the request if you want him or her informed of any amendment we may subsequently agree to execute. RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS Roller Pharmacy recognizes that members have the right to receive communications regarding their PHI in a manner or at a location that the individual feels is safe from an authorized use or disclosure. To support this comment, Roller Pharmacy will permit individuals to request that they receive PHI by alternative means or at alternative locations. We will attempt to accommodate reasonable requests. All requests must be made in writing. RIGHT TO AN ACCOUNTING OF DISCLOSURES OF PHI You have the right to request an accounting of those instances in which we have disclosed your PHI for any purpose other than the following: * For treatment, payment or health care operations * To others involved in your care * Disclosures that you or your designated personal representative have authorized * Certain other disclosures, such as disclosures for national security purposes * Information disclosed to correctional institutions, law enforcement agencies, and health oversight agencies. * Information that was disclosed or used as part of a limited data set for research, public health or health care operations purposes, and * Disclosures made prior to April 14, 2003. All requests must be made in writing. Roller Pharmacy will required you to provide us with the specific information we need to fulfill your request. If you request this accounting more than once in a twelve month period, we may charge you a reasonable fee. RIGHT TO REQUEST LIMITS ON USES AND DISCLOSURES OF YOUR PHI You have the right to ask us to place restrictions on the way we use or disclose your PHI for treatment, payment or health care operations or as described in the section of this notice titled ?Other Permitted or Required Uses and Disclosures of PHI.? We are not, however, required by law to agree to these restrictions. If we do agree to a restriction, we may not use or disclose your PHI in violation of that restriction, unless it is related to an emergency. We may ask that you request these limits in writing. RIGHT TO RECEIVE Roller Pharmacy NOTICE OF PRIVACY PRACTICES You have the right to receive a paper copy of the Notice of Privacy Practices upon request at any time and you may also view a pdf version of the Notice. RIGHTS UNDER STATE LAW You may be entitled to additional rights under state law, e.g. Tennessee provides for enhanced protection of genetic testing and HIV testing. While Roller Pharmacy pays careful attention to protecting this information for all of our members, there are state laws that are more stringent than Provisions of HIPAA?s Privacy Rule. HOW TO OBTAIN INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT PRIVACY PRACTICES To request a copy of this Notice of Privacy Practices at any time, or obtain additional information about this notice, you may contact: Roller Pharmacy 109 N Main Ave. Erwin, TN 37650 423-743-7105 If you believe your privacy rights have been violated, you may file a written complaint with: President Roller Pharmacy: Roller Pharmacy, 109 N Main Ave., Erwin, TN 37650 or by contacting this office at 423- 743-7105. CHANGES TO THIS NOTICE We may make a change to this notice and our privacy practices at any time, as long as the change is consistent with our current privacy policies or state or federal law. If we make an important change to our policies, we will promptly provide you with the new notice by mail and post it on our website. EFFECTIVE DATE OF THIS NOTICE The original effective date is April 14, 2003 and the first revision became effective on September 1, 2004.
Welcome to Roller 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.