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HIPAA Notice of Privacy Practice
NOTICE OF ST. JOHN?S HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE: DECEMBER 1, 2006 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This notice explains how we may use and disclose your medical information, our obligations related to the use and disclosure of your medical information and your rights related to any medical information that we have about you. Thin notice applies to the medical information that is generated in or by St. John?s entities and facilities. This notice also describes the practices of St. John?s and that of any physician with staff privileged with respect to your Protected Health Information (PHI) created while you are a patient of St. John?s. Physicians with staff privileges and personnel authorized to have access to your medical chart are subject to this notice. In addition, physicians with staff privileges may share medical information with each other for treatment, payment or healthcare operations described in this notice. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this notice related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required by law to follow the terms of the notice that is currently in effect. I understand that the physicians participating in my care at St. John?s may not be employees or agents of St. John?s and may not be acting for or on behalf of St. John?s but are independent physicians who have been granted privileges to use facilities for the care of their patients. I understand that medical decisions regarding my care and treatment at St. John?s may be made by such physicians and not by St. John?s. With a few exceptions, we are required to obtain your authorization for the use or disclosure of the information. We have listed some of the reasons why we might use or disclose your medical information and some examples of the types of uses and disclosures below. Not every use or disclosure is covered but all of the ways that we are allowed to use and disclose information will fall into one of the categories. If you have any questions about the content of this notice, or if you need to contact someone at At this site about any of the information contained in this notice, please contact: St. John?s Corporate Privacy Officer 1235 E. Cherokee, Springfield, MO 65804 Toll free for areas outside of Springfield (1-888-664-4722) In addition to hospital department, clinic departments, employees, staff, and other St. John?s personnel, the following persons will also follow the practices described in this notice: * Any healthcare professional who is authorized to enter information in your medical record; * Any member of a volunteer group that we allow to help you while you are at this site; any student, resident or intern. All sites within St. John?s will follow the terms of this Notice of Privacy practices. In addition, they may share medical information for treatment, payment, healthcare operations as they are describes in this Notice of Privacy Practices. USE AND DISCLOSURE OF MEDICAL INFORMATION We can use or disclose medical information about you regarding your treatment, payment for services or for healthcare operations. We may also disclose your protected health information (PHI) for the treatment activities of another provider, the payment activities of another provider or covered entity, and certain limited healthcare operations of another covered entity. For treatment: to provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Departments within the hospital may share medical information about you to coordinate your care. For instance, the laboratory may request the information to complete lab work. Also for coordination of care, we will disclose information to other healthcare providers from whom you seek treatment in order that the combined treatment provided by all is in your best interest. For example, we will seek and/or inform other healthcare providers of pharmaceutical prescriptions that we have or they have written on your behalf to ensure that there are no harmful drug interactions and to ensure that prescribed dosages are appropriate. We may disclose medical information about you to people who may be involved in you medical care after you leave the hospital, such as home health agencies, nursing homes, your family, and clergy members. For payment: we may use and disclose your medical information for the hospital to bill and receive payment for the treatment that you received here. For example, we may use or disclose your medical information to your insurance company about a service you received at the hospital so that your insurance company can pay us or reimburse you for the service. We may also ask your insurance company for prior authorization for a service to determine whether or not the insurance will cover it. For health care operations: we can use and disclose medical information about you for hospital operations. These include uses and disclosures that are necessary to run the hospital and make sure that our patients receive quality care. For example, we may use or disclose medical information about you to evaluate our staff?s performance in caring for you. Medical information about you and other St. John?s patients may also be combines to allow us to evaluate whether St. John?s should offer additional services or discontinue other services and whether certain treatments are effective. We may also compare this information with other hospitals to evaluate whether we can make improvements in the care and services that we offer, to best protect your privacy when we are combining medical information, we will make best efforts to remove information that identifies you. For Research: We may disclose information to researched when their research has been approved by institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. USES AND DISCLOSURES OF MEDICAL INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION We can use or disclose health information about you without your authorization when there is an emergency or when we are required by law to treat you; when we are required by law to use or disclose certain information, or when substantial communication barriers to obtaining authorization from you. Further, we may use or disclose your health information without your authorization in any of the following circumstances. When necessary to contact you to provide: * Appointment reminders * Information about treatment alternatives or other health related benefits or services that may be of interest to you or, * Participation in a clinical trial or research protocol; * When it is required by law; * When it involves use and disclosure for public health activities, such as mandated disease reporting; * When reporting information about victims of abuse or neglect; * When disclosing information for the purpose of medical device tracking and health oversight activities, such as audits, investigations, inspections, licensure or disciplinary actions, or legal proceedings or actions; * When disclosing information for judicial and administrative proceedings in accordance with state and /or federal laws, for instance, in response to a court order such as a court ordered subpoena; * When disclosing information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness, or missing persons or regarding a victim of a crime who cannot give consent or authorization because of incapacity; * When disclosing information about deceased persons to medical examiners, coroners, and funeral directors; * When disclosing or using information for organ and tissue donation purposes; * When disclosing information related to a research project when a waiver of authorization has been approved by the institutional review board and/or the Privacy Committee; * When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the public?s safety; * When disclosure is necessary for specialized government functions, such as military service, for the protection of the president, or for national security and intelligence activities; * When required by military command authorities, if you are a member of the armed forces (or foreign military personnel, to appropriate authorities); * In the case of a prison inmate, information can be released to the correctional facility in which he or she resides for the following purposes: (1) for the institution to provide the inmate with healthcare, (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility; and * When disclosure is necessary to comply with worker?s compensation laws or purposes. PLANNED USES OR DISCLOSURES TO WHICH YOU MAY OBJECT * We will use or disclose your health information for any of the purposes described in the above section unless you affirmatively object to or otherwise restrict a particular release. You must direct your written objections or restrictions to a Privacy Site Coordinator or the St. John?s Corporate Privacy Officer, 1235 E. Cherokee, Springfield, MO 65804. * We may use or disclose your health information in order to include you in the hospital patient directory. Directory information includes your name, location in the hospital, your room number, and condition. We may disclose this information to people who ask for you by name. In addition, a member of clergy may obtain your religious affiliation. * We may use health information about you to contact you in an effort to raise money for the hospital. A Foundation related to the hospitals or clinics may receive contact information, which includes your name, address and phone number and the dates that you received services from the hospital, clinics, Mercy Villa or Home Care but will not receive medical information from your medical records. * We may release health information about you to your personal representative, a friend and/or family member who is involved in your care, if applicable to state and federal regulations. We can tell you personal representative, family and/or friend of your condition and that you are in the hospital for treatment or services. We can also give this information to someone who will help or is helping pay for your care. * We can disclose health information about you to a public or privacy entity that is authorized by law or its charter to assist in disaster relief, i.e. American Red Cross, for the purpose of notification of family and/or friends of your whereabouts and condition. OTHER USES AND DISCLOSURES We will not use or disclose your health information without your written authorization except a describes in this Notice of Privacy Practices. If you provide us written authorization to use or disclose information, you can change your mind and revoke your authorization at any time, as long as it is in writing. If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to take back any disclosures that we have made pursuant to your previous authorization. YOUR HEALTH INFORMATION RIGHTS Although your health record is the property of St. John?s you have the right to: * Request Restrictions: you have the right to request that we restrict any use or disclosure of your health information. We are not required to agree to any restriction that you request. If we do agree to adhere to your restrictions, we will comply with your request unless the information is needed to provide you emergency treatment. Any request to restrict uses or disclosures must be made in writing to St. John?s Privacy Officer. Your request must indicate (1) what information you want limited; (2) whether you want to limit use, disclosure, or both; and (3) to whom you want the limits to apply. * Receive Information In Certain Form And Location: you have the right to receive information about your health in a certain form and location. For instance, you can request that we not contact you at work. To request confidential communications, make a written request to a Privacy Site Coordinator or St. John?s Corporate Privacy Officer. The request must tell us how and where you want to receive information. We will accommodate reasonable requests. If your request is approved, the confidential communication will remain in effect until revoked in writing by you. * Inspect And Copy Personal Health Information: you have the right to inspect and copy your health information that may be used to make decisions about your care, with the exception of psychotherapy notes. If you want to see or copy your medical information you must submit your request in writing to the Privacy Site Coordinator or to St. John?s Corporate Privacy Officer. If you request copies of information, we may charge you a fee for any costs associated with your request, including the cost of copies, mailing, and other supplies. In limited circumstances, we can deny access to your health information. If access is denied, you can request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. We will adhere to the decision of the reviewer. * Request Amendment to Personal Health Information: you have a right to request that your health information be amended if you believe that it is incorrect or incomplete. You have the right to request amendments as long as the information is kept by St. John?s. To request an amendment of your information, you must submit it in writing to St. John?s Privacy Officer. In addition, you must give the reason that want the information amended, including why you think the information is incorrect or incomplete and specify whom you want notified of the change such as your personal physician. We may extend the time for an additional 30 days provided we notify you of our reason for delay and the date we expect to complete our action on your request. We can deny your request it is not in writing and if it does not include a reason why the information should be amended. We can also deny the request for the following reasons: (1) the information was not created by the hospital, unless the person or entity that created the information is no longer available; (2) the information is not part of the medical record kept by or for the hospital; (3) the information is not part of the information that you would be permitted to inspect and copy; or (4) we believe the information is accurate and complete. * Accounting of Disclosures: you have the right to receive an accounting of disclosures of medical information that we have made, with some exceptions. You must submit your request in writing to a Privacy Site Coordinator or St. John?s Privacy Officer. Your request must state the time period that may not be longer than six years and may not include dates before April 14, 2003. You should include how you want the information reported to you. You have the right to receive a free accounting every 12 months. If you request more than one accounting in a 12 month period, we may charge you a reasonable fee for the costs of providing that list. We will notify you of the charge for such a request and you can then choose to withdraw or change your request before any costs are incurred. Exception: disclosures made pursuant to an authorization signed by you or your representatives are exempted from the accounting of disclosures requirement. * Receive A Paper Copy Of This Notice: even if you agreed to receive this notice in another form, you can still have a paper copy of this notice. To obtain a paper copy, contact the Privacy Site Coordinator or St. John?s privacy Officer. You can also obtain a copy of this notice at our website, www.stjohns.com COMPLAINTS If you believe that we have violated any of your privacy rights or have hot adhered to the information contained in this notice, you can file a complaint by putting it in writing and sending it to a Privacy Site Coordinator or the St. John?s Corporate Privacy Officer, 1235 E. Cherokee, Springfield, MO 65804. You may also file a complaint with the Secretary of the US Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. To acquire a copy of the St. John?s Complaint form contact the Privacy and Data Security Department 417-820-8471 or you may contact the Office for Civil Rights at 1-800-368-1019. According to the law, you will not be retaliated against not intimidated for filing a complaint with either St. John?s or the Department of Health and Human Services. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES We reserve the right to change or modify the information contained in this notice. Any changes that we make will be effective for any health information that we may have about you and information that we might obtain. Each time you receive services from St. John?s, we will make available to you the most current copy of our notice. The most recent version of the notice will be posted in our building or can be obtained from a Privacy site Coordinator or St. John?s Corporate Privacy Officer whose information is included on the first page of this Notice of Privacy Practices.

About Us

Welcome to Mercy Pharmacy-Licking. As your local Good Neighbor Pharmacy, we offer quality products at affordable prices, while providing the personalized attention and customer service you expect from a local business. As your neighbors, we live, work and play in the same community as you and your family. We’re the local business owners you see in the neighborhood, at the school play, and volunteering at the local charity. We believe it is our responsibility to take care of our community and our neighbors, and it’s one we take very seriously. We thrive on the opportunity to serve you and your family to the best of our abilities because your business and your health are very important to us. Get to know your neighbor – we’re here to help.

    HIPAA Notice of Privacy Practice
    NOTICE OF ST. JOHN?S HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE: DECEMBER 1, 2006 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This notice explains how we may use and disclose your medical information, our obligations related to the use and disclosure of your medical information and your rights related to any medical information that we have about you. Thin notice applies to the medical information that is generated in or by St. John?s entities and facilities. This notice also describes the practices of St. John?s and that of any physician with staff privileged with respect to your Protected Health Information (PHI) created while you are a patient of St. John?s. Physicians with staff privileges and personnel authorized to have access to your medical chart are subject to this notice. In addition, physicians with staff privileges may share medical information with each other for treatment, payment or healthcare operations described in this notice. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this notice related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required by law to follow the terms of the notice that is currently in effect. I understand that the physicians participating in my care at St. John?s may not be employees or agents of St. John?s and may not be acting for or on behalf of St. John?s but are independent physicians who have been granted privileges to use facilities for the care of their patients. I understand that medical decisions regarding my care and treatment at St. John?s may be made by such physicians and not by St. John?s. With a few exceptions, we are required to obtain your authorization for the use or disclosure of the information. We have listed some of the reasons why we might use or disclose your medical information and some examples of the types of uses and disclosures below. Not every use or disclosure is covered but all of the ways that we are allowed to use and disclose information will fall into one of the categories. If you have any questions about the content of this notice, or if you need to contact someone at At this site about any of the information contained in this notice, please contact: St. John?s Corporate Privacy Officer 1235 E. Cherokee, Springfield, MO 65804 Toll free for areas outside of Springfield (1-888-664-4722) In addition to hospital department, clinic departments, employees, staff, and other St. John?s personnel, the following persons will also follow the practices described in this notice: * Any healthcare professional who is authorized to enter information in your medical record; * Any member of a volunteer group that we allow to help you while you are at this site; any student, resident or intern. All sites within St. John?s will follow the terms of this Notice of Privacy practices. In addition, they may share medical information for treatment, payment, healthcare operations as they are describes in this Notice of Privacy Practices. USE AND DISCLOSURE OF MEDICAL INFORMATION We can use or disclose medical information about you regarding your treatment, payment for services or for healthcare operations. We may also disclose your protected health information (PHI) for the treatment activities of another provider, the payment activities of another provider or covered entity, and certain limited healthcare operations of another covered entity. For treatment: to provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Departments within the hospital may share medical information about you to coordinate your care. For instance, the laboratory may request the information to complete lab work. Also for coordination of care, we will disclose information to other healthcare providers from whom you seek treatment in order that the combined treatment provided by all is in your best interest. For example, we will seek and/or inform other healthcare providers of pharmaceutical prescriptions that we have or they have written on your behalf to ensure that there are no harmful drug interactions and to ensure that prescribed dosages are appropriate. We may disclose medical information about you to people who may be involved in you medical care after you leave the hospital, such as home health agencies, nursing homes, your family, and clergy members. For payment: we may use and disclose your medical information for the hospital to bill and receive payment for the treatment that you received here. For example, we may use or disclose your medical information to your insurance company about a service you received at the hospital so that your insurance company can pay us or reimburse you for the service. We may also ask your insurance company for prior authorization for a service to determine whether or not the insurance will cover it. For health care operations: we can use and disclose medical information about you for hospital operations. These include uses and disclosures that are necessary to run the hospital and make sure that our patients receive quality care. For example, we may use or disclose medical information about you to evaluate our staff?s performance in caring for you. Medical information about you and other St. John?s patients may also be combines to allow us to evaluate whether St. John?s should offer additional services or discontinue other services and whether certain treatments are effective. We may also compare this information with other hospitals to evaluate whether we can make improvements in the care and services that we offer, to best protect your privacy when we are combining medical information, we will make best efforts to remove information that identifies you. For Research: We may disclose information to researched when their research has been approved by institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. USES AND DISCLOSURES OF MEDICAL INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION We can use or disclose health information about you without your authorization when there is an emergency or when we are required by law to treat you; when we are required by law to use or disclose certain information, or when substantial communication barriers to obtaining authorization from you. Further, we may use or disclose your health information without your authorization in any of the following circumstances. When necessary to contact you to provide: * Appointment reminders * Information about treatment alternatives or other health related benefits or services that may be of interest to you or, * Participation in a clinical trial or research protocol; * When it is required by law; * When it involves use and disclosure for public health activities, such as mandated disease reporting; * When reporting information about victims of abuse or neglect; * When disclosing information for the purpose of medical device tracking and health oversight activities, such as audits, investigations, inspections, licensure or disciplinary actions, or legal proceedings or actions; * When disclosing information for judicial and administrative proceedings in accordance with state and /or federal laws, for instance, in response to a court order such as a court ordered subpoena; * When disclosing information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness, or missing persons or regarding a victim of a crime who cannot give consent or authorization because of incapacity; * When disclosing information about deceased persons to medical examiners, coroners, and funeral directors; * When disclosing or using information for organ and tissue donation purposes; * When disclosing information related to a research project when a waiver of authorization has been approved by the institutional review board and/or the Privacy Committee; * When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the public?s safety; * When disclosure is necessary for specialized government functions, such as military service, for the protection of the president, or for national security and intelligence activities; * When required by military command authorities, if you are a member of the armed forces (or foreign military personnel, to appropriate authorities); * In the case of a prison inmate, information can be released to the correctional facility in which he or she resides for the following purposes: (1) for the institution to provide the inmate with healthcare, (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility; and * When disclosure is necessary to comply with worker?s compensation laws or purposes. PLANNED USES OR DISCLOSURES TO WHICH YOU MAY OBJECT * We will use or disclose your health information for any of the purposes described in the above section unless you affirmatively object to or otherwise restrict a particular release. You must direct your written objections or restrictions to a Privacy Site Coordinator or the St. John?s Corporate Privacy Officer, 1235 E. Cherokee, Springfield, MO 65804. * We may use or disclose your health information in order to include you in the hospital patient directory. Directory information includes your name, location in the hospital, your room number, and condition. We may disclose this information to people who ask for you by name. In addition, a member of clergy may obtain your religious affiliation. * We may use health information about you to contact you in an effort to raise money for the hospital. A Foundation related to the hospitals or clinics may receive contact information, which includes your name, address and phone number and the dates that you received services from the hospital, clinics, Mercy Villa or Home Care but will not receive medical information from your medical records. * We may release health information about you to your personal representative, a friend and/or family member who is involved in your care, if applicable to state and federal regulations. We can tell you personal representative, family and/or friend of your condition and that you are in the hospital for treatment or services. We can also give this information to someone who will help or is helping pay for your care. * We can disclose health information about you to a public or privacy entity that is authorized by law or its charter to assist in disaster relief, i.e. American Red Cross, for the purpose of notification of family and/or friends of your whereabouts and condition. OTHER USES AND DISCLOSURES We will not use or disclose your health information without your written authorization except a describes in this Notice of Privacy Practices. If you provide us written authorization to use or disclose information, you can change your mind and revoke your authorization at any time, as long as it is in writing. If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to take back any disclosures that we have made pursuant to your previous authorization. YOUR HEALTH INFORMATION RIGHTS Although your health record is the property of St. John?s you have the right to: * Request Restrictions: you have the right to request that we restrict any use or disclosure of your health information. We are not required to agree to any restriction that you request. If we do agree to adhere to your restrictions, we will comply with your request unless the information is needed to provide you emergency treatment. Any request to restrict uses or disclosures must be made in writing to St. John?s Privacy Officer. Your request must indicate (1) what information you want limited; (2) whether you want to limit use, disclosure, or both; and (3) to whom you want the limits to apply. * Receive Information In Certain Form And Location: you have the right to receive information about your health in a certain form and location. For instance, you can request that we not contact you at work. To request confidential communications, make a written request to a Privacy Site Coordinator or St. John?s Corporate Privacy Officer. The request must tell us how and where you want to receive information. We will accommodate reasonable requests. If your request is approved, the confidential communication will remain in effect until revoked in writing by you. * Inspect And Copy Personal Health Information: you have the right to inspect and copy your health information that may be used to make decisions about your care, with the exception of psychotherapy notes. If you want to see or copy your medical information you must submit your request in writing to the Privacy Site Coordinator or to St. John?s Corporate Privacy Officer. If you request copies of information, we may charge you a fee for any costs associated with your request, including the cost of copies, mailing, and other supplies. In limited circumstances, we can deny access to your health information. If access is denied, you can request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. We will adhere to the decision of the reviewer. * Request Amendment to Personal Health Information: you have a right to request that your health information be amended if you believe that it is incorrect or incomplete. You have the right to request amendments as long as the information is kept by St. John?s. To request an amendment of your information, you must submit it in writing to St. John?s Privacy Officer. In addition, you must give the reason that want the information amended, including why you think the information is incorrect or incomplete and specify whom you want notified of the change such as your personal physician. We may extend the time for an additional 30 days provided we notify you of our reason for delay and the date we expect to complete our action on your request. We can deny your request it is not in writing and if it does not include a reason why the information should be amended. We can also deny the request for the following reasons: (1) the information was not created by the hospital, unless the person or entity that created the information is no longer available; (2) the information is not part of the medical record kept by or for the hospital; (3) the information is not part of the information that you would be permitted to inspect and copy; or (4) we believe the information is accurate and complete. * Accounting of Disclosures: you have the right to receive an accounting of disclosures of medical information that we have made, with some exceptions. You must submit your request in writing to a Privacy Site Coordinator or St. John?s Privacy Officer. Your request must state the time period that may not be longer than six years and may not include dates before April 14, 2003. You should include how you want the information reported to you. You have the right to receive a free accounting every 12 months. If you request more than one accounting in a 12 month period, we may charge you a reasonable fee for the costs of providing that list. We will notify you of the charge for such a request and you can then choose to withdraw or change your request before any costs are incurred. Exception: disclosures made pursuant to an authorization signed by you or your representatives are exempted from the accounting of disclosures requirement. * Receive A Paper Copy Of This Notice: even if you agreed to receive this notice in another form, you can still have a paper copy of this notice. To obtain a paper copy, contact the Privacy Site Coordinator or St. John?s privacy Officer. You can also obtain a copy of this notice at our website, www.stjohns.com COMPLAINTS If you believe that we have violated any of your privacy rights or have hot adhered to the information contained in this notice, you can file a complaint by putting it in writing and sending it to a Privacy Site Coordinator or the St. John?s Corporate Privacy Officer, 1235 E. Cherokee, Springfield, MO 65804. You may also file a complaint with the Secretary of the US Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. To acquire a copy of the St. John?s Complaint form contact the Privacy and Data Security Department 417-820-8471 or you may contact the Office for Civil Rights at 1-800-368-1019. According to the law, you will not be retaliated against not intimidated for filing a complaint with either St. John?s or the Department of Health and Human Services. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES We reserve the right to change or modify the information contained in this notice. Any changes that we make will be effective for any health information that we may have about you and information that we might obtain. Each time you receive services from St. John?s, we will make available to you the most current copy of our notice. The most recent version of the notice will be posted in our building or can be obtained from a Privacy site Coordinator or St. John?s Corporate Privacy Officer whose information is included on the first page of this Notice of Privacy Practices.
       
       
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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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    (573) 674-2922

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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.