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HIPAA Notice of Privacy Practice
Tuolumne Me-Wuk Indian Health Center, Inc. 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. Understanding Your Health Record/Information Once you visit TMWIHC for services, a record of your visit is made. If you are referred by TMWIHC through the Contract Health Services (CHS) then TMWIHC also keeps a record of your CHS visit. Typically this record contains your symptoms, examination, test results, diagnosis, treatment and a plan for future care. This information often referred to as a health record serves as a: Record of your care and treatment Communication source between healthcare professionals Records with which we can check results and continually work to improve the services we provide Records by which Medicare, Medicaid or private insurance payers can verify services billed Records for education of health care professionals Record of information for public health authorities charged with improving the health of the people Your Health Information Rights Although your health record is the physical property of Tuolumne Me-Wuk Indian Health Center the information belongs to you. You have the right to: Inspect and receive a copy of your health record Request a restriction on certain uses and disclosures of your health information. For example, you may ask that we not disclose your health information and or treatment to a family member. IHS is not required to agree to your request, but if we do we will comply with your request unless the information is needed to provide you with emergency service. Request a correction/amendment of your health record if you believe the health information we have about you in incorrect or incomplete, we may amend your record or include your statement of agreement. Request confidential communications about your health information. You may ask that we communicate with you at a location other than your home or by a different means of communications such as telephone or mail. Receive a listing of certain disclosures. TMWIHC has made of your health information upon request. This information is maintained for six years or the life of the record, whichever is longer. Revoke your written authorization to use or disclose health information. This does not apply to health information already disclosed or used or in circumstances where we have taken action on your authorization or the authorization was obtained as a condition of obtaining insurance coverage if the insurer has a legal right to consent a claim under the policy or the policy itself. Obtain a paper copy of the TMWIHC Notice of Privacy Practices upon request you may obtain a paper copy of the TMWIHC Health and Medical records System Notice upon request. TMWIHC?s Responsibilities Tuolumne Me-Wuk Indian Health Center Inc is required by law to: -Maintain the privacy of your health information -Inform you about our privacy practices regarding health information we collect and maintain about you -Notifying you if we are unable to agree to a requested restriction -Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations -Honor the terms of this notice or any subsequent revisions of this notice -TMWIHC reserves the right to change its privacy practices and to make the new provisions effective for all protected health information it maintains. If TMWIHC makes any significant changes to this Notice, it will send you a copy within 60 days. TMWIHC also will post any revised Notice of Privacy Practices at public places in its health care facilities and on its website at www.tmwihc.com and you may also request a copy of the notice. TMWIHC understands that health information about you is personal and is committed to protecting your health information. TMWIHC will not use or disclose your health information without your permission, except as described in this notice and as permitted by the Privacy Act and the HIS Health and Medical Records System Notice 09-17-0001. IV. How TMWIHC may use and disclose health information about you The following categories describe how we may use and disclose health information about you. We will use and disclose your health information to provide your treatment. For example: Your personal information will be recorded in your health record and used to determine the course of treatment for you. Your health care provider will document is your health record her/his instructions to members of your healthcare team. The actions taken and the observations made by the members of your healthcare team will be recorded in your health record so your health care provider will know how you are responding to treatment. If TMWIHC refers you to another health care facility under the Contract Health Service (CHS) program, TMWIHC may disclose your health information to that health care provider for treatment decisions. If you are transferred to another facility for further care and treatment, TMWIHC may disclose information to that facility to enable them to know the extent of treatment you have received and other information about your condition. Your health care provider(s) may give copies of your health information to others to assist in your treatment. We will use and disclose your health information for payment purposes. For example: If you have private insurance, Medicare, or Medicaid coverage, a bill will be sent to your health plan for payment. The information on or accompanying the bill will include information that identifies you, as well as your diagnosis, procedures, and supplies used for your treatment. If TMWIHC refers you to another health care facility under the Contract Health Service (CHS) program, TMWIHC may disclose your health information with that provider for health care payment purposes. We will use and disclose your health information for health care operations. For example: We may use your health information to evaluate your care and treatment outcomes with our quality improvement team. This information will be used to continually improve the quality and effectiveness of the services we provide. This includes health care services provided under Contract Health Services (CHS) programs. Business Associates: TMWIHC provides some healthcare services and related functions through the use of contracts with business associates. For example: TMWICH may have contracts with medical transcriptions. For example: TMWIHC may have contracts with medical transcriptions. When these services are contracted, TMWIHC may disclose your health information to business associates so that they can perform their jobs. We required our business associates to protect and safeguard your health information in accordance with all applicable federal laws. Directory: If you admitted to an HIS facility, TMWIHC may use or disclose your name, general condition, religious affiliation and location within our facility, for facility directory purposes, unless you notify us that you object to this information being listed. TMWIHC may provide your religious affiliation only to members of the clergy. Notification: TMWIHC may use or disclose your health information to notify or assist in the notification of a family member, personal representative, or other authorized person(s) responsible for your care, unless you notify us that you object. Communication with family: TMWIHC health providers may use or disclose your health information to others responsible for your care unless you object. For example: If TMWIHC may provide your family members, other relatives, close personal friends or any other person you identify with health information which is relevant tot that person?s involvement with your care or payment for such care. Interpreters: In order to provide you proper care and services, TMWIHC may use the services of an interpreter. This may require the use or disclosure of your personal health information to the interpreter. Research: TMWIHC may use or disclose your health information for research purposes that has been approved by an IHS Institutional Review Board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. TMWIHC may disclose your health information for research purposes based on your written authorization. Uses and Disclosures about Decedents: TMWIHC may use or disclose health information about decedents to a coroner or medical examiner for the purpose of identifying a deceased person determining a cause of death, or other duties as authorized by law. TMWIHC also may disclose health information to funeral directors consistent with applicable law as necessary to carry out their duties. In addition, TMWIHC may disclose protected health information about decedents where required under the Freedom of Information Act or otherwise required by law. Organ Procurement Organizations: TMWIHC may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of facilitation organ, eye, or tissue donation and transplant. Treatment Alternatives and Other Health-related Benefits and Services: TMWIHC may contact you to provide information about treatment alternatives or other types of health-related benefits and services that may be of interest to you. For example: we may contact you about the availability of a new treatment or services for diabetes. Appointment reminders: TMWIHC may contact you with a reminder that you have an appointment for medical care and to advise you of a missed appointment. Food and Drug Administration(FDA): HIS may use or disclose your health information to the FDA. In connection with an FDA-regulated product or activity. For example: we may disclose to the FDA information concerning adverse events involving food, dietary supplements, product defects or problems, and information needed to track FDA-regulated products to conduct product recalls, repairs, replacements, or lookbacks (including locating people who have received products that have been recalled or withdrawn) or post marketing surveillance. Workers Compensation: TMWIHC may use or disclose your health information for workers compensation purposes or as required by law. Public Health: TMWIHC may use or disclose your health information to public health or other appropriate government authorities as follows: (1) TMWIHC may use or disclose your health information to government authorities that are authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or conducting public health surveillance, investigations and intervention. (2)TMWIHC may disclose your health information to government authorities that are authorized by law to receive reports of child abuse or neglect and (3) TMWIHC may disclose your health information to government authorities that are authorized by law to receive reports of other abuse, neglect or domestic violence as required by law, or as authorized by law, if TMWIHC believes it is necessary to prevent serious harm. Where authorized by law, TMWIHC may disclose your health information to an individual who may have been exposed to communicable disease or may otherwise be at risk of contracting or spreading a disease or condition. In some situations (for example, if you are employed by TMWIHC, or another component of the Department of Health and Human Services, or if necessary to prevent or lessen a serious and imminent threat to the health and safety of an individual or the public), TMWIHC may disclose to your employer health information concerning a work-related illness or injury or a workplace-related medical surveillance. Correctional Institution: If you are an inmate of a correctional institution, TMWIHC may use or disclose to the institution, health information necessary for your health and the health and safety of other individuals such as officers or employees or other inmates. Law Enforcement: TMWIHC may use or disclose your health information for law enforcement activities as authorized by law or in response to a court of competent jurisdiction. Members of the Military: If you are ea member of the military services including the Commissioned Corps of the United States, Public Health Services, TMWIHC may use or disclose your health information if necessary to the appropriate military command authorities as authorized by law. Health Oversight Authorities: TMWIHC may use or disclose your health information to health oversight agencies for activities authorized by law. These oversight activities include: investigations, audits, inspections and other actions. These are necessary for the government to monitor the health care system, government benefit programs, and entities subject to government regulatory programs and/or civil rights laws for which health information is necessary to determine compliance. TMWIHC is required by law to disclose protected health information to the Secretary of HHS to investigate or determine compliance with the HIPAA privacy standards. Compelling Circumstances: TMWIHC may use or disclose your health information in certain other situations involving compelling circumstances affecting the health or safety of an individual. For example, in certain circumstances: (1) we may disclose limited protected health information where requested by a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness or missing person; (2) if you are believed to be a victim of a crime, a law enforcement official requests information about you and we are unable to obtain your agreement because of incapacity or other emergency circumstances, we may disclose the requested information if we determine that such disclosure would be in your best interest; (3)we may use or disclose protected health information as we believe is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person; (4) we may use or disclose protected health information in the course of judiciary and administrative proceedings if required or authorized by law; (5) we may use or disclose protected health information to report a crime committed on TMWIHC health facility or premises or when TMWIHC is providing emergency health care; and (6) we may make any other disclosures that are required by law. [Can?t read first part of sentence] the HIPAA Privacy Rule if any of its employees or its contractors (business associates) discloses protected health information under the following circumstances: 1. Disclosures by Whistleblowers: If a TMWIHC employee or contractor (business associate) in good faith believes that TMWIHC has engaged in conduct that is unlawful or otherwise violates clinical and professional standards or that the care or services provided by TMWIHC has the potential of endangering one or more patients or members of the workplace or the public and discloses such information to: a. A Public Health Authority or Health Oversight Authority authorized by law to investigate or otherwise oversee the relevant conduct or conditions, or the suspected violation, or an appropriate health care accreditation organization for the purpose of reporting the allegation of failure to meet professional standards or misconduct by TMWIHC; or b. An attorney on behalf of the workforce member, or contractor (business associate) or hired by the workforce member or contractor (business associate) for the purpose of determining their legal options regarding the suspected violation. 2. Disclosures by Workforce Member Crime Victims: Under certain circumstances, a TMWIHC workforce member (either an employee or contractor) who is a victim of a crime on or off the hospital premises may disclose information about the suspect to law enforcement official provided that: a. The information disclosed is about the suspect who committed the criminal act. b. The information disclosed is limited to identifying and locating the suspect. Any other uses and disclosures will be made only with your written authorization which you may later revoke in writing at any time. (Such revocation would not apply where the health information has already been disclosed or used or in circumstances where TMWIHC has taken action in reliance on your authorization or the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim under the policy or the policy itself.) To exercise your rights under this Notice, to ask for more information, or to report a problem contact the Service Unit Director/Chief Executive Officer or the Service Unit Privacy official at: Privacy Officer 18880 Cherry Valley Blvd. Tuolumne, CA 95379 If you believe your privacy rights have been violated, you may file a written complaint with the above individual(s) or the Secretary of Health and Human Services, U.S. Department of Health and Human Services, Washington, D.C. 20201. There will be not retaliation for filing a complaint. Effective Date: April 14, 2003

About Us

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

    HIPAA Notice of Privacy Practice
    Tuolumne Me-Wuk Indian Health Center, Inc. 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. Understanding Your Health Record/Information Once you visit TMWIHC for services, a record of your visit is made. If you are referred by TMWIHC through the Contract Health Services (CHS) then TMWIHC also keeps a record of your CHS visit. Typically this record contains your symptoms, examination, test results, diagnosis, treatment and a plan for future care. This information often referred to as a health record serves as a: Record of your care and treatment Communication source between healthcare professionals Records with which we can check results and continually work to improve the services we provide Records by which Medicare, Medicaid or private insurance payers can verify services billed Records for education of health care professionals Record of information for public health authorities charged with improving the health of the people Your Health Information Rights Although your health record is the physical property of Tuolumne Me-Wuk Indian Health Center the information belongs to you. You have the right to: Inspect and receive a copy of your health record Request a restriction on certain uses and disclosures of your health information. For example, you may ask that we not disclose your health information and or treatment to a family member. IHS is not required to agree to your request, but if we do we will comply with your request unless the information is needed to provide you with emergency service. Request a correction/amendment of your health record if you believe the health information we have about you in incorrect or incomplete, we may amend your record or include your statement of agreement. Request confidential communications about your health information. You may ask that we communicate with you at a location other than your home or by a different means of communications such as telephone or mail. Receive a listing of certain disclosures. TMWIHC has made of your health information upon request. This information is maintained for six years or the life of the record, whichever is longer. Revoke your written authorization to use or disclose health information. This does not apply to health information already disclosed or used or in circumstances where we have taken action on your authorization or the authorization was obtained as a condition of obtaining insurance coverage if the insurer has a legal right to consent a claim under the policy or the policy itself. Obtain a paper copy of the TMWIHC Notice of Privacy Practices upon request you may obtain a paper copy of the TMWIHC Health and Medical records System Notice upon request. TMWIHC?s Responsibilities Tuolumne Me-Wuk Indian Health Center Inc is required by law to: -Maintain the privacy of your health information -Inform you about our privacy practices regarding health information we collect and maintain about you -Notifying you if we are unable to agree to a requested restriction -Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations -Honor the terms of this notice or any subsequent revisions of this notice -TMWIHC reserves the right to change its privacy practices and to make the new provisions effective for all protected health information it maintains. If TMWIHC makes any significant changes to this Notice, it will send you a copy within 60 days. TMWIHC also will post any revised Notice of Privacy Practices at public places in its health care facilities and on its website at www.tmwihc.com and you may also request a copy of the notice. TMWIHC understands that health information about you is personal and is committed to protecting your health information. TMWIHC will not use or disclose your health information without your permission, except as described in this notice and as permitted by the Privacy Act and the HIS Health and Medical Records System Notice 09-17-0001. IV. How TMWIHC may use and disclose health information about you The following categories describe how we may use and disclose health information about you. We will use and disclose your health information to provide your treatment. For example: Your personal information will be recorded in your health record and used to determine the course of treatment for you. Your health care provider will document is your health record her/his instructions to members of your healthcare team. The actions taken and the observations made by the members of your healthcare team will be recorded in your health record so your health care provider will know how you are responding to treatment. If TMWIHC refers you to another health care facility under the Contract Health Service (CHS) program, TMWIHC may disclose your health information to that health care provider for treatment decisions. If you are transferred to another facility for further care and treatment, TMWIHC may disclose information to that facility to enable them to know the extent of treatment you have received and other information about your condition. Your health care provider(s) may give copies of your health information to others to assist in your treatment. We will use and disclose your health information for payment purposes. For example: If you have private insurance, Medicare, or Medicaid coverage, a bill will be sent to your health plan for payment. The information on or accompanying the bill will include information that identifies you, as well as your diagnosis, procedures, and supplies used for your treatment. If TMWIHC refers you to another health care facility under the Contract Health Service (CHS) program, TMWIHC may disclose your health information with that provider for health care payment purposes. We will use and disclose your health information for health care operations. For example: We may use your health information to evaluate your care and treatment outcomes with our quality improvement team. This information will be used to continually improve the quality and effectiveness of the services we provide. This includes health care services provided under Contract Health Services (CHS) programs. Business Associates: TMWIHC provides some healthcare services and related functions through the use of contracts with business associates. For example: TMWICH may have contracts with medical transcriptions. For example: TMWIHC may have contracts with medical transcriptions. When these services are contracted, TMWIHC may disclose your health information to business associates so that they can perform their jobs. We required our business associates to protect and safeguard your health information in accordance with all applicable federal laws. Directory: If you admitted to an HIS facility, TMWIHC may use or disclose your name, general condition, religious affiliation and location within our facility, for facility directory purposes, unless you notify us that you object to this information being listed. TMWIHC may provide your religious affiliation only to members of the clergy. Notification: TMWIHC may use or disclose your health information to notify or assist in the notification of a family member, personal representative, or other authorized person(s) responsible for your care, unless you notify us that you object. Communication with family: TMWIHC health providers may use or disclose your health information to others responsible for your care unless you object. For example: If TMWIHC may provide your family members, other relatives, close personal friends or any other person you identify with health information which is relevant tot that person?s involvement with your care or payment for such care. Interpreters: In order to provide you proper care and services, TMWIHC may use the services of an interpreter. This may require the use or disclosure of your personal health information to the interpreter. Research: TMWIHC may use or disclose your health information for research purposes that has been approved by an IHS Institutional Review Board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. TMWIHC may disclose your health information for research purposes based on your written authorization. Uses and Disclosures about Decedents: TMWIHC may use or disclose health information about decedents to a coroner or medical examiner for the purpose of identifying a deceased person determining a cause of death, or other duties as authorized by law. TMWIHC also may disclose health information to funeral directors consistent with applicable law as necessary to carry out their duties. In addition, TMWIHC may disclose protected health information about decedents where required under the Freedom of Information Act or otherwise required by law. Organ Procurement Organizations: TMWIHC may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of facilitation organ, eye, or tissue donation and transplant. Treatment Alternatives and Other Health-related Benefits and Services: TMWIHC may contact you to provide information about treatment alternatives or other types of health-related benefits and services that may be of interest to you. For example: we may contact you about the availability of a new treatment or services for diabetes. Appointment reminders: TMWIHC may contact you with a reminder that you have an appointment for medical care and to advise you of a missed appointment. Food and Drug Administration(FDA): HIS may use or disclose your health information to the FDA. In connection with an FDA-regulated product or activity. For example: we may disclose to the FDA information concerning adverse events involving food, dietary supplements, product defects or problems, and information needed to track FDA-regulated products to conduct product recalls, repairs, replacements, or lookbacks (including locating people who have received products that have been recalled or withdrawn) or post marketing surveillance. Workers Compensation: TMWIHC may use or disclose your health information for workers compensation purposes or as required by law. Public Health: TMWIHC may use or disclose your health information to public health or other appropriate government authorities as follows: (1) TMWIHC may use or disclose your health information to government authorities that are authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or conducting public health surveillance, investigations and intervention. (2)TMWIHC may disclose your health information to government authorities that are authorized by law to receive reports of child abuse or neglect and (3) TMWIHC may disclose your health information to government authorities that are authorized by law to receive reports of other abuse, neglect or domestic violence as required by law, or as authorized by law, if TMWIHC believes it is necessary to prevent serious harm. Where authorized by law, TMWIHC may disclose your health information to an individual who may have been exposed to communicable disease or may otherwise be at risk of contracting or spreading a disease or condition. In some situations (for example, if you are employed by TMWIHC, or another component of the Department of Health and Human Services, or if necessary to prevent or lessen a serious and imminent threat to the health and safety of an individual or the public), TMWIHC may disclose to your employer health information concerning a work-related illness or injury or a workplace-related medical surveillance. Correctional Institution: If you are an inmate of a correctional institution, TMWIHC may use or disclose to the institution, health information necessary for your health and the health and safety of other individuals such as officers or employees or other inmates. Law Enforcement: TMWIHC may use or disclose your health information for law enforcement activities as authorized by law or in response to a court of competent jurisdiction. Members of the Military: If you are ea member of the military services including the Commissioned Corps of the United States, Public Health Services, TMWIHC may use or disclose your health information if necessary to the appropriate military command authorities as authorized by law. Health Oversight Authorities: TMWIHC may use or disclose your health information to health oversight agencies for activities authorized by law. These oversight activities include: investigations, audits, inspections and other actions. These are necessary for the government to monitor the health care system, government benefit programs, and entities subject to government regulatory programs and/or civil rights laws for which health information is necessary to determine compliance. TMWIHC is required by law to disclose protected health information to the Secretary of HHS to investigate or determine compliance with the HIPAA privacy standards. Compelling Circumstances: TMWIHC may use or disclose your health information in certain other situations involving compelling circumstances affecting the health or safety of an individual. For example, in certain circumstances: (1) we may disclose limited protected health information where requested by a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness or missing person; (2) if you are believed to be a victim of a crime, a law enforcement official requests information about you and we are unable to obtain your agreement because of incapacity or other emergency circumstances, we may disclose the requested information if we determine that such disclosure would be in your best interest; (3)we may use or disclose protected health information as we believe is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person; (4) we may use or disclose protected health information in the course of judiciary and administrative proceedings if required or authorized by law; (5) we may use or disclose protected health information to report a crime committed on TMWIHC health facility or premises or when TMWIHC is providing emergency health care; and (6) we may make any other disclosures that are required by law. [Can?t read first part of sentence] the HIPAA Privacy Rule if any of its employees or its contractors (business associates) discloses protected health information under the following circumstances: 1. Disclosures by Whistleblowers: If a TMWIHC employee or contractor (business associate) in good faith believes that TMWIHC has engaged in conduct that is unlawful or otherwise violates clinical and professional standards or that the care or services provided by TMWIHC has the potential of endangering one or more patients or members of the workplace or the public and discloses such information to: a. A Public Health Authority or Health Oversight Authority authorized by law to investigate or otherwise oversee the relevant conduct or conditions, or the suspected violation, or an appropriate health care accreditation organization for the purpose of reporting the allegation of failure to meet professional standards or misconduct by TMWIHC; or b. An attorney on behalf of the workforce member, or contractor (business associate) or hired by the workforce member or contractor (business associate) for the purpose of determining their legal options regarding the suspected violation. 2. Disclosures by Workforce Member Crime Victims: Under certain circumstances, a TMWIHC workforce member (either an employee or contractor) who is a victim of a crime on or off the hospital premises may disclose information about the suspect to law enforcement official provided that: a. The information disclosed is about the suspect who committed the criminal act. b. The information disclosed is limited to identifying and locating the suspect. Any other uses and disclosures will be made only with your written authorization which you may later revoke in writing at any time. (Such revocation would not apply where the health information has already been disclosed or used or in circumstances where TMWIHC has taken action in reliance on your authorization or the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim under the policy or the policy itself.) To exercise your rights under this Notice, to ask for more information, or to report a problem contact the Service Unit Director/Chief Executive Officer or the Service Unit Privacy official at: Privacy Officer 18880 Cherry Valley Blvd. Tuolumne, CA 95379 If you believe your privacy rights have been violated, you may file a written complaint with the above individual(s) or the Secretary of Health and Human Services, U.S. Department of Health and Human Services, Washington, D.C. 20201. There will be not retaliation for filing a complaint. Effective Date: April 14, 2003
       
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    HIPAA Notice of Privacy Practice

    JOSEPH PHARMACY 216 WEST 72ND STREET NEW YORK, NY 10023 TEL (212) 875-1718 FAX (212) 875-0921 E-Mail: JOSEPHPHARMACY@YAHOO.COM OR WWW.JOSEPHPHARMACY.COM NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. JOSEPH PHARMACY is required by law to maintain the privacy of Protected Health Information ('PHI') and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices ('Notice') describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights and with respect to PHI about you. JOSEPH PHARMACY is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, expect as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you. Your Health Information Rights You have the following rights with respect to PHI about you: *Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact the Privacy Officer at (212) 875-1718 or e-mail request to JOSEPHPHARMACY@YAHOO.COM. *Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use and disclosure of PHI about you by sending a written request to the Privacy Officer or e-mailing the request to JOSEPHPHARMACY@YAHOO.COM. We are not required to agree to those restrictions. *Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as JOSEPH PHARMACY maintains the PHI. The 'designated record set' usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to the Privacy Officer or e-mail it to JOSEPHPHARMACY@YAHOO.COM. We may charge you a fee for the cost of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed. *Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to the Privacy Officer or e-mail it to: JOSEPHPHARMACY@YAHOO.COM. In addition, you must include a reason that supports your request. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision, and we give you a rebuttal to your statement. *Receive an accounting of disclosure of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude disclosures we have made directly to you, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in to the Privacy Officer or e-mail it to JOSEPHPHARMACY@YAHOO.COM. Your request must specify the time period, but may not be longer than six years. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time. *Request communications of PHI by alternative means or at alternative locations. For instance, you may request we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must submit a request in writing to the Privacy Officer or e-mail it to JOSEPHPHARMACY@YAHOO.COM. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests. *Revoke your consent to use or disclose PHI. You may revoke consent in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that that we have already taken action in reliance on the consent. We may refuse to continue to treat a customer that revokes his or her consent. Example of How We May Use and Disclose PHI The following categories describe and provide examples of different ways we use and disclose PHI about you. We will use PHI for treatment. Example: Information obtained by the pharmacist will be used to dispense prescription medications to you. We will document in your record information related to the medications dispensed to you and services provided to you. We will use PHI for payment. Example: We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment. We will bill you or third-party payer for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking. We will use PHI for health care operations. Example: JOSEPH PHARMACY may use information in your health record to monitor the performance of the pharmacists providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide. We are likely to use or disclose PHI for the following purposes: Business associates: There are some services provided by us through contracts with business associates. Examples include the analysis of prescription costs and their trends for groups and sub- groups of patient populations. When these services are contracted for, we may disclose PHI about you to our business associates so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect PHI about you, we require the business associate to appropriately safeguard the PHI. Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you can identify, PHI relevant to that person's involvement in your care or payment related to your care. Personal communications: We may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements. Worker's compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker's compensation or similar programs established by law. Public Health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury or disability. Law enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process. Health Oversight activities: We must disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws. Judicial and administrative proceedings: If you are involved in a lawsuit or dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI. We are permitted to use and disclose PHI about you for the following purposes: Research: We may disclose PHI about you to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information has approved their research. Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties. Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. Fundraising: We may contact you as part of a fundraising effort. Notification: We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and your general condition. Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others. To avert a serious threat to health and safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Military or veterans: If you are a member of the armed forces, we may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. National Security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Protective services for the President and others: We may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations. Victims of abuse, neglect, or domestic violent: We may disclose PHI about you to a government authority, such as a social service, or protective service agency. If we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure of if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you. Other Uses and Disclosures of PHI JOSEPH PHARMACY will obtain your written authorization before using or disclosing the PHI about you for purposes other than those provided above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. For More Information or to Report a Problem If you have questions or would like additional information about Joseph Pharmacy's privacy practices, you may contact our privacy officer. If you believe your privacy right have been violated, you can file a complaint with our HIPAA privacy officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. Effective Date

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    Tuolumne, CA, 95379
    (209) 928-5407

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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.