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HIPAA Notice of Privacy Practice
ULTIMA RX PHARMACY Notice of Privacy Practices This notice describes how medical information about you may he used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions, please ask the Privacy Officer, Pharmacy Manager or the Pharmacy Staff Pharmacy considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as om own company privacy policies. This notice describes how we may use and disclose information about you in administering yow- benefits, and it explains your legal rights regarding the information. When we use the term "personal information," we mean financial, health and other information about you tlylt is nonpublic, and that we obtain so we can provide you with Pharmacy services. By "health information," we mean information that identifies you and relates to your 1edical history (i.e., the health care you receive or the amounts paid for that care). This notice will become effective on April14, 2003. How the Pharmacy Uses and Discloses Personal Information In order to provide you with pharmacy services, we need personal information about you, and we obtain that information from many different sources, you, your employer or benefits plan sponsor, other insw-ers, HMOs or third-party administrators (TPAs), and health care providers. In administering your pharmacy services, we may use and disclose personal information about you in various ways, including: Health Care Operations: We may use and disclose personal information during the course of running Our Pharmacy business- that is, during operational activities such as quality assessment and improvement; Licensing; accreditation by independent organizations; performance measurement and outcomes assessment; health services research; and preventive health, disease management, case management and care coordination. For example, we may use the information to provide disease management programs for members with specific conditions, such as diabetes, asthma or heart failure. Other operational activities requiring use and disclosure include administration of reinsurance and stop loss; detection and investigation of fraud; administration of pharmaceutical programs and payments; transfer of policies or contracts from and to other health plans; facilitation of a sale, transfer, merger or consolidation of all or part of the pharmacy with another entity (including due diligence related to such activity); and other general administrative activities, including data and information systems management, and customer service. Payment: To help pay for your covered services, we may use and disclose personal information in a number of ways - in conducting utilization and medical necessity reviews; coordinating care; determining eligibility; determining formulary compliance; collecting premiums; calculating cost sharing amounts; calculating medication inventory; and responding to complaints, appeals and requests for external review. For example, we may use your pharmacy history and other health information about you to decide whether a particular treatment is medically necessary .and what the payment should be- and during the process, we may disclose information to your provider. We also use personal information to obtain payment for any delivery pharmacy services provided to you. Treatment: We use medical information about you in order to provide you with the proper medications. We use medical information about you in order to counsel you on proper use of your medications and in order to monitor your progress. We may disclose information to doctors, dentists, pharmacies, hospitals and other Health care providers who take care of you. For example, doctors may request pharmacy information from us to supplement their own records. We also may use personal information in providing delivery pharmacy services and by sending certain information to doctors for patient safety or other treatment-related reasons. Prescription Reminders: We may use your personal information to contact you in order to inform you that a refill is due or a prescription is ready for pick-up or delivery. Disclosures to Other Covered Entities: We may disclose personal information to other covered entities, or business associates of those entities for treatment, payment and certain health care operations purposes. For example, we may disclose personal information to other health plans maintained by your employer if it has been arranged for us to do so in order to have certain expenses reimbursed. Additional Reasons for Disclosure We may use or disclose health information about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services. We also may disclose such information in support of: ? Plan Administration- to your benefit plan, when we have been informed that appropriate language has been included in your pharmacy benefits. ? Research -to researchers, provided measures are taken to protect your privacy. ? Business Associates - to persons who provide services to us and assure us they will under contract protect the information. ? Industry Regulation- to state insurance departments, boards of pharmacy, U.S. Food and Drug Administration, U.S. Department of Labor and other government agencies that regulate us. ? Law Enforcement- to federal, state and local law enforcement officials. ? Legal Proceedings - in response to a court order or other lawful process. ? Public Welfare - to address matters of public interest as required or permitted by law (e.g., child abuse and neglect, threats to public health and safety, and national security). Disclosure to Others Involved in Your Health Care We may disclose health information about you to you, your legal representative, the Department of Health pursuant to existing law, in the event that you are incapacitated or unable to request your records, your spouse, in any civil or criminal proceeding, upon, the issuance of a subpoena from a court of competent jurisdiction and proper notice to you or your legal representative, by the party seeking the records, a relative, a friend, the subscriber of your health benefits plan or any other person you identify, provided the information is directly relevant to that person's involvement with your health care or payment for that care. For example, if a family member or a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been received and paid. You have the right to stop or limit this kind of disclosure by calling the pharmacy. If you are a minor, you also may have the right to block parental access to your health information in certain circumstances, if permitted by state law. Uses and Disclosures Requiring Your Written Authorization In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you. If you have given us an authorization, you may revoke it at any time, if we have not already acted on it. If you have questions regarding authorizations, please contact the Pharmacy Manager or the Privacy Officer. Your Legal Rights .he federal privacy regulations give you the right to make certain requests regarding health information about you. You may ask us to: ? Communicate with you in a certain way or at a certain location. For example, you might want us to send medications to a different address from that of your permanent address or communicate with you via phone, fax, or mail. We will accommodate reasonable requests. ? Restrict the way we use or disclose health information about you in connection with pharmacy operations, payment and treatment. We will consider, but may not agree to, such requests. You also have the right to ask us to restrict disclosures to persons involved in your health care. ? Obtain a copy of pharmacy information that is contained in our pharmacy records - medical records and other records maintained and used in payment, claims adjudication, medical management and other decisions. We may ask you to make your request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases, may deny the request. ? Amend private information that is in our files. Your request must be in writing and must include the reason for the request. If we deny the request, you may file a written statement of disagreement. ? Provide a list of certain disclosures we have made about you, such as disclosures of your address, age, etc. to government agencies that license us. Your request must be in writing. If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee. You may make any of the requests described above calling the pharmacy or contacting the pharmacy Privacy 1fficer. You have the right to a copy of this notice. You also have the right to file a complaint if you think your privacy rights have been violated. To do so, Call or visit the pharmacy. You also may write to the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint. Pharmacy's Legal Obligations The federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. This Notice is Subject to Change We may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will be effective for all of the information that we already have about you, as well as any information that we may receive or hold in the future. Please note that we do not destroy personal information about you when you stop using the pharmacy services with us. It may be necessary to use and disclose this information for the purposes described above even after you no longer use the pharmacy, although policies and procedures will remain in place to protect against inappropriate use or disclosure. If you have questions regarding this notice, please contact the ULTIMA RX PHARMACY; at 3900 NW 79th St Miami, FL 33166 by phone at 305-827-9582; or by fax at 305-556-3182. Include your name, phone and fax number. ULTIMA RX PHARMACY Notiticacion sobre las Practicas de Contidencialidad Por estos medios se describe como Ia informacion medica que tenemos sobre usted podria ser usada y revelada y como usted puede tener acceso a dicha informacion. Por favor lea esta informacion detalladamente. Si tiene alguna pregunta,favor de dirigirse al Farmaceutico(a), al Oficial de Confidencialidad o al Personal de Ia Farmacia La farmacia considera que Ia informacion personal tiene que ser tratada confidencialmente. Nosotros protegemos Ia confidencialidad de dicha informacion de conformidad con las !eyes federales y estatales de confidencialidad, asi como por medio de nuestras propias p·'oJiticas de confidencialidad. 'or medio de esta notificacion se describe como pudieramos usar y revelar Ia informacion que tenemos sobre usted para Ia administracion de sus beneficios de farmacia y se explican sus derechos legales con respecto a esta informacion. Cuando usamos el termino "informacion personal", queremos decir informacion financiera o sobre Ia salud y otra informacion sobre usted que no es para conocimiento publico, Ia cual obtenemos con el fin de proporcionarle beneficios de farmacia. Con "informacion sobre Ia salud", queremos decir informacion que lo identifica a usted y que esta relacionada con su historial medico (por ejemplo, Ia atencion medica que usted recibe o las sumas pagadas por dicha atencion). Esta notificaci6n entrara en vigor el14 de abril del2003. Como Ia Farmacia Usa y Revela Ia Informacion Personal Para proporcionarle servicios de farmacia, necesitamos informacion personal sobre usted, nosotros obtenemos tal informacion de diferentes Fuentes, usted, de su empleador o del patrocinador del plan, de otros aseguradores, de planes HMO ode agentes administradores (third-party administrators- TPAs) y de proveedores de atencion de Ia salud, para proporcionar servicios farmaceuticos , podriamos usar y revelar Ia informacion personal que tenemos sobre usted de varias maneras, incluyendo: Diligencias Relativas a los Planes de Atencion de Ia Salud: Podriamo·s usar y revelar informacion personal durante el curso de nuestro negocio de Farmacia- es decir, al realizar las diligenciaso los tramites relacionados on el funcionamiento de Ia farmacia, de los planes de atencion de Ia salud tales como para evaluar y mejorar Ia alidad; para el proceso de acreditacion realizado por organizaciones independientes; para evaluar el funcionamiento y los resultados obtenidos; para servicios de investigacion medica; para coordinar servicios medicos preventivos, el cuidado y Ia atencion exacta de una enfermedad, Ia administracion de casos y para Ia ·oordinacion de Ia atencion medica. Por ejemplo, pudierarnos usar Ia informacion para ofrecer prograrnas para J cuidado y atencion exacta de enfermedades para las personas que padecen de enfermedades especificas, tales como diabetes, asma o enfermedades cardfacas. Entre las otras actividades para las cuales es necesario usar y revelar informacion personal se incluyen Ia administracion de seguros y de stop loss; el proceso para asegurar y clasificar; las diligencias para Ia deteccion e investigacion de fraude; Ia administracion de prograrnas farmaceuticos y el pago de los mismos; para Ia transferencia de polizas o contratos de un plan de salud a otro; para facilitar Ia venta, transferencia, fusion o consolidacion de Ia farmacia con otra entidad o de una parte de ella (incluyendo los tramites necesarios para ejecutar dicha actividad); y para otras actividades administrativas generales, incluyendo Ia administracion de nuestros sistemas de datos e informacion y a!brindar servicios a los clientes. Pago de los Beneficios: Para facilitar el pago de los servicios cubiertos que le fueron prestados, podrfarnos usar y revelar informacion personal de varias maneras - para asesorar el uso y Ia necesidad medica de los servicios o suministros; para coordinar Ia atencion medica; para determinar si Ia persona es elegible; para determinar si se observan los terminos del formulario de medicinas; para cobrar las primas; para calcular las cantidades por las cuales se va a compartir el costo; para responder a quejas, apelaciones y solicitudes de asesorarnientos realizados por agendas exteriores que no estan vinculadas con Ia farmacia. Por ejemplo, podrfarnos usar su historial medico y otra informacion relativa a su salud para determinar si un tratarniento en particular es medicarnente necesario y lo que se va a pagar por el - y durante ese proceso, podrfarnos revelar informacion a!proveedor que le presto dicho tratarniento. Ademas, el suscriptor y todos los dependientes cubiertos tienen acceso a informacion sobre las reclarnaciones en Ia farmacia y por vias telefonica. Tratamientos: Utilizarnos su informacion medica para proveerle medicamentos adecuados y aconsejarle sobre stos. Podrfarnos revelar informacion a medicos, dentistas, farmacias, hospitales y a otros proveedores de de Ia salud que le atienden. Por ejemplo, los medicos podrfan pedimos informacion medica para completar Ia informacion que ellos tienen sobre usted. Nosotros tarnbien podrfarnos usar informacion a!enviar cierto tipo de informacion a los medicos para Ia seguridad de los pacientes o por otras razones relacionadas con el tratamiento al cual un paciente se somete. Recordatorios sobre sus Recetas Podrfarnos utilizar su informacion personal (telefono) para llarnarlo y recordarle sobre repeticiones o recetas que ya esten listas para ser recogidas o distribuirlas con un mensajero. Revelaciones a otras Entidades Cubiertas: Podrfarnos revelar informacion personal a otras entidades cubiertas, o a los socios de negocios de dichas entidades en cuanto a tratarnientos, pagos y diligencias relativas a los planes de salud. Por ejemplo, podemos revelar informacion personal a otros planes de salud ofrecidos por su empleador, si asf fue dispuesto, para que ciertos gastos sean reembolsados. · Otras Razones para Revelar Informacion Podemos usar o revelar informacion relacionada con su salud al proporcionarle las diferentes opciones en cuanto a un tratarniento, al enviarles advertencias sobre tratarnientos, o al brindarle otros beneficios y servicios relacionados con el cuidado de Ia salud. Tarnbien podrfarnos revelar dicha informacion para: ? Administracion del Plan - a su empleador, cuando se nos haya notificado sobre carnbios en su beneficia de farmacia ? Investigaciones - a los investigadores, siempre y cuando se tomen medidas para proteger su privacidad. ? Socios de Negocios- a personas que nos prestan sus servicios y que nos han garantizado que protegeran Ia informacion. ? Reguladores de Ia Industria - a las agendas estatales de seguros, juntas fannaceuticas, a!Departamento de Administracion de Alimentos y Medicinas (U.S. Food and Drug Administration), al Departamento de Trabajo de los Estados Unidos (U.S. Department of Labor) y a otras agendas gubemamentales que regulan nuestro negocio. ? Hacer Cumplir Ia Ley - a los agentes federales, estatales y locales encargados de hacer . cumplir Ia ley. ? Procedimientos Legales -para cumplir con una sentecia judicial o con otro proceso legal. ? Bienestar Publico -para tratar asuntos de interes publico de conformidad con lo exigido o permitido por ley (por ejemplo abuso y negligencia de nifios, amenazas a !a sa!ud y seguridad publica y para Ia seguridad nacional). RevelaciOn de Informacion a Otras Personas Que Toman Parte en sus Cuidados de Atenci6n de Ia Salud Podriamos revelar informacion medica sobre usted a usted, su representante legal, a!Departamento de Salud siguiendo !eyes existentes, en caso de que este incapacitado, a su esposo(a), en procedimientos criminates, con un subpoena de jurisdiccion competente, un pariente, a un amigo, a!subscriptor de su plan de atencion de Ia salud, o a cualquier otra persona que usted identifique, si Ia informacion esta directamente relacionada con !a participacion de dicha persona en sus cuidados de atencion de Ia salud o en el pago de los gastos contraidos. Por ejemplo, si una persona que es miembro de su familia o que esta encargada de atenderlo, tiene conocimiento de una reclamacion que fue presentada y nos llama por tel6fono, nosotros podriamos confirmar si recibimos o ·agamos dicha reclamacion. Usted tiene derecho a suspender o limitar este tipo de revelacion y puede ejercer este derecho llamando a Ia fannacia. Si usted es menor de edad tambien podria tener derecho a impedir que sus padres tengan acceso a informacion sobre su salud, bo ciertas circunstancias, si fuera permitido por ley estatal. Uso y Revelacion de Informacion que Requiere su Autorizacion por Escrito En todos los casos, a menos que se trate de aquellos descritos anteriormente, nosotros pediremos su autorizacion por escrito antes de usar o revelar informacion personal sobre usted. Si nos ha dado su autorizacion, podra revocarla en cualquier momento, si no hemos puesto ya en practica su autorizacion. Si tiene preguntas con respecto a las autorizaciones, por favor !lame por telefono o venga personalmente a !a fannacia. Sus Derechos Legales Los reglamentos federales con respecto a !a confidencialidad de Ia informacion personal le otorgan derecho de hacer ciertos tipos de solicitudes relacionadas con !a informacion de Ia salud que tenemos sobre usted. Usted pudiera pedimos que: ? Nos comuniquemos con usted de cierta manera o en cierto Iugar. Por ejemplo, si usted desea recibir por mensajero las medicinas a una direccion diferente a Ia permanente o si desea comunicarse con nosotros por telefono, fax o correo. Nosotros trataremos de satisfacer las solicitudes razonables. ? Limitemos !a forma en que usamos o revelamos Ia informacion sobre su expediente fannaceutico, los pagos y tratamientos. Nosotros tomaremos estas solicitudes en consideracion, pero tambien pudieramos rechazar dichas solicitudes. Tambien tiene derecho a pedimos que limitemos Ia revelacion de informacion a las personas encargadas de su atenci6n de !a salud. ? Obtengamos una copia de Ia informacion de sus recetas que se encuentra en nuestros archivos designados - esto es el historial medico y otros expedients actualizados que se usan para tomar decisiones relacionadas con el despacho de recetas, los pagos, Ia adjudicacion de las reclamaciones, Ia administracion de Ia atencion medica y con otras decisiones. Nosotros podriamos pedirle que presente su so!icitud por escrito, podriamos cobrarle una suma razonable por producir las copias y enviarselas por correo yen ciertos casos, podriamos negar Ia socilitud. ? Enmendemos Ia informacion contenida en el archivo. Tendni que presentar su solicitud por escrito y en Ia misma explicar Ia razon para dicha solicitud. Si denegamos su solicitud, usted podra presentar una declaracion por escrito expresando su desacuerdo. ? Le proporcionemos una lista de ciertas revelaciones que hemos hecho sobre usted, tales como las revelaciones de informacion de su expediente farmaceutico que hemos proporcionado a las agencias gubernamentales que nos otorgan nuestra !icencia. Tendra que presentar Ia solicitud por escrito. Si usted solicita este tipo de lista mas de una vez durante un periodo de 12 meses, podriamos cobrarle una surna razonable. Usted podria hacer cualquier solicitud descrita anteriormente, llamando a Ia farmacia o comunicarselo a!Oficial · de Confidencialidad de Ia Farmacia. Usted tiene derecho a una copia de esta Notificacion sobre las Practicas de Confidencialidad. Si en su opinion, sus derechos de confidencialidad han sido violados, usted tambien tiene derecho a presentar una queja. Para hacer!o, por favor siga los procedimientos para presenter quejas de Ia farmacia. Tambien puede escribir a!Secretario del Departamento de Sahtd y Recursos Hurnanos de Estados Unidos (Secretary of the U.S. Department of Health and Human Services). Nose le impondra penalidad alguna por presentar una queja. t.Joligaciones Legales de Ia Farmacia Los reglamentos federales de confidencialidad nos exigen que conservemos su informacion personal de forma confidencial, que Je notifiquemos de nuestras obligaciones legales y sobre nuestras polizas de confidencialidad y que curnplamos con los terminos de Ia notificacion actualmente en vigor. Esta Notificacion Esta Sujeta a Cambios Nosotros podriamos cambiar los terminos de esta notificacion y nuestras politicas de confidencialidad en cualquier momento. Si asi Jo hacemos, los nuevos terminos y politicas se aplicaran a toda Ia informacion personal que conservamos en nuestro poder, asi como a Ia que prodriamos recibir o conservar en el futuro. Por favor tenga en cuenta que nosotros no destruimos Ia informacion personal que tenemos sobre usted cuando usted termina de utilizar Ia farmacia. Podria ser necesario usar y revelar esta informacion de conformidad a lo descrito anteriormente aun cuando no utilize nuestra farmacia, aunque habran politicas y procedimientos que seguiran en vigor para proteger contra el uso o revelacion de informacion impropio. En caso de tener oreguntas con respecto a esta notificacion, por favor comuniquese con Ia farmacia ULTIMA RX PHARMACY a Ia direccion; 3900 NW 79th Ave, Miami FL 33166, o por telefono llamando a!305-827-9582; o por fax a!305-556- 3182. Incluya su nombre, su nfunero de telefono y de fax. NOTA: ESTA ES UNA TRADUCCION DE LA VERSION DEL DOCUMENTO EN INGLES QUE OBRA EN LOS ARCHIVOS DE LA FARMACIA. EN CASO DE D/SCREPANC/A ENTRE ESTA VERSION EN ESPANOL Y LA VERSION EQUIVALENT£ EN INGLES, LOS TERM/NOS DE LA VERSI6N EN INGLES PREVALECERA.

About Us

Welcome to Ultima Rx. 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
    ULTIMA RX PHARMACY Notice of Privacy Practices This notice describes how medical information about you may he used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions, please ask the Privacy Officer, Pharmacy Manager or the Pharmacy Staff Pharmacy considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as om own company privacy policies. This notice describes how we may use and disclose information about you in administering yow- benefits, and it explains your legal rights regarding the information. When we use the term "personal information," we mean financial, health and other information about you tlylt is nonpublic, and that we obtain so we can provide you with Pharmacy services. By "health information," we mean information that identifies you and relates to your 1edical history (i.e., the health care you receive or the amounts paid for that care). This notice will become effective on April14, 2003. How the Pharmacy Uses and Discloses Personal Information In order to provide you with pharmacy services, we need personal information about you, and we obtain that information from many different sources, you, your employer or benefits plan sponsor, other insw-ers, HMOs or third-party administrators (TPAs), and health care providers. In administering your pharmacy services, we may use and disclose personal information about you in various ways, including: Health Care Operations: We may use and disclose personal information during the course of running Our Pharmacy business- that is, during operational activities such as quality assessment and improvement; Licensing; accreditation by independent organizations; performance measurement and outcomes assessment; health services research; and preventive health, disease management, case management and care coordination. For example, we may use the information to provide disease management programs for members with specific conditions, such as diabetes, asthma or heart failure. Other operational activities requiring use and disclosure include administration of reinsurance and stop loss; detection and investigation of fraud; administration of pharmaceutical programs and payments; transfer of policies or contracts from and to other health plans; facilitation of a sale, transfer, merger or consolidation of all or part of the pharmacy with another entity (including due diligence related to such activity); and other general administrative activities, including data and information systems management, and customer service. Payment: To help pay for your covered services, we may use and disclose personal information in a number of ways - in conducting utilization and medical necessity reviews; coordinating care; determining eligibility; determining formulary compliance; collecting premiums; calculating cost sharing amounts; calculating medication inventory; and responding to complaints, appeals and requests for external review. For example, we may use your pharmacy history and other health information about you to decide whether a particular treatment is medically necessary .and what the payment should be- and during the process, we may disclose information to your provider. We also use personal information to obtain payment for any delivery pharmacy services provided to you. Treatment: We use medical information about you in order to provide you with the proper medications. We use medical information about you in order to counsel you on proper use of your medications and in order to monitor your progress. We may disclose information to doctors, dentists, pharmacies, hospitals and other Health care providers who take care of you. For example, doctors may request pharmacy information from us to supplement their own records. We also may use personal information in providing delivery pharmacy services and by sending certain information to doctors for patient safety or other treatment-related reasons. Prescription Reminders: We may use your personal information to contact you in order to inform you that a refill is due or a prescription is ready for pick-up or delivery. Disclosures to Other Covered Entities: We may disclose personal information to other covered entities, or business associates of those entities for treatment, payment and certain health care operations purposes. For example, we may disclose personal information to other health plans maintained by your employer if it has been arranged for us to do so in order to have certain expenses reimbursed. Additional Reasons for Disclosure We may use or disclose health information about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services. We also may disclose such information in support of: ? Plan Administration- to your benefit plan, when we have been informed that appropriate language has been included in your pharmacy benefits. ? Research -to researchers, provided measures are taken to protect your privacy. ? Business Associates - to persons who provide services to us and assure us they will under contract protect the information. ? Industry Regulation- to state insurance departments, boards of pharmacy, U.S. Food and Drug Administration, U.S. Department of Labor and other government agencies that regulate us. ? Law Enforcement- to federal, state and local law enforcement officials. ? Legal Proceedings - in response to a court order or other lawful process. ? Public Welfare - to address matters of public interest as required or permitted by law (e.g., child abuse and neglect, threats to public health and safety, and national security). Disclosure to Others Involved in Your Health Care We may disclose health information about you to you, your legal representative, the Department of Health pursuant to existing law, in the event that you are incapacitated or unable to request your records, your spouse, in any civil or criminal proceeding, upon, the issuance of a subpoena from a court of competent jurisdiction and proper notice to you or your legal representative, by the party seeking the records, a relative, a friend, the subscriber of your health benefits plan or any other person you identify, provided the information is directly relevant to that person's involvement with your health care or payment for that care. For example, if a family member or a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been received and paid. You have the right to stop or limit this kind of disclosure by calling the pharmacy. If you are a minor, you also may have the right to block parental access to your health information in certain circumstances, if permitted by state law. Uses and Disclosures Requiring Your Written Authorization In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you. If you have given us an authorization, you may revoke it at any time, if we have not already acted on it. If you have questions regarding authorizations, please contact the Pharmacy Manager or the Privacy Officer. Your Legal Rights .he federal privacy regulations give you the right to make certain requests regarding health information about you. You may ask us to: ? Communicate with you in a certain way or at a certain location. For example, you might want us to send medications to a different address from that of your permanent address or communicate with you via phone, fax, or mail. We will accommodate reasonable requests. ? Restrict the way we use or disclose health information about you in connection with pharmacy operations, payment and treatment. We will consider, but may not agree to, such requests. You also have the right to ask us to restrict disclosures to persons involved in your health care. ? Obtain a copy of pharmacy information that is contained in our pharmacy records - medical records and other records maintained and used in payment, claims adjudication, medical management and other decisions. We may ask you to make your request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases, may deny the request. ? Amend private information that is in our files. Your request must be in writing and must include the reason for the request. If we deny the request, you may file a written statement of disagreement. ? Provide a list of certain disclosures we have made about you, such as disclosures of your address, age, etc. to government agencies that license us. Your request must be in writing. If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee. You may make any of the requests described above calling the pharmacy or contacting the pharmacy Privacy 1fficer. You have the right to a copy of this notice. You also have the right to file a complaint if you think your privacy rights have been violated. To do so, Call or visit the pharmacy. You also may write to the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint. Pharmacy's Legal Obligations The federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. This Notice is Subject to Change We may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will be effective for all of the information that we already have about you, as well as any information that we may receive or hold in the future. Please note that we do not destroy personal information about you when you stop using the pharmacy services with us. It may be necessary to use and disclose this information for the purposes described above even after you no longer use the pharmacy, although policies and procedures will remain in place to protect against inappropriate use or disclosure. If you have questions regarding this notice, please contact the ULTIMA RX PHARMACY; at 3900 NW 79th St Miami, FL 33166 by phone at 305-827-9582; or by fax at 305-556-3182. Include your name, phone and fax number. ULTIMA RX PHARMACY Notiticacion sobre las Practicas de Contidencialidad Por estos medios se describe como Ia informacion medica que tenemos sobre usted podria ser usada y revelada y como usted puede tener acceso a dicha informacion. Por favor lea esta informacion detalladamente. Si tiene alguna pregunta,favor de dirigirse al Farmaceutico(a), al Oficial de Confidencialidad o al Personal de Ia Farmacia La farmacia considera que Ia informacion personal tiene que ser tratada confidencialmente. Nosotros protegemos Ia confidencialidad de dicha informacion de conformidad con las !eyes federales y estatales de confidencialidad, asi como por medio de nuestras propias p·'oJiticas de confidencialidad. 'or medio de esta notificacion se describe como pudieramos usar y revelar Ia informacion que tenemos sobre usted para Ia administracion de sus beneficios de farmacia y se explican sus derechos legales con respecto a esta informacion. Cuando usamos el termino "informacion personal", queremos decir informacion financiera o sobre Ia salud y otra informacion sobre usted que no es para conocimiento publico, Ia cual obtenemos con el fin de proporcionarle beneficios de farmacia. Con "informacion sobre Ia salud", queremos decir informacion que lo identifica a usted y que esta relacionada con su historial medico (por ejemplo, Ia atencion medica que usted recibe o las sumas pagadas por dicha atencion). Esta notificaci6n entrara en vigor el14 de abril del2003. Como Ia Farmacia Usa y Revela Ia Informacion Personal Para proporcionarle servicios de farmacia, necesitamos informacion personal sobre usted, nosotros obtenemos tal informacion de diferentes Fuentes, usted, de su empleador o del patrocinador del plan, de otros aseguradores, de planes HMO ode agentes administradores (third-party administrators- TPAs) y de proveedores de atencion de Ia salud, para proporcionar servicios farmaceuticos , podriamos usar y revelar Ia informacion personal que tenemos sobre usted de varias maneras, incluyendo: Diligencias Relativas a los Planes de Atencion de Ia Salud: Podriamo·s usar y revelar informacion personal durante el curso de nuestro negocio de Farmacia- es decir, al realizar las diligenciaso los tramites relacionados on el funcionamiento de Ia farmacia, de los planes de atencion de Ia salud tales como para evaluar y mejorar Ia alidad; para el proceso de acreditacion realizado por organizaciones independientes; para evaluar el funcionamiento y los resultados obtenidos; para servicios de investigacion medica; para coordinar servicios medicos preventivos, el cuidado y Ia atencion exacta de una enfermedad, Ia administracion de casos y para Ia ·oordinacion de Ia atencion medica. Por ejemplo, pudierarnos usar Ia informacion para ofrecer prograrnas para J cuidado y atencion exacta de enfermedades para las personas que padecen de enfermedades especificas, tales como diabetes, asma o enfermedades cardfacas. Entre las otras actividades para las cuales es necesario usar y revelar informacion personal se incluyen Ia administracion de seguros y de stop loss; el proceso para asegurar y clasificar; las diligencias para Ia deteccion e investigacion de fraude; Ia administracion de prograrnas farmaceuticos y el pago de los mismos; para Ia transferencia de polizas o contratos de un plan de salud a otro; para facilitar Ia venta, transferencia, fusion o consolidacion de Ia farmacia con otra entidad o de una parte de ella (incluyendo los tramites necesarios para ejecutar dicha actividad); y para otras actividades administrativas generales, incluyendo Ia administracion de nuestros sistemas de datos e informacion y a!brindar servicios a los clientes. Pago de los Beneficios: Para facilitar el pago de los servicios cubiertos que le fueron prestados, podrfarnos usar y revelar informacion personal de varias maneras - para asesorar el uso y Ia necesidad medica de los servicios o suministros; para coordinar Ia atencion medica; para determinar si Ia persona es elegible; para determinar si se observan los terminos del formulario de medicinas; para cobrar las primas; para calcular las cantidades por las cuales se va a compartir el costo; para responder a quejas, apelaciones y solicitudes de asesorarnientos realizados por agendas exteriores que no estan vinculadas con Ia farmacia. Por ejemplo, podrfarnos usar su historial medico y otra informacion relativa a su salud para determinar si un tratarniento en particular es medicarnente necesario y lo que se va a pagar por el - y durante ese proceso, podrfarnos revelar informacion a!proveedor que le presto dicho tratarniento. Ademas, el suscriptor y todos los dependientes cubiertos tienen acceso a informacion sobre las reclarnaciones en Ia farmacia y por vias telefonica. Tratamientos: Utilizarnos su informacion medica para proveerle medicamentos adecuados y aconsejarle sobre stos. Podrfarnos revelar informacion a medicos, dentistas, farmacias, hospitales y a otros proveedores de de Ia salud que le atienden. Por ejemplo, los medicos podrfan pedimos informacion medica para completar Ia informacion que ellos tienen sobre usted. Nosotros tarnbien podrfarnos usar informacion a!enviar cierto tipo de informacion a los medicos para Ia seguridad de los pacientes o por otras razones relacionadas con el tratamiento al cual un paciente se somete. Recordatorios sobre sus Recetas Podrfarnos utilizar su informacion personal (telefono) para llarnarlo y recordarle sobre repeticiones o recetas que ya esten listas para ser recogidas o distribuirlas con un mensajero. Revelaciones a otras Entidades Cubiertas: Podrfarnos revelar informacion personal a otras entidades cubiertas, o a los socios de negocios de dichas entidades en cuanto a tratarnientos, pagos y diligencias relativas a los planes de salud. Por ejemplo, podemos revelar informacion personal a otros planes de salud ofrecidos por su empleador, si asf fue dispuesto, para que ciertos gastos sean reembolsados. · Otras Razones para Revelar Informacion Podemos usar o revelar informacion relacionada con su salud al proporcionarle las diferentes opciones en cuanto a un tratarniento, al enviarles advertencias sobre tratarnientos, o al brindarle otros beneficios y servicios relacionados con el cuidado de Ia salud. Tarnbien podrfarnos revelar dicha informacion para: ? Administracion del Plan - a su empleador, cuando se nos haya notificado sobre carnbios en su beneficia de farmacia ? Investigaciones - a los investigadores, siempre y cuando se tomen medidas para proteger su privacidad. ? Socios de Negocios- a personas que nos prestan sus servicios y que nos han garantizado que protegeran Ia informacion. ? Reguladores de Ia Industria - a las agendas estatales de seguros, juntas fannaceuticas, a!Departamento de Administracion de Alimentos y Medicinas (U.S. Food and Drug Administration), al Departamento de Trabajo de los Estados Unidos (U.S. Department of Labor) y a otras agendas gubemamentales que regulan nuestro negocio. ? Hacer Cumplir Ia Ley - a los agentes federales, estatales y locales encargados de hacer . cumplir Ia ley. ? Procedimientos Legales -para cumplir con una sentecia judicial o con otro proceso legal. ? Bienestar Publico -para tratar asuntos de interes publico de conformidad con lo exigido o permitido por ley (por ejemplo abuso y negligencia de nifios, amenazas a !a sa!ud y seguridad publica y para Ia seguridad nacional). RevelaciOn de Informacion a Otras Personas Que Toman Parte en sus Cuidados de Atenci6n de Ia Salud Podriamos revelar informacion medica sobre usted a usted, su representante legal, a!Departamento de Salud siguiendo !eyes existentes, en caso de que este incapacitado, a su esposo(a), en procedimientos criminates, con un subpoena de jurisdiccion competente, un pariente, a un amigo, a!subscriptor de su plan de atencion de Ia salud, o a cualquier otra persona que usted identifique, si Ia informacion esta directamente relacionada con !a participacion de dicha persona en sus cuidados de atencion de Ia salud o en el pago de los gastos contraidos. Por ejemplo, si una persona que es miembro de su familia o que esta encargada de atenderlo, tiene conocimiento de una reclamacion que fue presentada y nos llama por tel6fono, nosotros podriamos confirmar si recibimos o ·agamos dicha reclamacion. Usted tiene derecho a suspender o limitar este tipo de revelacion y puede ejercer este derecho llamando a Ia fannacia. Si usted es menor de edad tambien podria tener derecho a impedir que sus padres tengan acceso a informacion sobre su salud, bo ciertas circunstancias, si fuera permitido por ley estatal. Uso y Revelacion de Informacion que Requiere su Autorizacion por Escrito En todos los casos, a menos que se trate de aquellos descritos anteriormente, nosotros pediremos su autorizacion por escrito antes de usar o revelar informacion personal sobre usted. Si nos ha dado su autorizacion, podra revocarla en cualquier momento, si no hemos puesto ya en practica su autorizacion. Si tiene preguntas con respecto a las autorizaciones, por favor !lame por telefono o venga personalmente a !a fannacia. Sus Derechos Legales Los reglamentos federales con respecto a !a confidencialidad de Ia informacion personal le otorgan derecho de hacer ciertos tipos de solicitudes relacionadas con !a informacion de Ia salud que tenemos sobre usted. Usted pudiera pedimos que: ? Nos comuniquemos con usted de cierta manera o en cierto Iugar. Por ejemplo, si usted desea recibir por mensajero las medicinas a una direccion diferente a Ia permanente o si desea comunicarse con nosotros por telefono, fax o correo. Nosotros trataremos de satisfacer las solicitudes razonables. ? Limitemos !a forma en que usamos o revelamos Ia informacion sobre su expediente fannaceutico, los pagos y tratamientos. Nosotros tomaremos estas solicitudes en consideracion, pero tambien pudieramos rechazar dichas solicitudes. Tambien tiene derecho a pedimos que limitemos Ia revelacion de informacion a las personas encargadas de su atenci6n de !a salud. ? Obtengamos una copia de Ia informacion de sus recetas que se encuentra en nuestros archivos designados - esto es el historial medico y otros expedients actualizados que se usan para tomar decisiones relacionadas con el despacho de recetas, los pagos, Ia adjudicacion de las reclamaciones, Ia administracion de Ia atencion medica y con otras decisiones. Nosotros podriamos pedirle que presente su so!icitud por escrito, podriamos cobrarle una suma razonable por producir las copias y enviarselas por correo yen ciertos casos, podriamos negar Ia socilitud. ? Enmendemos Ia informacion contenida en el archivo. Tendni que presentar su solicitud por escrito y en Ia misma explicar Ia razon para dicha solicitud. Si denegamos su solicitud, usted podra presentar una declaracion por escrito expresando su desacuerdo. ? Le proporcionemos una lista de ciertas revelaciones que hemos hecho sobre usted, tales como las revelaciones de informacion de su expediente farmaceutico que hemos proporcionado a las agencias gubernamentales que nos otorgan nuestra !icencia. Tendra que presentar Ia solicitud por escrito. Si usted solicita este tipo de lista mas de una vez durante un periodo de 12 meses, podriamos cobrarle una surna razonable. Usted podria hacer cualquier solicitud descrita anteriormente, llamando a Ia farmacia o comunicarselo a!Oficial · de Confidencialidad de Ia Farmacia. Usted tiene derecho a una copia de esta Notificacion sobre las Practicas de Confidencialidad. Si en su opinion, sus derechos de confidencialidad han sido violados, usted tambien tiene derecho a presentar una queja. Para hacer!o, por favor siga los procedimientos para presenter quejas de Ia farmacia. Tambien puede escribir a!Secretario del Departamento de Sahtd y Recursos Hurnanos de Estados Unidos (Secretary of the U.S. Department of Health and Human Services). Nose le impondra penalidad alguna por presentar una queja. t.Joligaciones Legales de Ia Farmacia Los reglamentos federales de confidencialidad nos exigen que conservemos su informacion personal de forma confidencial, que Je notifiquemos de nuestras obligaciones legales y sobre nuestras polizas de confidencialidad y que curnplamos con los terminos de Ia notificacion actualmente en vigor. Esta Notificacion Esta Sujeta a Cambios Nosotros podriamos cambiar los terminos de esta notificacion y nuestras politicas de confidencialidad en cualquier momento. Si asi Jo hacemos, los nuevos terminos y politicas se aplicaran a toda Ia informacion personal que conservamos en nuestro poder, asi como a Ia que prodriamos recibir o conservar en el futuro. Por favor tenga en cuenta que nosotros no destruimos Ia informacion personal que tenemos sobre usted cuando usted termina de utilizar Ia farmacia. Podria ser necesario usar y revelar esta informacion de conformidad a lo descrito anteriormente aun cuando no utilize nuestra farmacia, aunque habran politicas y procedimientos que seguiran en vigor para proteger contra el uso o revelacion de informacion impropio. En caso de tener oreguntas con respecto a esta notificacion, por favor comuniquese con Ia farmacia ULTIMA RX PHARMACY a Ia direccion; 3900 NW 79th Ave, Miami FL 33166, o por telefono llamando a!305-827-9582; o por fax a!305-556- 3182. Incluya su nombre, su nfunero de telefono y de fax. NOTA: ESTA ES UNA TRADUCCION DE LA VERSION DEL DOCUMENTO EN INGLES QUE OBRA EN LOS ARCHIVOS DE LA FARMACIA. EN CASO DE D/SCREPANC/A ENTRE ESTA VERSION EN ESPANOL Y LA VERSION EQUIVALENT£ EN INGLES, LOS TERM/NOS DE LA VERSI6N EN INGLES PREVALECERA.
       
       
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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

    Store Location & Directions

    3900 Northwest 79th Avenue, Suite 216
    Miami, FL, 33166
    (305) 557-9512

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    Pharmacy Hours

    Mon - Fri: 8:00am - 6:00pm;Sat: Closed;Sun: Closed;

    Store Hours

    Mon - Fri: 8:00am - 6:00pm;Sat: Closed;Sun: Closed;
     
     
     
    • HIPAA
      Notice of Privacy
    • About HIPAA’s Notice of Privacy and how it protects you.

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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.