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HIPAA Notice of Privacy Practice
York Hospital Privacy NoticeThis Notice describes how York may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
“Protected health information” or “PHI” is individually identifiable health information about you, including demographic information collected from you, that is created or received by York and that relates to (i) your past, present, or future physical or mental health or condition, (ii) the provision of health care to you, or (iii) the past, present or future payment of your health care. PHI also includes any health information and records provided to York by other health care providers and facilities who have provided care to you or are involved in your care.
York Hospital participates in an organized health care arrangement with its affiliated facilities and providers. Accordingly, this Notice applies to and describes the privacy practices of the following York-affiliated facilities, entities, programs, practices and delivery sites (collectively, “York”): See Other York Entities and Service Delivery Site Location/Address Utilizing this Notice of Privacy Practices at the end of this form.
YORK’S DUTIES WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION:
York Hospital is required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to notify affected individuals following a breach of unsecured PHI. Although York is required to abide by the terms of the Notice that is currently in effect, we reserve the right to change our privacy practices at any time and to make the new Notice provisions effective for all PHI that we maintain about you. If our privacy practices change, we will provide you with a revised Notice during your next visit.
PROTECTED HEALTH INFORMATION:
York may use and disclose your PHI, without your authorization, for purposes of treatment, payment, and health care operations. For example:
• TREATMENT: York may use or disclose your PHI to other health care providers for treatment and continuity of care purposes and to arrange for the provision, coordination, and management of health care services for you. For example, York may disclose information about your hospital stay to your primary care physician to arrange for appropriate post-hospital care is provided to you following your discharge from the hospital. York may also disclose PHI about you to a pharmacist to process your prescription, or to a medical equipment supplier for supplies and equipment necessary for your care.
• PAYMENT: York may use or disclose PHI about you to your health insurance company or other third-party payor health plans such as Medicare or MaineCare (Medicaid) to obtain payment or reimbursement for health care services provided to you, or to determine your eligibility for coverage and benefits, unless you pay in full out of pocket for services provided to you and request in writing that your PHI not be disclosed to third-party payors.
• HEALTH CARE OPERATIONS: York may use or disclose your PHI for certain health care operations purposes, such as quality review and improvement activities, risk management activities, and to conduct and process patient satisfaction surveys.
• ORGANIZED HEALTH CARE ARRANGEMENT PURPOSES: York entities participating in York’s organized health care arrangement (described below) may share your PHI with each other as necessary to carry out treatment, payment or health care operations relating to the organized health care arrangement.
York may also use and disclose your PHI without your authorization in the following additional circumstances:
• AS REQUIRED BY LAW: York may use and disclose your PHI when required or authorized by state and federal law.
• PUBLIC HEALTH ACTIVITIES: York may use and disclose your PHI to public health authorities for public health activities, such as to comply with mandatory communicable disease and vital statistics reporting laws.
• ABUSE, NEGLECT, AND EXPLOITATION REPORTING: York may disclose your PHI to government authorities, such as Child Protective Services or Adult Protective Services, that are authorized by law to receive reports of actual or suspected cases of abuse, neglect, or exploitation of children and incapacitated or dependent adults.
• HEALTH OVERSIGHT ACTIVITIES: York may use and disclose your PHI to a health oversight agency for activities authorized by law such as compliance with health oversight audits, investigations, licensure surveys and inspections, and compliant investigations. Oversight agencies authorized to receive your PHI include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs, including the Maine Department of Health and Human Services, the federal

AUTHORIZED USES AND DISCLOSURES OF YOUR Medicare program, and Maine health care professional licensing boards.
• JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: York may disclose your PHI in judicial or administrative proceedings when required or authorized by law, for example, in response to an order of a court or pursuant to a subpoena served by a governmental entity authorized by law to have access to your PHI.
• LAW ENFORCEMENT PURPOSES: York may disclose your PHI, so long as applicable legal requirements are met, for certain law enforcement purposes such as to report gunshot wounds, crimes committed on York’s premises, or crimes committed against York personnel.
• CORONERS AND MEDICAL EXAMINERS: York may use and disclose PHI to coroners and medical examiners regarding a deceased patient for identification purposes, or for a coroner or medical examiner to determine a cause of death or to perform other duties authorized by law.
• FUNERAL DIRECTORS: York may use and disclose PHI to funeral directors consistent with applicable law as necessary to carry out their duties with respect to making funeral arrangements for a deceased patient. If necessary to carry out such duties, York may disclose such information prior to and in reasonable anticipation of a patient’s death.
• BODY, ORGAN, EYE OR TISSUE DONATION PURPOSES: York may use and disclose PHI to organ procurement organizations or other entities for cadaveric (body), organ, eye, or tissue donation purposes.
• RESEARCH: York may use and disclose your PHI for research purposes so long as the research and any uses and disclosures related to such research are approved by an Institutional Review Board (IRB) or a Privacy Board and no identifying information about you is disclosed in any report arising from or published in connection with the research.
• USES AND DISCLOSURES TO AVERT THREATS OF HARM OR SAFETY: York may use and disclose your PHI when necessary to prevent or lessen a direct threat of serious, imminent harm to health or safety.
• SPECIALIZED GOVERNMENT FUNCTIONS: York may disclose your PHI for the following specialized government functions when such disclosures are authorized or required by applicable law:
1. Armed Forces and Foreign Military Personnel: York may disclose the PHI of persons who are members of the Armed Forces and of foreign military personnel for activities deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
2. National Security and Intelligence Activities: York may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act and related Executive Orders.
3. Protective Services for the President and Others: York may disclose your PHI to authorized federal officials for the provision of protective services to the President or other persons, or for the conduct of investigations, authorized under applicable federal law.
4. Correctional Institutions and Law Enforcement Custodians: York may disclose to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual, PHI about the inmate or other person when necessary (i) to provide health care to the inmate or person in custody, (ii) for the health and safety of the inmate or person in custody, (iii) for the health and safety of correctional personnel, (iv) for the health and safety of persons responsible for transporting the inmate or person in custody, (v) for law enforcement on correctional facility premises, and (vi) for administering and maintaining the safety, security and good order of the correctional institution.
• WORKERS’ COMPENSATION: York may disclose your PHI when authorized by and to comply with comply with laws relating to workers’ compensation or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
• BUSINESS ASSOCIATES: York may disclose your PHI to business associate contractors performing services for or on behalf of York when such contractors have agreed in writing to appropriately protect your PHI.
• PERSONAL REPRESENTATIVES: York may disclose your PHI to a personal representative, such as your guardian, health care power of attorney agent, or health care surrogate, who is authorized to make health care decisions on your behalf when you lack the capacity to make your own health care decisions.
• USES AND DISCLOSURES FOR FACILITY DIRECTORY PURPOSES: Unless you or your personal representative notify York that you object to and wish to prohibit or restrict any such uses and disclosures, York may use and disclose the following limited PHI about you for the following facility directory purposes:
1. York may use limited PHI about you to maintain a facility directory—namely, your presence and room location in a York facility, a brief general description of your health status and condition that does not communicate specific medical information about you, and your religious affiliation.
2. York may disclose such facility directory information about you (except for your religious affiliation) to persons who ask for you by name, including members of the public and law enforcement officials.
3. York may also disclose such facility directly information about you, including your religious affiliation, to members of the clergy.
4. York may also disclose a brief general description of your health status and condition that does not communicate specific medical information about you (but not your room number) to members of the media who ask for you by name.
• PERSONS INVOLVED IN YOUR CARE AND USES AND DISCLOSURES FOR NOTIFICATION PURPOSES: York may disclose your PHI to family members, relatives, or close personal friends involved in your care, involved in securing payment for your care, or for notification purposes, unless you or your personal representative notify us that you object to and wish to prohibit or restrict such disclosures.
• DISASTER RELIEF: York may use and disclose your PHI to public or private entities authorized by law to assist in disaster relief efforts for certain notification purposes, provided you have been given the opportunity to agree or to object to such uses and disclosures.
• FUNDRAISING ACTIVITIES: York may use limited PHI about you—namely, your name, address, contact information, age, gender, date of birth, dates of service, department of service, treating physician, outcome information, and health insurance status—to contact you for York fundraising activities in furtherance of York’s nonprofit mission. However, you have the right to opt out of receiving York fundraising communications by notifying York’s Privacy Officer that you do not wish to receive such communications. We may also disclose such limited information to an institutionally related foundation to conduct fundraising activities for the benefit of York.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR AUTHORIZATION:
• WRITTEN AUTHORIZATION: For other types of uses and disclosures not described in this Notice of Privacy Practices, York will obtain your written authorization before using or disclosing your PHI. For example, the following uses and disclosures require York to obtain your written authorization:
• Psychotherapy Notes: In the event that York maintains psychotherapy notes about you that are kept separate from the rest of your York medical record, York will obtain your written authorization to use or disclose such psychotherapy notes unless an exception to the authorization requirement applies under applicable law.
• Marketing: York will obtain your written authorization for any use or disclosure of your PHI to sell or market products or services, except in limited circumstances (for example, in face-to-face marketing communications with you).
• Sale of PHI: York will obtain your written authorization for any disclosure of your PHI that involves a sale of your PHI, unless an exception applies under applicable law.
• Photographs and Videorecordings: York will not photograph or videorecord you, or use or disclose any photographs and videorecordings of you, for non-treatment related purposes, for marketing or public relations purposes, without your written authorization, unless the creation, use or disclosure of such photographs or videorecordings are authorized by law (e.g., for York facility security surveillance purposes).
• RIGHT TO REVOKE AUTHORIZATION: You may revoke an authorization to disclose your PHI at any time, to the extent that York or others have not already relied upon your authorization, by giving written notice of your revocation to York’s Privacy Officer.
SPECIAL PROTECTIONS FOR CERTAIN TYPES OF PROTECTED HEALTH INFORMATION:
• CONFIDENTIALITY OF MENTAL HEALTH INFORMATION: If York maintains information about you derived from mental health services provided to you by a York psychiatrist, psychologist, clinical nurse specialist, social worker or counseling professional, York will not disclose such mental health information to another health practitioner or facility outside of York or its organizational affiliates for a diagnostic, treatment or continuity of care purpose, without your written authorization, unless such disclosure is necessary in an emergency or is otherwise authorized or required by law. If a York licensed mental health facility, program or agency maintains mental health information about you, York will not use or disclose such mental health facility PHI about you except as authorized or required by applicable mental health confidentiality laws and regulations.
• CONFIDENTIALITY OF HIV INFORMATION: If York maintains any information regarding your HIV status (such as HIV test results or medical records containing HIV information), such information is afforded heightened protection under Maine law and York will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by Maine’s HIV confidentiality laws.
• CONFIDENTIALITY OF SUBSTANCE ABUSE PROGRAM INFORMATION: If a York substance abuse program maintains, or if York acquires from another provider or facility, any substance abuse PHI about you that is subject to the heightened federal confidentiality protections afforded to certain substance abuse program records under 42 C.F.R. Part 2, York will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by 42 C.F.R. Part 2. If York creates, acquires or maintains any substance abuse information about you that is not from a Part 2 substance abuse program, York will protect the confidentiality of such information and use and disclose such information in the same way York protects, uses and discloses your other PHI.
YOUR RIGHTS WITH RESPECT TO PROTECTED HEALTH INFORMATION: The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
• YOU HAVE THE RIGHT TO ACCESS, INSPECT AND COPY YOUR PHI. This means you may inspect at reasonable times and obtain a copy of your clinical records and billing records within 30 days of receipt of your written request. If we need extra time, we may extend the time once for an additional 30 days and we will provide you written notice of the extension. You have the right to receive your health information in the form and format of your choosing, if such information can be readily produced in such form and format, or in a readable hardcopy form, or in another format agreed to between you and York. If York maintains your PHI in an electronic health record, you have the right to obtain a copy of your health information in an electronic format and to direct York to transmit an electronic copy of your PHI directly to another clearly specified entity or person of your choice. You may be charged reasonable costs (including labor and supplies) associated with providing copies of your records, or of preparing any summaries that you request. In certain limited circumstances, you may be denied access to your health information and records. However, you may request that a decision denying you access to your PHI and records be reviewed. Please contact York’s Privacy Officer if you have questions about your right to access your PHI.
• YOU HAVE THE RIGHT TO REQUEST A RESTRICTION ON CERTAIN USES AND DISCLOSURES OF YOUR PHI. For example, you may request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. If you request that York not disclose your PHI to a third-party payor health plan for purposes of carrying out payment or health care operations, and you have paid York in full out of pocket for services provided to you, York is required to honor your requested restriction. Otherwise, York is not required to agree to a requested restriction and has sole discretion to decide whether to honor a requested restriction on a case-by-case basis. If York agrees to a requested restriction, York will not use or disclose your PHI in violation of the agreed upon restriction, unless the use or disclosure is needed to provide emergency treatment. Your request for a restriction must state the specific restriction requested and to whom you want the restriction to apply. Disclosures of PHI authorized by you or permitted or required by law as described in this Notice, may include disclosures of PHI York has received from other health care providers and facilities, unless you request and York agrees to a requested restriction on the disclosure of such information.
• YOU HAVE THE RIGHT TO REQUEST TO RECEIVE CONFIDENTIAL COMMUNICATIONS OF PHI FROM US BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION. York will accommodate reasonable requests. York may place conditions on such accommodations, for example, by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. York will not request an explanation from you as to the basis for the request. Please make such requests in writing to York’s Privacy Officer.
• YOU HAVE THE RIGHT TO SUBMIT AMENDMENTS, CORRECTIONS AND CLARIFICATIONS TO YOUR PHI. You may request amendments, corrections and clarifications to PHI contained in your medical records. Your request must be in writing and you must provide a reason supporting your request. If you are requesting a change to the PHI in your treatment record, we will place your requested amendment, correction or clarification in your record. York may add a response to your record, and will provide to you a copy of our response. If you are requesting a change in other records (that are neither medical or billing records), York may deny your request. If your request is denied, we will notify you in writing and provide our reasons for the denial. You have the right to file a statement of disagreement with York’s Privacy Officer and York may prepare a response to your statement. York will provide you with a copy of our response. Please contact York’s Privacy Officer if you have any questions about modifying your PHI.
• YOU HAVE THE RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES. You have the right to receive an accounting of certain disclosures of your PHI made by York in the six years prior to the date of your request. The accounting will not include disclosures made directly to you, disclosures made to others pursuant to your written authorization, disclosures made to carry out treatment, payment, and health care operations for which your written authorization was not required, incidental uses and disclosures, and uses and disclosures for which an accounting is not required by law. However, you have the right to request an accounting of disclosures made for purposes of treatment, payment, or health care operations through an electronic health record during the three years prior to your request. To request an accounting of disclosures of your PHI, contact York’s Privacy Officer.
• IMPORTANT NOTICE TO MINORS REGARDING MINOR’S PRIVACY RIGHTS: If you are a minor authorized by law to consent to health care services on your own behalf and you in fact consent to such services on your own behalf, York is required to protect the privacy of your PHI with respect to health care services you have consented to on your own behalf in the same way that York protects the privacy of an adult’s PHI, unless a special exception applies under the law. For example, York is authorized by law to notify your parent or guardian if, in the judgment of your York provider failure to inform your parent or guardian would seriously jeopardize your health or would seriously limit the ability of your York provider to provide treatment to you. Additionally, if you want York to bill your parent’s insurance for services provided to you, your parents will receive from their insurance company an Explanation of Benefits regarding the services provided to you by York and, as a result, the fact that you received services from York will not be confidential from your parents. However, if you do not want your parents to know that you are receiving services from York, you must notify York of that fact at the time services are provided to you so that arrangements can be made for payment of such services privately or out-of-pocket, or to determine your eligibility for free or discounted care.
• YOU HAVE THE RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM US, UPON REQUEST, even if you have agreed to accept this Notice electronically.
• YOU HAVE THE RIGHT TO FILE A COMPLAINT. You have the right to file a complaint with York or the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by York. You may file a complaint with York by notifying York’s Privacy Officer using the contact information provided below. York will not retaliate against you in any way for filing a complaint.







CONTACTING YORK’S PRIVACY OFFICER
FOR MORE INFORMATION:
If you have any questions about this Notice,
or would like more information about York’s privacy practices, please contact York’s Privacy Officer at:
York Hospital Privacy Officer
15 Hospital Drive, York, Maine 03909
Phone: (207) 351-2139 email: privacyofficer@yorkhospital.com
15 Hospital Drive, York, ME 03909 (207) 363-4321 | toll free 877-363-4321




























LIST OF YORK ENTITIES AND SERVICE DELIVERY SITE
LOCATION/ADDRESS OF PRIVACY PRACTICES

YORK HOSPITAL CAMPUS
• York Hospital: 15 Hospital Dr, York, ME 03909 [main building]
• Erwin Medical Office Building: 2 Hospital Dr/233 York Street, York Maine 03909 [Webhannet Internal Medicine - York, Neurology Associates of YH]
• Ulan Medical Office Building: 12 Hospital Dr, York, ME 03909 [Pulmonary Associates of YH, York Plastic Surgery/Aesthetics, General Surgery Associates of YH, Cardiovascular Care of York Hospital.
• Warner Medical Office Building: 16 Hospital Dr, York, ME 03909 [Orthopaedic Associates of YH, Pediatric Associates of YH, YH OBGYN, Surgical & Midwifery Assoc, Cottage Program]
YORK VILLAGE:
• York Hospital at Long Sands: 127 Long Sands Rd (Stes 7A, 7B, 9, 11, 12), York, ME 03909 [Oncology & Infusion - York, Home Care & Hospice, York Family Practice, Physical Therapy - York]
• York Hospital Community Health & Psychiatry Associates of York Hospital: 32 York St, York, ME 03909
• Urology Associates of York Hospital: 16 Long Sands Rd, York, Maine 03909
WELLS/MOODY:
• York Hospital in Wells: 112 & 114 Sanford Rd, Wells, ME 04090 [Cardiovascular Care, Myhealth@Wells, Wells Emergency Care, Lab, Imaging, Wound Healing, Breast Care - Wells, Physical Therapy - Wells, OBGYN -Wells, Pediatrics - Wells, Oncology - Wells]
• Webhannet Internal Medicine: 277 Post Rd, Moody, ME 04054
THE BERWICKS:
• York Hospital in Berwick: 4 Dana Dr, Berwick, ME 03901 [Myhealth@Berwick, Lab, X-ray, Berwick Pharmacy]
• York Hospital in North Berwick: 23 Wells St, North Berwick, ME 03906 [Webannet Internal Medicine - North Berwick]
• York Hospital in South Berwick: 57 Portland St, South Berwick, ME 03908 [Great Works Family Practice, Lab, X-ray, Physical Therapy - South Berwick, Pediatric Physical Therapy, Oncology - South Berwick, OBGYN - South Berwick]
KITTERY:
• York Hospital in Kittery: 35 Walker St, Kittery, ME 03904 [Myhealth@Kittery, Lab, X-ray, Kittery Family Practice]
• Oncology & Physical Therapy: 75 US Route 1 Bypass, Kittery, ME 03904
NEW HAMPSHIRE:
• Cardiovascular Care of NH & York Hospital: 7 Works Way, Somersworth, NH 03878
• Cardiovascular Care of NH & York Hospital:, 2064 Woodbury Ave, Newington, NH 03802
15 Hospital Drive, York, ME 03909 (207) 363-4321 | toll free 877-363-4321

About Us

A good neighbor is someone who cares about your community, your family, and your wellbeing. That’s York Hospital Berwick Pharmacy, your local Good Neighbor Pharmacy. York Hospital Berwick Pharmacy has been part of the local community since 2005, serving the residents of Berwick and surrounding area. As a member of Good Neighbor Pharmacy, we’re able to offer quality products and services – at prices that are competitive with the big national chains. Plus, we offer a special dose of caring that makes you feel right at home. Get to know us, and get to know the value we can bring to your family’s life.

    HIPAA Notice of Privacy Practice
    York Hospital Privacy NoticeThis Notice describes how York may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information.
    “Protected health information” or “PHI” is individually identifiable health information about you, including demographic information collected from you, that is created or received by York and that relates to (i) your past, present, or future physical or mental health or condition, (ii) the provision of health care to you, or (iii) the past, present or future payment of your health care. PHI also includes any health information and records provided to York by other health care providers and facilities who have provided care to you or are involved in your care.
    York Hospital participates in an organized health care arrangement with its affiliated facilities and providers. Accordingly, this Notice applies to and describes the privacy practices of the following York-affiliated facilities, entities, programs, practices and delivery sites (collectively, “York”): See Other York Entities and Service Delivery Site Location/Address Utilizing this Notice of Privacy Practices at the end of this form.
    YORK’S DUTIES WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION:
    York Hospital is required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to notify affected individuals following a breach of unsecured PHI. Although York is required to abide by the terms of the Notice that is currently in effect, we reserve the right to change our privacy practices at any time and to make the new Notice provisions effective for all PHI that we maintain about you. If our privacy practices change, we will provide you with a revised Notice during your next visit.
    PROTECTED HEALTH INFORMATION:
    York may use and disclose your PHI, without your authorization, for purposes of treatment, payment, and health care operations. For example:
    • TREATMENT: York may use or disclose your PHI to other health care providers for treatment and continuity of care purposes and to arrange for the provision, coordination, and management of health care services for you. For example, York may disclose information about your hospital stay to your primary care physician to arrange for appropriate post-hospital care is provided to you following your discharge from the hospital. York may also disclose PHI about you to a pharmacist to process your prescription, or to a medical equipment supplier for supplies and equipment necessary for your care.
    • PAYMENT: York may use or disclose PHI about you to your health insurance company or other third-party payor health plans such as Medicare or MaineCare (Medicaid) to obtain payment or reimbursement for health care services provided to you, or to determine your eligibility for coverage and benefits, unless you pay in full out of pocket for services provided to you and request in writing that your PHI not be disclosed to third-party payors.
    • HEALTH CARE OPERATIONS: York may use or disclose your PHI for certain health care operations purposes, such as quality review and improvement activities, risk management activities, and to conduct and process patient satisfaction surveys.
    • ORGANIZED HEALTH CARE ARRANGEMENT PURPOSES: York entities participating in York’s organized health care arrangement (described below) may share your PHI with each other as necessary to carry out treatment, payment or health care operations relating to the organized health care arrangement.
    York may also use and disclose your PHI without your authorization in the following additional circumstances:
    • AS REQUIRED BY LAW: York may use and disclose your PHI when required or authorized by state and federal law.
    • PUBLIC HEALTH ACTIVITIES: York may use and disclose your PHI to public health authorities for public health activities, such as to comply with mandatory communicable disease and vital statistics reporting laws.
    • ABUSE, NEGLECT, AND EXPLOITATION REPORTING: York may disclose your PHI to government authorities, such as Child Protective Services or Adult Protective Services, that are authorized by law to receive reports of actual or suspected cases of abuse, neglect, or exploitation of children and incapacitated or dependent adults.
    • HEALTH OVERSIGHT ACTIVITIES: York may use and disclose your PHI to a health oversight agency for activities authorized by law such as compliance with health oversight audits, investigations, licensure surveys and inspections, and compliant investigations. Oversight agencies authorized to receive your PHI include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs, including the Maine Department of Health and Human Services, the federal

    AUTHORIZED USES AND DISCLOSURES OF YOUR Medicare program, and Maine health care professional licensing boards.
    • JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: York may disclose your PHI in judicial or administrative proceedings when required or authorized by law, for example, in response to an order of a court or pursuant to a subpoena served by a governmental entity authorized by law to have access to your PHI.
    • LAW ENFORCEMENT PURPOSES: York may disclose your PHI, so long as applicable legal requirements are met, for certain law enforcement purposes such as to report gunshot wounds, crimes committed on York’s premises, or crimes committed against York personnel.
    • CORONERS AND MEDICAL EXAMINERS: York may use and disclose PHI to coroners and medical examiners regarding a deceased patient for identification purposes, or for a coroner or medical examiner to determine a cause of death or to perform other duties authorized by law.
    • FUNERAL DIRECTORS: York may use and disclose PHI to funeral directors consistent with applicable law as necessary to carry out their duties with respect to making funeral arrangements for a deceased patient. If necessary to carry out such duties, York may disclose such information prior to and in reasonable anticipation of a patient’s death.
    • BODY, ORGAN, EYE OR TISSUE DONATION PURPOSES: York may use and disclose PHI to organ procurement organizations or other entities for cadaveric (body), organ, eye, or tissue donation purposes.
    • RESEARCH: York may use and disclose your PHI for research purposes so long as the research and any uses and disclosures related to such research are approved by an Institutional Review Board (IRB) or a Privacy Board and no identifying information about you is disclosed in any report arising from or published in connection with the research.
    • USES AND DISCLOSURES TO AVERT THREATS OF HARM OR SAFETY: York may use and disclose your PHI when necessary to prevent or lessen a direct threat of serious, imminent harm to health or safety.
    • SPECIALIZED GOVERNMENT FUNCTIONS: York may disclose your PHI for the following specialized government functions when such disclosures are authorized or required by applicable law:
    1. Armed Forces and Foreign Military Personnel: York may disclose the PHI of persons who are members of the Armed Forces and of foreign military personnel for activities deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
    2. National Security and Intelligence Activities: York may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act and related Executive Orders.
    3. Protective Services for the President and Others: York may disclose your PHI to authorized federal officials for the provision of protective services to the President or other persons, or for the conduct of investigations, authorized under applicable federal law.
    4. Correctional Institutions and Law Enforcement Custodians: York may disclose to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual, PHI about the inmate or other person when necessary (i) to provide health care to the inmate or person in custody, (ii) for the health and safety of the inmate or person in custody, (iii) for the health and safety of correctional personnel, (iv) for the health and safety of persons responsible for transporting the inmate or person in custody, (v) for law enforcement on correctional facility premises, and (vi) for administering and maintaining the safety, security and good order of the correctional institution.
    • WORKERS’ COMPENSATION: York may disclose your PHI when authorized by and to comply with comply with laws relating to workers’ compensation or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
    • BUSINESS ASSOCIATES: York may disclose your PHI to business associate contractors performing services for or on behalf of York when such contractors have agreed in writing to appropriately protect your PHI.
    • PERSONAL REPRESENTATIVES: York may disclose your PHI to a personal representative, such as your guardian, health care power of attorney agent, or health care surrogate, who is authorized to make health care decisions on your behalf when you lack the capacity to make your own health care decisions.
    • USES AND DISCLOSURES FOR FACILITY DIRECTORY PURPOSES: Unless you or your personal representative notify York that you object to and wish to prohibit or restrict any such uses and disclosures, York may use and disclose the following limited PHI about you for the following facility directory purposes:
    1. York may use limited PHI about you to maintain a facility directory—namely, your presence and room location in a York facility, a brief general description of your health status and condition that does not communicate specific medical information about you, and your religious affiliation.
    2. York may disclose such facility directory information about you (except for your religious affiliation) to persons who ask for you by name, including members of the public and law enforcement officials.
    3. York may also disclose such facility directly information about you, including your religious affiliation, to members of the clergy.
    4. York may also disclose a brief general description of your health status and condition that does not communicate specific medical information about you (but not your room number) to members of the media who ask for you by name.
    • PERSONS INVOLVED IN YOUR CARE AND USES AND DISCLOSURES FOR NOTIFICATION PURPOSES: York may disclose your PHI to family members, relatives, or close personal friends involved in your care, involved in securing payment for your care, or for notification purposes, unless you or your personal representative notify us that you object to and wish to prohibit or restrict such disclosures.
    • DISASTER RELIEF: York may use and disclose your PHI to public or private entities authorized by law to assist in disaster relief efforts for certain notification purposes, provided you have been given the opportunity to agree or to object to such uses and disclosures.
    • FUNDRAISING ACTIVITIES: York may use limited PHI about you—namely, your name, address, contact information, age, gender, date of birth, dates of service, department of service, treating physician, outcome information, and health insurance status—to contact you for York fundraising activities in furtherance of York’s nonprofit mission. However, you have the right to opt out of receiving York fundraising communications by notifying York’s Privacy Officer that you do not wish to receive such communications. We may also disclose such limited information to an institutionally related foundation to conduct fundraising activities for the benefit of York.
    USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR AUTHORIZATION:
    • WRITTEN AUTHORIZATION: For other types of uses and disclosures not described in this Notice of Privacy Practices, York will obtain your written authorization before using or disclosing your PHI. For example, the following uses and disclosures require York to obtain your written authorization:
    • Psychotherapy Notes: In the event that York maintains psychotherapy notes about you that are kept separate from the rest of your York medical record, York will obtain your written authorization to use or disclose such psychotherapy notes unless an exception to the authorization requirement applies under applicable law.
    • Marketing: York will obtain your written authorization for any use or disclosure of your PHI to sell or market products or services, except in limited circumstances (for example, in face-to-face marketing communications with you).
    • Sale of PHI: York will obtain your written authorization for any disclosure of your PHI that involves a sale of your PHI, unless an exception applies under applicable law.
    • Photographs and Videorecordings: York will not photograph or videorecord you, or use or disclose any photographs and videorecordings of you, for non-treatment related purposes, for marketing or public relations purposes, without your written authorization, unless the creation, use or disclosure of such photographs or videorecordings are authorized by law (e.g., for York facility security surveillance purposes).
    • RIGHT TO REVOKE AUTHORIZATION: You may revoke an authorization to disclose your PHI at any time, to the extent that York or others have not already relied upon your authorization, by giving written notice of your revocation to York’s Privacy Officer.
    SPECIAL PROTECTIONS FOR CERTAIN TYPES OF PROTECTED HEALTH INFORMATION:
    • CONFIDENTIALITY OF MENTAL HEALTH INFORMATION: If York maintains information about you derived from mental health services provided to you by a York psychiatrist, psychologist, clinical nurse specialist, social worker or counseling professional, York will not disclose such mental health information to another health practitioner or facility outside of York or its organizational affiliates for a diagnostic, treatment or continuity of care purpose, without your written authorization, unless such disclosure is necessary in an emergency or is otherwise authorized or required by law. If a York licensed mental health facility, program or agency maintains mental health information about you, York will not use or disclose such mental health facility PHI about you except as authorized or required by applicable mental health confidentiality laws and regulations.
    • CONFIDENTIALITY OF HIV INFORMATION: If York maintains any information regarding your HIV status (such as HIV test results or medical records containing HIV information), such information is afforded heightened protection under Maine law and York will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by Maine’s HIV confidentiality laws.
    • CONFIDENTIALITY OF SUBSTANCE ABUSE PROGRAM INFORMATION: If a York substance abuse program maintains, or if York acquires from another provider or facility, any substance abuse PHI about you that is subject to the heightened federal confidentiality protections afforded to certain substance abuse program records under 42 C.F.R. Part 2, York will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by 42 C.F.R. Part 2. If York creates, acquires or maintains any substance abuse information about you that is not from a Part 2 substance abuse program, York will protect the confidentiality of such information and use and disclose such information in the same way York protects, uses and discloses your other PHI.
    YOUR RIGHTS WITH RESPECT TO PROTECTED HEALTH INFORMATION: The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
    • YOU HAVE THE RIGHT TO ACCESS, INSPECT AND COPY YOUR PHI. This means you may inspect at reasonable times and obtain a copy of your clinical records and billing records within 30 days of receipt of your written request. If we need extra time, we may extend the time once for an additional 30 days and we will provide you written notice of the extension. You have the right to receive your health information in the form and format of your choosing, if such information can be readily produced in such form and format, or in a readable hardcopy form, or in another format agreed to between you and York. If York maintains your PHI in an electronic health record, you have the right to obtain a copy of your health information in an electronic format and to direct York to transmit an electronic copy of your PHI directly to another clearly specified entity or person of your choice. You may be charged reasonable costs (including labor and supplies) associated with providing copies of your records, or of preparing any summaries that you request. In certain limited circumstances, you may be denied access to your health information and records. However, you may request that a decision denying you access to your PHI and records be reviewed. Please contact York’s Privacy Officer if you have questions about your right to access your PHI.
    • YOU HAVE THE RIGHT TO REQUEST A RESTRICTION ON CERTAIN USES AND DISCLOSURES OF YOUR PHI. For example, you may request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. If you request that York not disclose your PHI to a third-party payor health plan for purposes of carrying out payment or health care operations, and you have paid York in full out of pocket for services provided to you, York is required to honor your requested restriction. Otherwise, York is not required to agree to a requested restriction and has sole discretion to decide whether to honor a requested restriction on a case-by-case basis. If York agrees to a requested restriction, York will not use or disclose your PHI in violation of the agreed upon restriction, unless the use or disclosure is needed to provide emergency treatment. Your request for a restriction must state the specific restriction requested and to whom you want the restriction to apply. Disclosures of PHI authorized by you or permitted or required by law as described in this Notice, may include disclosures of PHI York has received from other health care providers and facilities, unless you request and York agrees to a requested restriction on the disclosure of such information.
    • YOU HAVE THE RIGHT TO REQUEST TO RECEIVE CONFIDENTIAL COMMUNICATIONS OF PHI FROM US BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION. York will accommodate reasonable requests. York may place conditions on such accommodations, for example, by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. York will not request an explanation from you as to the basis for the request. Please make such requests in writing to York’s Privacy Officer.
    • YOU HAVE THE RIGHT TO SUBMIT AMENDMENTS, CORRECTIONS AND CLARIFICATIONS TO YOUR PHI. You may request amendments, corrections and clarifications to PHI contained in your medical records. Your request must be in writing and you must provide a reason supporting your request. If you are requesting a change to the PHI in your treatment record, we will place your requested amendment, correction or clarification in your record. York may add a response to your record, and will provide to you a copy of our response. If you are requesting a change in other records (that are neither medical or billing records), York may deny your request. If your request is denied, we will notify you in writing and provide our reasons for the denial. You have the right to file a statement of disagreement with York’s Privacy Officer and York may prepare a response to your statement. York will provide you with a copy of our response. Please contact York’s Privacy Officer if you have any questions about modifying your PHI.
    • YOU HAVE THE RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES. You have the right to receive an accounting of certain disclosures of your PHI made by York in the six years prior to the date of your request. The accounting will not include disclosures made directly to you, disclosures made to others pursuant to your written authorization, disclosures made to carry out treatment, payment, and health care operations for which your written authorization was not required, incidental uses and disclosures, and uses and disclosures for which an accounting is not required by law. However, you have the right to request an accounting of disclosures made for purposes of treatment, payment, or health care operations through an electronic health record during the three years prior to your request. To request an accounting of disclosures of your PHI, contact York’s Privacy Officer.
    • IMPORTANT NOTICE TO MINORS REGARDING MINOR’S PRIVACY RIGHTS: If you are a minor authorized by law to consent to health care services on your own behalf and you in fact consent to such services on your own behalf, York is required to protect the privacy of your PHI with respect to health care services you have consented to on your own behalf in the same way that York protects the privacy of an adult’s PHI, unless a special exception applies under the law. For example, York is authorized by law to notify your parent or guardian if, in the judgment of your York provider failure to inform your parent or guardian would seriously jeopardize your health or would seriously limit the ability of your York provider to provide treatment to you. Additionally, if you want York to bill your parent’s insurance for services provided to you, your parents will receive from their insurance company an Explanation of Benefits regarding the services provided to you by York and, as a result, the fact that you received services from York will not be confidential from your parents. However, if you do not want your parents to know that you are receiving services from York, you must notify York of that fact at the time services are provided to you so that arrangements can be made for payment of such services privately or out-of-pocket, or to determine your eligibility for free or discounted care.
    • YOU HAVE THE RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM US, UPON REQUEST, even if you have agreed to accept this Notice electronically.
    • YOU HAVE THE RIGHT TO FILE A COMPLAINT. You have the right to file a complaint with York or the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by York. You may file a complaint with York by notifying York’s Privacy Officer using the contact information provided below. York will not retaliate against you in any way for filing a complaint.







    CONTACTING YORK’S PRIVACY OFFICER
    FOR MORE INFORMATION:
    If you have any questions about this Notice,
    or would like more information about York’s privacy practices, please contact York’s Privacy Officer at:
    York Hospital Privacy Officer
    15 Hospital Drive, York, Maine 03909
    Phone: (207) 351-2139 email: privacyofficer@yorkhospital.com
    15 Hospital Drive, York, ME 03909 (207) 363-4321 | toll free 877-363-4321




























    LIST OF YORK ENTITIES AND SERVICE DELIVERY SITE
    LOCATION/ADDRESS OF PRIVACY PRACTICES

    YORK HOSPITAL CAMPUS
    • York Hospital: 15 Hospital Dr, York, ME 03909 [main building]
    • Erwin Medical Office Building: 2 Hospital Dr/233 York Street, York Maine 03909 [Webhannet Internal Medicine - York, Neurology Associates of YH]
    • Ulan Medical Office Building: 12 Hospital Dr, York, ME 03909 [Pulmonary Associates of YH, York Plastic Surgery/Aesthetics, General Surgery Associates of YH, Cardiovascular Care of York Hospital.
    • Warner Medical Office Building: 16 Hospital Dr, York, ME 03909 [Orthopaedic Associates of YH, Pediatric Associates of YH, YH OBGYN, Surgical & Midwifery Assoc, Cottage Program]
    YORK VILLAGE:
    • York Hospital at Long Sands: 127 Long Sands Rd (Stes 7A, 7B, 9, 11, 12), York, ME 03909 [Oncology & Infusion - York, Home Care & Hospice, York Family Practice, Physical Therapy - York]
    • York Hospital Community Health & Psychiatry Associates of York Hospital: 32 York St, York, ME 03909
    • Urology Associates of York Hospital: 16 Long Sands Rd, York, Maine 03909
    WELLS/MOODY:
    • York Hospital in Wells: 112 & 114 Sanford Rd, Wells, ME 04090 [Cardiovascular Care, Myhealth@Wells, Wells Emergency Care, Lab, Imaging, Wound Healing, Breast Care - Wells, Physical Therapy - Wells, OBGYN -Wells, Pediatrics - Wells, Oncology - Wells]
    • Webhannet Internal Medicine: 277 Post Rd, Moody, ME 04054
    THE BERWICKS:
    • York Hospital in Berwick: 4 Dana Dr, Berwick, ME 03901 [Myhealth@Berwick, Lab, X-ray, Berwick Pharmacy]
    • York Hospital in North Berwick: 23 Wells St, North Berwick, ME 03906 [Webannet Internal Medicine - North Berwick]
    • York Hospital in South Berwick: 57 Portland St, South Berwick, ME 03908 [Great Works Family Practice, Lab, X-ray, Physical Therapy - South Berwick, Pediatric Physical Therapy, Oncology - South Berwick, OBGYN - South Berwick]
    KITTERY:
    • York Hospital in Kittery: 35 Walker St, Kittery, ME 03904 [Myhealth@Kittery, Lab, X-ray, Kittery Family Practice]
    • Oncology & Physical Therapy: 75 US Route 1 Bypass, Kittery, ME 03904
    NEW HAMPSHIRE:
    • Cardiovascular Care of NH & York Hospital: 7 Works Way, Somersworth, NH 03878
    • Cardiovascular Care of NH & York Hospital:, 2064 Woodbury Ave, Newington, NH 03802
    15 Hospital Drive, York, ME 03909 (207) 363-4321 | toll free 877-363-4321
       
       
       
       
       

    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

    4 Dana Drive
    Berwick, ME, 03901
    (207) 698-6740

    Get Directions

    Pharmacy Hours

    Mon-Fri 8:30am - 6:00pm;Sat: 8:30am - 4:00pm;Sun: 8:30am - 4:00pm;

    Store Hours

    Mon-Fri 8:30am - 6:00pm;Sat: 8:30am - 4:00pm;Sun: 8:30am - 4:00pm;
     
     
     
    • 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.