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HIPAA Notice of Privacy Practice
Nortonville Pharmacy
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.
A. OUR COMMITMENT TO YOUR PRIVACY
Nortonville Pharmacy is dedicated to maintaining the privacy of your medical information. 1:1 con::kcling cur business-. We will: create records regarding you and the
treatment and services we provide to you. These records are our property. However, we are required by law maintain confidentiality of your medical information, to provide you with. This notice of our legal duties and privacy practices concerning your medical information, and to follow the notice of privacy practices
In eHe:::\ at \he lime. To summarize, this notice provides you with the following important information on how we may use and disclose your medical information, your
Privacy rights in your medical information, and our obligations concerning the use and disclosure of your medical information.
Changes to This Notice
The terms of this notice are all records containing your medical information that art: created or maintained by Nortonville Pharmacy. We reserve the right to revise,
change, or amend our notice of privacy practices. Any revision or amendment to this notice will be effecl:ive for all of the information that we already have about you,
as well as any of your medical information that we may receive, create, or maintain in the future. We will post a copy of our current notice in our pharmacy or a prominent location. You may request a ayy of cur most c:nrenmli::e dwing arvisit to !he pharrna:::y.
B. HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following paragraphs describe the different ways we may use ard d1s:::lose your medical inf:: r11aliofl. Ple::s:rote•.hat e2eh particular-use or dsclosure is not
li \ed be!aw.However, the afferent ways we a:e permilled to use ar.d ds.:lose your medea! m:ormaticn do fa Iwthir-o.1e of the calegcxies.
Treatment
Noconvil!e Pr.armacy may JSe Gnd disclose yor flledic::l information to !real you. For ex-ample, we may use your med:col nformalion to di pell3e pre:3cripfson
medicaliorn: to yoL rx tJ a6Jise you of possible side elfec{s cf)•our medications. We may dscme your medical informatior: lo anotPer pharmacist acting on your hehalf or to a cerlified o•licensed health care professior:alre-sponsible fo: your care when !hey or we need to obtai! c-rclari:Y informajon to provide trealmenllo yo1.. For exampe, we m3.Y disdose ym:r medeal in orma on tc anothee pharmacy whe.e you may be selling preso•ip,•ans or loa pharmacy you have conlacled requesting Lran:oro•of your prcscriprion record::;. In 1he coiJrse of pr011id ng lrea:mert to you, <liJr pharmacy may use you:name to rere•ence your prescri:::.tions nr ether services
you receive fran us. We rrey dsclcse yo•Jr mecfca1 lnfcrrnanon to another person ihat ycu rave asked to ass\ you v:ilh c::fning our ssrvces, sue:as a ram y
-nember, close personal frienc, :.r any othe•person :den!lfied 'l'J you. We v. ll fimil ltle inf01malion ::lisclm:d to thai which is directt1 re!ewmt to lhe perso1's
•IWG!u-emenl wilh your care. =ore:.:a-1lple, we may disc!cse m1nirr.al inf::Jrmation lo ap=lson l alyou have sent to 0.11 pharmacy to pick JP yom prescr lions.
Payment
NortoriVille Pharmacy may use aOO disdose your medical information to b.ll and collect paymeol for se-ruices and items we have pwvided lo you. Fer example, we rna• contact your healti-r insurer or the ma1ager of yo•Jr presc-riptioo drug benefit lo certi• thai you are e g!ble for benefits or \ho amount of your pre-sc.iptian cc 4 payment. We may use and dsclose-your medical informaUon to obtain paynent from :: !her people who may be raspo:-rs:ble lo pay fCfyour health care, sLch as rami
-neml:::ers. We may use '/O'.Ir medicaf i1forrnalon to biU you direcUy for Eenticec:.nd ile11s. Please nola thai Iinformalior. Cfl or ct"::JVidfd wth lht: bill may co1 ah
nfo•mation 'lat idenlJ es you and the medi:alionsyou are laking.
H ahll Care Operations
).brtorwllle Pharmat::-j may use and disciJS!:! '(O'Jr- med :al informaiOO in the operation oour business. l!'lese uses me .mportant !0 ensure that you rereive GW i y
care ar1d oLr pharmacy operates efficiently. F«example,we may use 2nd disclose your medical information loB alua!e the performam:e o;' Uie pharmacists rx-oviOOg rea\:nent to ym. to conductcost-manzgemer;t analyses for ltle seruiceswe offer Ia our patients and forlhe purposes of business planning.
Additional ways \YO mav use or disclose yourmedfcallnformatron:
•n addition to lhe ways we have idenlifie::l above for treatment, p;;ymenl. or health care cperat1cns, Nortonville Ph3rmacy wm use and disclose your medical
nfo•malion as follows:
Required by Law
\brlcrwilie harmac;y may use or disclose necfv.tl infor:nalioo aboLIyou w1en requirec to Co so by appli:aole law.
Public Health Activities
Nortonville Pharmacy may disclose your medical information to a public health authority Ulal is authorized by law to collect or receive soon information rolhe purpose of preventing or controlling disease, injury or disability; pretenting child abuse or neglect: or preventing the spread of cocr.mcnicable diseases. We may disclose your medical inrcrmation to a pl.Oik: health authority :halis authorized by law 10 ccflecl or receive information about he qua6ty, safety". cr effectiveness c;>rescription and nonprescriptioo medications and mEdical devices..
Abuse, Neglect, and Domes1:/c Violence
\brlorl'lille Pharna:;y may disclose your mecfJCal inrormation to a :JOVernment authority that is aul10r"zed b'Jiaw to receive reports of ;:;.dull \'idrrs of abuse, neglect or domestic violence if 'He suspect yoo are a viclim of such abuse, neglect or domestic •Jiole1Ce. If we make such a disclosure. we wil! inform you or your personal iepresen!at-ve of !he report, un ess Yre believe !halinforming you or your persona! repres€nlaiPJe we wlbe pladng you at risk of serkus harm.
Heallo Oversight AcUvltles
Nor!onville Pharmacy rr.ay disc:ose your mecf:cc.l informa on {o a hea:lh oversight ager.cy for cversighlactNllies authorized by law. Such wersight ac\N-tlies irdude
invesli!Jations; inspecUoos; aud'ls; survi!)'s; lfcersu eand disdplir:ary acEor s: cNiL adminislralive. ardcriminalpoocedures or actions;::: rother aclivilies necessary fa
:he government to monitor governm2nlpr rams, compliance 'Ni:h civJ rights laws. and the healll: care system in generaL The Kenlucky B<:.ard of Pharmacy and Drug
C:u-:trol E!ra1c1 of the Kentucky Cabinet for Heal!h SeNices are examples cf sorr•e or lhe health 0'/ersighlagoocies to which wed scbse mecfiCal infmma:ion.
Lawsuits and Similar Proceedings
NOI'Iorwitre Pharmacy may use ar.d cisdc-se your :nedkal infonn;: tbn in re ponse to a COJI\ cr adr.Jinisb li'Je ord-ar, if you are inv:JivOO in a tawsuil or sim ar proceeding.
Law Enforcement
Nor:.ooville Pharma...--y may dS<::Ose yoormedicat information to a federal, stale,or mumop-allrl'N enforcement officer whose duty is to enfocce the laws of this slate Of
Ihe Ur.iled Sletes relating to drugs and who is engaged in a c1fic investis-at on iflvolvir.-g a designaledpersoo. Speclaltzed Government Functions
rtmwille Pflarm:;cy may dsclose your medea! rnformallon if yoo am a membeoiU.S. :lf foreign ml!nary ro•cc::(lr.c IdlnQ veTP.Ian) and 1r required tij the awrop:tate :n ar>' conJrr.afld authorities. "n addi on, we may d close your medical in ormelicn lo federa: officials rOI' i11 ig!;!{I:..::E ;aud r'atiu1<ll 'S!:'I..-,.uity advitio.o ­ authorizedby la"-11. We RErf d.scloseycur meOica\ lnfc-Hnan lo federa offic;i-als in Ofder lo pro!ect the Presrjenl, olhe.r of\K:l"1s or fore gn heads of stale,or lo cotlduel
lnvestigal;ons.We may disclose vour r.Jetf:ca\ informalion io conec iona\ institu\i::ms or law enforcemenl{lffic'als il you ure an inmate or under the c.ustoa; of a law enforcement official. Oisclosurc for these purposes would be necessary: (i] for :he institulion to provide hcaHh r.are servtees \Q you. (n) tor lhe safely aM security or the irslilution, and/or {iii) to prated your he2.lt'i'. a dsarety cr ln.e heaiUl and safeof other iufrviduals.
Workers' Compensation and Other GovcmmcntAgontlus
NorlorNiYe Phalmacy may (fis(;kJse your mc-c!linforma on to Workers' Cmj:ers.atb,nne othrJ or.w:mmen\ gor1CIIJ".i ;l1a1wiU1the responst.ilitv or prO't.•idir'(l
medica: care for you, upon '1\"fitlen requestan au\hortzeJ rep e'3enta\No of the agency requF:s\ino l'illr.h infam1a\br..
Treatment Altern<rttves

f cr(OI"ll!i !! :;:.harmacy may .JSe yoor medical in ormalion [O inronr )GU of heaflh-rc\oJod l::crc[h;UIU.i sero;jccs 01 alteii'Ul.lrve lrea(ilents, lhe18pies. ro.....id3!l

1 Cl"

selliflgs of care lhffi may be of inleresl loyou. For e"Xample, we may con!acl you lo pra,rida refill re:ninc!ers, to -nvile you to a heaHh screening or to par1idpate In a
program we belreve may be beneficial to yo:Jr health
Marketing
Nortonville Pharmacy may c:JmmiHlicalo V.'ilh you abou:a prodi.JCI or service and cnco Lage you to pJrchase or use \hal proCuc\ lY er11ice. ThEse commooications must Either take place fao::e-lo-face with you orcOOGem produ:;\s: 'JIservices of nominalila:ue. Iyou ::fo n'JI wool to rece!Ve merkeling communica:ions please contact thPdvacy Officer at the p1armacy.

C. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Requesting Reslrfctions
Yu have. tha right to requ.el a reslrk:l-oo ln Nortonville Pnarmacy's use or disc:os-Jre of your medcal informiilion for lrealmenl_.payment, or hcal\f, care operations. Additional!\•, y:IU have lhe hi ((J reql.(lS! ';hat we limit our ciscl:ist.:re or your me:::licalinf::lrmallon o irldivh::IL•als involved in your care or the payment fer your care, such as fam)'.y members and friends.We are nolreqJired to 2gr00 to your request. lfw= do agree, hcmever,we me boundby our agreerner1 excepl when <Jtt.erwise
required by law. in emergencies, or when the information is necessary to t•eat to you. In crder to reques;a reslliclion n oor use o:- d-sdosure <J: your nedcal
information, you must mal:e your request ill writ ng to ti"e Pri'Jacy Officer a\1\brtooiJ'ile Pharmacy_ Your request must :f cribe in a <:lear and concise (ashbr: 0) the
in:ormalion you wish eslricled, { )whether you are reqLeslin-J to limit our p-actCe's-use, cisdc•su•e or both;a1d (iii) o whom yol. wan:tile fimils to apply. Confidenllal Communications
Yoo have U1e righllo request that Nort<Y.MIIe Pharrnacy commu:Jlcale Wl\h you Ebout your heall':l and related issues 1n a parU ;ular nanner, orate certain location. For inslaoce, you may ask that we contact you 'r1j mali, ather than 'r1f telephooe, or at home, ralher than work:_ In order lo req.resl a }Pe cJ c.polidenliel
communication, ycu must make a wriUen request to the Priva:y Officer alNorlollvi!Je Pharmacy specifying the reqJesled f,le\hOO of ccntacor tne l«ation where y::Ju
wish to be coolacled. OIJI' ::. ,armacywill aa:ommodale reasonab'e requests. You da nolneed to give a reaso.1for yoor requesl.
hwpoclion and Copies
You have lhe right lo inspect a•d obtain a Co)f:Y f l'le informEi:tior that Nortonv le Ph<:rmacy may use 1o make de:isrons aboJI ycur care, indudng piescrip!i<Jn
records anc biDing records. You mJs1 sul:mit yaur request in writing to the PrivacoJ Offcer at Nortcnvi!le Pha•rracy •n order tc inspect and/or cbtain a ::opy of your records. We may charge .a fee for he costs c;fcopying, ma fire, tabor and supplies associated with y(1Jr refllle l. o.A'e may deny your r es:lo inspect and/or copy in
certain timiled circumstances. Yoo may, l".o.vever, request a review of our deniaJ.The review of aur denial v1i!\ be ;:ondu :!edby another licensed heallh care professional chcsen by L!s,but not by the person that origiraldenied your reque-st
Amendment
Yoo may ask Nortowille Fharrr.acy to amend your .11edica1 informalion ifyoo believe;\ is incorreGl or incomplete. You may request an amet c'menl ror as long as !he
inform.stior is kepi by or for our pharmacy. To req. es:an amendme.'ll, y::.ur requC!3l mu;lbe. made in writing and st.hmitted to the Pfivao;O: cer at Nortonvrlle Pharmac'f. You 11uslprm1de us with a reason hat sup::xxls your req_ est for arr.sndnerl. We Villi deny your request if you faU !o subnityour Je:)l:est (and lle rea5on suppor1ing yoJr rei1Jesl) in writing. Also, we may d2ny vcur request {you ask us to mend hformc:.tion ;hal 's aCCtJrale ard romplele; not pari of lha medeaI
informalior kept by or for Nortonvile Pharmacr. not part of the medical inforrnE:Iion which you would be permitted to inspe:land copy;or not created by 1\'ortorw/le
Pharmacy. unless le individual or entity lhat created the ir,fo•rr.ation is not ava Eible lo arr.end the in ormation
Accounting of Disclosures
You have the right to request an accoonUng or dsclosures. An aro::ur.ting of disdosures is a lis; of certain dl3clos.ures Nvr!on•Ji\le PharmaC}' has made of your
medical inrormation_ to order to obtain an accounting of disclosures, you must submit your retfJest in writing to the Privacy Officer at Nortonville Pharmacy. An
req. ests for an E:o::ounllng of Otsdcsures r.1us1 stale a time perbd that m.:.y ne-t be lor.ger lha1six years and may not irctde dates befoce Apul14, 2003. The r ret
reqJest within a 12-rnonll". peli:xi is free of charge, bul we may ctmrgB you for addlional req. ests within the same 12-monUl pe;iod. We w U notify you of the costs
irr.rclved with additional requests, and ycu nay wiUida'l'l'P-lr request befora )'OU iocur any casts
Righi to a Paper Copy of This Notice
You are entitled 1o receive a paper rx:filYOf ouoolice of p1iva-:::y practices.l'ou may ask us to gi'Je you accpy oflhis notice at any firne. To oblain a poper copy oflhis noli. contact the Pcivacy Offat Nortonville Phalmaq_
Right to File a Complaint
If you believe your privac'j rights have been violated, 'JOJ may file a corrplainlwith Norlcn'vi1JB Pharmacy m wh the Secretary of \he Department of Health and
H man Ser•.-icas, Hubert H. Hum;= hre-_.,- Bl:itdi'ly, 200 lndqlendence Avenue SW, Washington, DC 20201 To ii1e a tx mplaht wilh our OJganizalion, contact the
P1ivecy Of :er at Norton!Jille Pharmacy. A!l com aints must be submi:le:f in writing_ You YJill notbo peoa zed for rlir.g a complainl
Right to Provide an Auihorlzatlon for 0\herUs:es and Disdosuros
Nor!cnville : harmacy wl or must cbtairr a Wiillen aulhor_zatkn for uses o: cisclosue nG! identir ec bj ihis notice or not parmilled by appl.cable law. "ou have the righ;lo revoke any autllorizalion you provide to us re;ar:Jing lhe use and disclosure cf your medK:al inrormation at any lime. Your revoca on must be in w:iting. Upon
receipt or your written Tevccallcn, we wit!no !ooger use or disclose yoor mediCC!I information ror lhe reasoos describeC in the authcc'fzation_ Of course, \\'E! are unab!e
to take batt. 811Y dsdosures we have alraad{ made with your permission.Flease aso note that we are requrEd to relain records ofyo-Jr ca;e_
D. CONTACT INFORMATION
You may contact Privacy Officer for Nortonville Pharmacy at:
Adam Coffman
Nortonville Pharmacy
270-676-8260
E. EFFECTIVE DATE
This Notice is Effective April 14, 2003.

About Us

GET BACK TO WHAT MATTERS
Ready for a break from the big national chains? Get to know Nortonville Pharmacy, your local Good Neighbor Pharmacy. Established in 1984, we’re committed to the Nortonville community and the local economy. Plus, our collective purchasing power allows us to offer extremely competitive prices on the prescriptions and other products you use every day. So give us a try, and discover how much better you can feel when a good neighbor cares for you.

    HIPAA Notice of Privacy Practice
    Nortonville Pharmacy
    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.
    A. OUR COMMITMENT TO YOUR PRIVACY
    Nortonville Pharmacy is dedicated to maintaining the privacy of your medical information. 1:1 con::kcling cur business-. We will: create records regarding you and the
    treatment and services we provide to you. These records are our property. However, we are required by law maintain confidentiality of your medical information, to provide you with. This notice of our legal duties and privacy practices concerning your medical information, and to follow the notice of privacy practices
    In eHe:::\ at \he lime. To summarize, this notice provides you with the following important information on how we may use and disclose your medical information, your
    Privacy rights in your medical information, and our obligations concerning the use and disclosure of your medical information.
    Changes to This Notice
    The terms of this notice are all records containing your medical information that art: created or maintained by Nortonville Pharmacy. We reserve the right to revise,
    change, or amend our notice of privacy practices. Any revision or amendment to this notice will be effecl:ive for all of the information that we already have about you,
    as well as any of your medical information that we may receive, create, or maintain in the future. We will post a copy of our current notice in our pharmacy or a prominent location. You may request a ayy of cur most c:nrenmli::e dwing arvisit to !he pharrna:::y.
    B. HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
    The following paragraphs describe the different ways we may use ard d1s:::lose your medical inf:: r11aliofl. Ple::s:rote•.hat e2eh particular-use or dsclosure is not
    li \ed be!aw.However, the afferent ways we a:e permilled to use ar.d ds.:lose your medea! m:ormaticn do fa Iwthir-o.1e of the calegcxies.
    Treatment
    Noconvil!e Pr.armacy may JSe Gnd disclose yor flledic::l information to !real you. For ex-ample, we may use your med:col nformalion to di pell3e pre:3cripfson
    medicaliorn: to yoL rx tJ a6Jise you of possible side elfec{s cf)•our medications. We may dscme your medical informatior: lo anotPer pharmacist acting on your hehalf or to a cerlified o•licensed health care professior:alre-sponsible fo: your care when !hey or we need to obtai! c-rclari:Y informajon to provide trealmenllo yo1.. For exampe, we m3.Y disdose ym:r medeal in orma on tc anothee pharmacy whe.e you may be selling preso•ip,•ans or loa pharmacy you have conlacled requesting Lran:oro•of your prcscriprion record::;. In 1he coiJrse of pr011id ng lrea:mert to you, <liJr pharmacy may use you:name to rere•ence your prescri:::.tions nr ether services
    you receive fran us. We rrey dsclcse yo•Jr mecfca1 lnfcrrnanon to another person ihat ycu rave asked to ass\ you v:ilh c::fning our ssrvces, sue:as a ram y
    -nember, close personal frienc, :.r any othe•person :den!lfied 'l'J you. We v. ll fimil ltle inf01malion ::lisclm:d to thai which is directt1 re!ewmt to lhe perso1's
    •IWG!u-emenl wilh your care. =ore:.:a-1lple, we may disc!cse m1nirr.al inf::Jrmation lo ap=lson l alyou have sent to 0.11 pharmacy to pick JP yom prescr lions.
    Payment
    NortoriVille Pharmacy may use aOO disdose your medical information to b.ll and collect paymeol for se-ruices and items we have pwvided lo you. Fer example, we rna• contact your healti-r insurer or the ma1ager of yo•Jr presc-riptioo drug benefit lo certi• thai you are e g!ble for benefits or \ho amount of your pre-sc.iptian cc 4 payment. We may use and dsclose-your medical informaUon to obtain paynent from :: !her people who may be raspo:-rs:ble lo pay fCfyour health care, sLch as rami
    -neml:::ers. We may use '/O'.Ir medicaf i1forrnalon to biU you direcUy for Eenticec:.nd ile11s. Please nola thai Iinformalior. Cfl or ct"::JVidfd wth lht: bill may co1 ah
    nfo•mation 'lat idenlJ es you and the medi:alionsyou are laking.
    H ahll Care Operations
    ).brtorwllle Pharmat::-j may use and disciJS!:! '(O'Jr- med :al informaiOO in the operation oour business. l!'lese uses me .mportant !0 ensure that you rereive GW i y
    care ar1d oLr pharmacy operates efficiently. F«example,we may use 2nd disclose your medical information loB alua!e the performam:e o;' Uie pharmacists rx-oviOOg rea\:nent to ym. to conductcost-manzgemer;t analyses for ltle seruiceswe offer Ia our patients and forlhe purposes of business planning.
    Additional ways \YO mav use or disclose yourmedfcallnformatron:
    •n addition to lhe ways we have idenlifie::l above for treatment, p;;ymenl. or health care cperat1cns, Nortonville Ph3rmacy wm use and disclose your medical
    nfo•malion as follows:
    Required by Law
    \brlcrwilie harmac;y may use or disclose necfv.tl infor:nalioo aboLIyou w1en requirec to Co so by appli:aole law.
    Public Health Activities
    Nortonville Pharmacy may disclose your medical information to a public health authority Ulal is authorized by law to collect or receive soon information rolhe purpose of preventing or controlling disease, injury or disability; pretenting child abuse or neglect: or preventing the spread of cocr.mcnicable diseases. We may disclose your medical inrcrmation to a pl.Oik: health authority :halis authorized by law 10 ccflecl or receive information about he qua6ty, safety". cr effectiveness c;>rescription and nonprescriptioo medications and mEdical devices..
    Abuse, Neglect, and Domes1:/c Violence
    \brlorl'lille Pharna:;y may disclose your mecfJCal inrormation to a :JOVernment authority that is aul10r"zed b'Jiaw to receive reports of ;:;.dull \'idrrs of abuse, neglect or domestic violence if 'He suspect yoo are a viclim of such abuse, neglect or domestic •Jiole1Ce. If we make such a disclosure. we wil! inform you or your personal iepresen!at-ve of !he report, un ess Yre believe !halinforming you or your persona! repres€nlaiPJe we wlbe pladng you at risk of serkus harm.
    Heallo Oversight AcUvltles
    Nor!onville Pharmacy rr.ay disc:ose your mecf:cc.l informa on {o a hea:lh oversight ager.cy for cversighlactNllies authorized by law. Such wersight ac\N-tlies irdude
    invesli!Jations; inspecUoos; aud'ls; survi!)'s; lfcersu eand disdplir:ary acEor s: cNiL adminislralive. ardcriminalpoocedures or actions;::: rother aclivilies necessary fa
    :he government to monitor governm2nlpr rams, compliance 'Ni:h civJ rights laws. and the healll: care system in generaL The Kenlucky B<:.ard of Pharmacy and Drug
    C:u-:trol E!ra1c1 of the Kentucky Cabinet for Heal!h SeNices are examples cf sorr•e or lhe health 0'/ersighlagoocies to which wed scbse mecfiCal infmma:ion.
    Lawsuits and Similar Proceedings
    NOI'Iorwitre Pharmacy may use ar.d cisdc-se your :nedkal infonn;: tbn in re ponse to a COJI\ cr adr.Jinisb li'Je ord-ar, if you are inv:JivOO in a tawsuil or sim ar proceeding.
    Law Enforcement
    Nor:.ooville Pharma...--y may dS<::Ose yoormedicat information to a federal, stale,or mumop-allrl'N enforcement officer whose duty is to enfocce the laws of this slate Of
    Ihe Ur.iled Sletes relating to drugs and who is engaged in a c1fic investis-at on iflvolvir.-g a designaledpersoo. Speclaltzed Government Functions
    rtmwille Pflarm:;cy may dsclose your medea! rnformallon if yoo am a membeoiU.S. :lf foreign ml!nary ro•cc::(lr.c IdlnQ veTP.Ian) and 1r required tij the awrop:tate :n ar>' conJrr.afld authorities. "n addi on, we may d close your medical in ormelicn lo federa: officials rOI' i11 ig!;!{I:..::E ;aud r'atiu1<ll 'S!:'I..-,.uity advitio.o ­ authorizedby la"-11. We RErf d.scloseycur meOica\ lnfc-Hnan lo federa offic;i-als in Ofder lo pro!ect the Presrjenl, olhe.r of\K:l"1s or fore gn heads of stale,or lo cotlduel
    lnvestigal;ons.We may disclose vour r.Jetf:ca\ informalion io conec iona\ institu\i::ms or law enforcemenl{lffic'als il you ure an inmate or under the c.ustoa; of a law enforcement official. Oisclosurc for these purposes would be necessary: (i] for :he institulion to provide hcaHh r.are servtees \Q you. (n) tor lhe safely aM security or the irslilution, and/or {iii) to prated your he2.lt'i'. a dsarety cr ln.e heaiUl and safeof other iufrviduals.
    Workers' Compensation and Other GovcmmcntAgontlus
    NorlorNiYe Phalmacy may (fis(;kJse your mc-c!linforma on to Workers' Cmj:ers.atb,nne othrJ or.w:mmen\ gor1CIIJ".i ;l1a1wiU1the responst.ilitv or prO't.•idir'(l
    medica: care for you, upon '1\"fitlen requestan au\hortzeJ rep e'3enta\No of the agency requF:s\ino l'illr.h infam1a\br..
    Treatment Altern<rttves

    f cr(OI"ll!i !! :;:.harmacy may .JSe yoor medical in ormalion [O inronr )GU of heaflh-rc\oJod l::crc[h;UIU.i sero;jccs 01 alteii'Ul.lrve lrea(ilents, lhe18pies. ro.....id3!l

    1 Cl"

    selliflgs of care lhffi may be of inleresl loyou. For e"Xample, we may con!acl you lo pra,rida refill re:ninc!ers, to -nvile you to a heaHh screening or to par1idpate In a
    program we belreve may be beneficial to yo:Jr health
    Marketing
    Nortonville Pharmacy may c:JmmiHlicalo V.'ilh you abou:a prodi.JCI or service and cnco Lage you to pJrchase or use \hal proCuc\ lY er11ice. ThEse commooications must Either take place fao::e-lo-face with you orcOOGem produ:;\s: 'JIservices of nominalila:ue. Iyou ::fo n'JI wool to rece!Ve merkeling communica:ions please contact thPdvacy Officer at the p1armacy.

    C. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
    Requesting Reslrfctions
    Yu have. tha right to requ.el a reslrk:l-oo ln Nortonville Pnarmacy's use or disc:os-Jre of your medcal informiilion for lrealmenl_.payment, or hcal\f, care operations. Additional!\•, y:IU have lhe hi ((J reql.(lS! ';hat we limit our ciscl:ist.:re or your me:::licalinf::lrmallon o irldivh::IL•als involved in your care or the payment fer your care, such as fam)'.y members and friends.We are nolreqJired to 2gr00 to your request. lfw= do agree, hcmever,we me boundby our agreerner1 excepl when <Jtt.erwise
    required by law. in emergencies, or when the information is necessary to t•eat to you. In crder to reques;a reslliclion n oor use o:- d-sdosure <J: your nedcal
    information, you must mal:e your request ill writ ng to ti"e Pri'Jacy Officer a\1\brtooiJ'ile Pharmacy_ Your request must :f cribe in a <:lear and concise (ashbr: 0) the
    in:ormalion you wish eslricled, { )whether you are reqLeslin-J to limit our p-actCe's-use, cisdc•su•e or both;a1d (iii) o whom yol. wan:tile fimils to apply. Confidenllal Communications
    Yoo have U1e righllo request that Nort<Y.MIIe Pharrnacy commu:Jlcale Wl\h you Ebout your heall':l and related issues 1n a parU ;ular nanner, orate certain location. For inslaoce, you may ask that we contact you 'r1j mali, ather than 'r1f telephooe, or at home, ralher than work:_ In order lo req.resl a }Pe cJ c.polidenliel
    communication, ycu must make a wriUen request to the Priva:y Officer alNorlollvi!Je Pharmacy specifying the reqJesled f,le\hOO of ccntacor tne l«ation where y::Ju
    wish to be coolacled. OIJI' ::. ,armacywill aa:ommodale reasonab'e requests. You da nolneed to give a reaso.1for yoor requesl.
    hwpoclion and Copies
    You have lhe right lo inspect a•d obtain a Co)f:Y f l'le informEi:tior that Nortonv le Ph<:rmacy may use 1o make de:isrons aboJI ycur care, indudng piescrip!i<Jn
    records anc biDing records. You mJs1 sul:mit yaur request in writing to the PrivacoJ Offcer at Nortcnvi!le Pha•rracy •n order tc inspect and/or cbtain a ::opy of your records. We may charge .a fee for he costs c;fcopying, ma fire, tabor and supplies associated with y(1Jr refllle l. o.A'e may deny your r es:lo inspect and/or copy in
    certain timiled circumstances. Yoo may, l".o.vever, request a review of our deniaJ.The review of aur denial v1i!\ be ;:ondu :!edby another licensed heallh care professional chcsen by L!s,but not by the person that origiraldenied your reque-st
    Amendment
    Yoo may ask Nortowille Fharrr.acy to amend your .11edica1 informalion ifyoo believe;\ is incorreGl or incomplete. You may request an amet c'menl ror as long as !he
    inform.stior is kepi by or for our pharmacy. To req. es:an amendme.'ll, y::.ur requC!3l mu;lbe. made in writing and st.hmitted to the Pfivao;O: cer at Nortonvrlle Pharmac'f. You 11uslprm1de us with a reason hat sup::xxls your req_ est for arr.sndnerl. We Villi deny your request if you faU !o subnityour Je:)l:est (and lle rea5on suppor1ing yoJr rei1Jesl) in writing. Also, we may d2ny vcur request {you ask us to mend hformc:.tion ;hal 's aCCtJrale ard romplele; not pari of lha medeaI
    informalior kept by or for Nortonvile Pharmacr. not part of the medical inforrnE:Iion which you would be permitted to inspe:land copy;or not created by 1\'ortorw/le
    Pharmacy. unless le individual or entity lhat created the ir,fo•rr.ation is not ava Eible lo arr.end the in ormation
    Accounting of Disclosures
    You have the right to request an accoonUng or dsclosures. An aro::ur.ting of disdosures is a lis; of certain dl3clos.ures Nvr!on•Ji\le PharmaC}' has made of your
    medical inrormation_ to order to obtain an accounting of disclosures, you must submit your retfJest in writing to the Privacy Officer at Nortonville Pharmacy. An
    req. ests for an E:o::ounllng of Otsdcsures r.1us1 stale a time perbd that m.:.y ne-t be lor.ger lha1six years and may not irctde dates befoce Apul14, 2003. The r ret
    reqJest within a 12-rnonll". peli:xi is free of charge, bul we may ctmrgB you for addlional req. ests within the same 12-monUl pe;iod. We w U notify you of the costs
    irr.rclved with additional requests, and ycu nay wiUida'l'l'P-lr request befora )'OU iocur any casts
    Righi to a Paper Copy of This Notice
    You are entitled 1o receive a paper rx:filYOf ouoolice of p1iva-:::y practices.l'ou may ask us to gi'Je you accpy oflhis notice at any firne. To oblain a poper copy oflhis noli. contact the Pcivacy Offat Nortonville Phalmaq_
    Right to File a Complaint
    If you believe your privac'j rights have been violated, 'JOJ may file a corrplainlwith Norlcn'vi1JB Pharmacy m wh the Secretary of \he Department of Health and
    H man Ser•.-icas, Hubert H. Hum;= hre-_.,- Bl:itdi'ly, 200 lndqlendence Avenue SW, Washington, DC 20201 To ii1e a tx mplaht wilh our OJganizalion, contact the
    P1ivecy Of :er at Norton!Jille Pharmacy. A!l com aints must be submi:le:f in writing_ You YJill notbo peoa zed for rlir.g a complainl
    Right to Provide an Auihorlzatlon for 0\herUs:es and Disdosuros
    Nor!cnville : harmacy wl or must cbtairr a Wiillen aulhor_zatkn for uses o: cisclosue nG! identir ec bj ihis notice or not parmilled by appl.cable law. "ou have the righ;lo revoke any autllorizalion you provide to us re;ar:Jing lhe use and disclosure cf your medK:al inrormation at any lime. Your revoca on must be in w:iting. Upon
    receipt or your written Tevccallcn, we wit!no !ooger use or disclose yoor mediCC!I information ror lhe reasoos describeC in the authcc'fzation_ Of course, \\'E! are unab!e
    to take batt. 811Y dsdosures we have alraad{ made with your permission.Flease aso note that we are requrEd to relain records ofyo-Jr ca;e_
    D. CONTACT INFORMATION
    You may contact Privacy Officer for Nortonville Pharmacy at:
    Adam Coffman
    Nortonville Pharmacy
    270-676-8260
    E. EFFECTIVE DATE
    This Notice is Effective April 14, 2003.
       
       
       
       
       

    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

    102 Greenville Road
    Nortonville, KY, 42442
    (270) 676-8268

    Get Directions

    Pharmacy Hours

    Mon - Fri: 9:00am - 5:00pm;Sat-Sun: Closed;

    Store Hours

    Mon - Fri: 9:00am - 5:00pm;Sat-Sun: Closed;
     
     
     
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      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.