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HIPAA Notice of Privacy Practice
ADAIRDRUQ
HIPAA NOTICE OF PRIVACY PRACTICE$

THIS NOTICI DltCIIBit HOW MIDICAL INPOIMAIION ABOUT YOU MAY 81 USID AND DISCLOSID AND HOW YOU CAN Gil ACCIJJ TO IHit INPOIMAIION. PLIAJI IIVIIW II CAIIPULLY.

A. OUR COMMITMINT TO YOUR PRIVACY
Aolodr lh-111II oleolk•eol I• 11111hdodnlnt lh• p""'"IJI •l11•11• Meoll..llnl•...,...... In ••nol11dlnt •11• lt11tln•11, -...UI ......-•r41
rqarolln1 pu anol lh•lr..tl111ent ••ol t•rul••• - p...,.ol•l•11••• lhtlt '"•'"'••• ••• .........11• H_.,-... law
I• modnlodn lh• confldtllllnlftp of 11011r m..Ucnllnlor alton, to Provide 11011 with tht111.atct of 011r tqat ......., and prtvacp pracllat

oenctl'lllnl 11•11• ..,.....,.Int..........,, ••"tt t•ll•w th• to""t ot •11• 11ollco of p""'"IJI pradl1•1 In ofhd .. lholhllo. I• 111111111....., lhlt llolkt pMiiloltl ptu ""'h tho loflowln1 ln...ttanl lnt....,atlono how ... onap lilt anol olltiiOI* "*"' oneolllnllnl•-atl••• ••••
pl'lvaiJirlthtlln 11011r mMicel lnfol'lllatlon, and our oltolltatlonl concemlnt tho "'' and dllclot..,. of 11011r m..Ucallnfonnatlon. CHANOE! TO THI! NOTICE: tM tllrml of th" I'Wtlctl apply to all I'«<rdl t:tmtalnlntl JI<'Uf' mtldlcallnfcrmatk:m that C/lfl <1'0<¥t«<"' l'lta/f7fld 1/jJ Adair Drug. WI """""'th<l r/ghf.lo """""- <hr:mrlo, or,.,.;our notk•of pr/oJQ(;y proal=. Anv ""'""'" or am1mdm.ntlo lhli not/co will b<o off«ttv.for all of IMinflmm:ttk:m that ""'h<MI about ,you.. m well m any of your fTH!I(:'il(:(l/lrtlormatkm that ws mtlJItrtJ('Jf(t or malrtttJiff Iff thillutU!tl. Ws will prut o t:apy of out rurtJtnt tJtJtkti 111 oor phatmat':y lrt a p"'mlnfmt ica1tkm. You may""'""'t" """V of aur m<nt c;urront nat/co durlw anv visit Ia tho phr;rrma(v.

•• HOW WI MAY U.l AND DIICLOSI YOUR MIDICAL INPORMATION
Tho toll•wlnt par-epht oloec.U.. tho .utforont -•- map 1110 Bllol ollecl•to 11•11• Mooltc•l lntoro•••••• JIOI.. t• 11olo that ...h
,...,,..,.,""or dltcl•turo It not .......INlow. Ho-r, tht diHtrtnt -• we .,."""lttM •• ""411141 dltd••• !l*llrlnkrmatlon
4et.ttlllllhlnet eelthe..e..-.,.
IRIAIMINI • Adair Drug may uoa and dlsdooo your modlcallnformatlon to trolat you. For examplo, wo may use your modlcallnfoomatlon to di1pomo promlptlon modlcatlom to you or to advl•• you of poulblo 1ldo offocl• of your medicatlom. We may dl!ciOio your modicallnformatlon to
another phormocllt acting on yo<r behalf or to a certlflod or llcen•ed he<>h care profoulonal re•pon•lblo for your care when they or we need to be
obtaining pre•crlptlom or to a pharmacy you havo contacted requo1tlng tramfor of your pre1crlption records. In the cour>u of providing treatment to
you,our pharamcy may use your name to reference your prescription• or other 1ervlce1you receive from u•. We may dlscl01e your medical Information to
another penon that you have mbod to anllt you with obtaining our uuvlccu, such as a family member, closo pononal frlenor any other penon
ldentlfled by you. We wlllllmft the Information disclosed to that which Is directly relevant to the per;on'slnvolvernent wfth your care. For example, we may disclose minimal Information to a penon that you have 1entlo our pharmacy to plcl:l up your prelcrlpllon•.

PAYIIINI • Adair Drug may UHI and dlclose your medical Information to bill and collect payment for service• and Items we have provldod to you. For example,we may contact your heah Insurer or the manager of your prescr1ptlon drug benefit to certify that you are eligible for beneflt1 or the amount of your prescription co-payment. Wa may Lne and disclose your medlc.allnformatlon to obtain payment from other people who may ba re•ponsible to pay for your heah care,1uch cu family member;. We may u1e your rnedlcallnforrnatlon to bill you directly for 1ervlce1 and ern1. Plec11e nolelhat tho lnfonnatlon on or provided wh the bill may contain Information that Identifies you and the modlcatlons you are tablna.

HilA&.hi C:A•I 0JOIU110tU • Adair Drug may use and dl1cl01e your mudieallnfonnatlon In the oporatlon of our buslne11. ThOle uses are Important to eniura that your receive qualtty cara and our pharmacy operate efficiently. For example, we may use and disclose your medical Information to evaluate the perfonnance of the pharamclsb providing treatment to you,to conduct coso-management onolysM for the 1ervlce1 we offer to our patient• and for the purpo1m of bu1lne11 planning,

RIOUIRID IY LAW • Adair Drug may u1o of disclose medical information about you when required to do 10 by applicable law.

PUILIC HIALIH ACTIYITIIt • Adair Drug may dl•dose your medlcallnforrnatlon to a public heah authory that 11 authorl ed by law to collect or receive such Information for the purpose of prll<Jel'lttng or controlling dl<ome,lnfury or dlmbllfty:preventing child abu1e or neglect:or preventing the sprec;cl of communicable diseases. We may also dlscl01e your modlcollnformatlon to a public heah authory !hot 11 authorlzod by law to collect or receive Information about the qual y.mfety, or effectlvenen of prescription and nonpre•crlptlon modlcotlom and modlcal dovlcm.

AIU.I, NIOLICT, AND DOMitiiC VIOLINCI • Adair Drug may dlsclo•• your modlcallnformatlon to a government authorky that II authorilod by law to receive reports of aduft victims of abuse, neglect or domestic violence If we suspect you are a victim of meh obuse,neglect or dome1tl< vlolen<e. If we malooe such a dbclo•ure, we will inform yor or your pononal rcprc•cl'ltatlve of the report, unl"''we believe that by lnforrnlny;o<1 or your per;onal ropre•antallvo wt will be placing you at rlsof sarlou• harm.

HIALYH OVIR.IOHI ACTIVIIIII • Adair Drug may dl!cl01e your medlcallnforrnatlon to a heah ovenlght agency for oversight actlv IEII authorized by law. Such over;lght actlvftle• lndudo lnvo•tlgatlons;ln<pectlon•: oudfts: survays:ilcomure and disciplinary action<;civil,administrative,and criminal procedures or action<: or other actlvftles nece11ary for the government to mon or government pr(lllrams,compliance wh civil right• law;,and
the heafth care system In general. The Kentuchy Poard of Phaomacy Md Drug Control Branch of the Kentucl>y Coblnat for H..,h Sorvlcos ora ••amples
of J.Qm• ;f th• health ov n,lght ag•n(:les t:Q which we dbclo1e medical lnfurmoth;;m.

LAWIUITI AND SIMILAR PROCIIDINOI • Adolr Drug may use and dl•dose your medical Information In re pon•e to a court Qr adrnlnlltratlve order If you are Involved In a lawsuor >lmllar procHdlng.

LAW INPORCIMINI •Adair Drug may disdoso your modic<Ollnformatlon too federal, <tate. or municipal law enfot'l;emont officer who••
duty Is to enforce the laws of this state or the Un ed States relating to drugs and who 11 engaged In a <peclflc tnve•tlaatton Involving a de<lonated penon.


ADAIR DRUCi
HIPAA NOTICE OF PRIVACY PRACTICES

JPICIALIIID GOVUNMINY PUNCIIONI • Adair Drug rnadl•clo•e your medltallnformatlon If you are a member ol U.S. or foreign mll ary forciH (incudlng veteran!) and If required by the appropriate mll ary command author leo, In add lon,wo may dl elo•• your medical lnfonmatlon to federal official• for Intelligence and natlonallecury actlvftl"' authorlted by law. We may dl1clooe your modlcallnfonmatlon to fodoral officials in order to protect the Pre;ldent,other officials or foreign headlol1tato,or to conduct lnveltlgatiom. We may dllciOie your medical lnfonmatlon to corroctlonallnltftutlons or law envorcement official• If you are an Inmate or under the cu>otdy of a law enforcement official. Disclosure for the;o purpotM would be ne<:eiiCiry. for tho lnot utlon to provide heafth care service< to you,(10 for the safety ond !eCUry Of the lmt utlon, and/or 010 to protect your haolth and 1afety or the haolth and oafoty of other Individuals.

WORICIR'I COMPINIAIION AND OIHIR GOVIRNMINY ACIINCIU • Adair Drug may dloclooe our medical information to WorR&r'• Compenlallon and other govamment agencle; charged wfth the ra ponolbllftof providing medicalcare for ou, upon wr en reque;t by em authorl•ed repre entotlve of agency requmtlng •uch lrtfonmotlon.

IRIAIMINT .II.LfiRNAIIVIt • Adair Drug moy use your medicalInformation to Inform you of haalth•related benemo and servlceo or altematlve treatments. therapl..,, provldon. or setting< of care that moy bo of lnter..t to YOl!. For example, we may contact you to provide reflll remlnden, to Invite you to a heah screening or to participate In a program we believe may be beneficial to your health.

MARKUING • Adair Drug may communicate with you about a product or •ervlce and encourage you to purcha1e or use that product or
1ervlce. These comm1.1nlcatlom mu1t e her talle place face-to•face wRh vou or concem products or •ervlce; of nominal value. If you do not want to receive marlffll:lng communication• plaa1e contact the Privacy Offlcor ot the phormocy.

C. ¥0UI liGHTS IIGARDING ¥OUR MIDICAL INPOIMATION
RIOUQnNG RIIIRICYIONS • You have the right to roquiHIa rmtrlctlon In Adair Drug's ulll or dl•dmure of vour rnec:llcallnformatlon lor treatment,pgyment,or health core operatlom. Addftlonally,yau have the right to request that we llmft our di1clooure of vour medical Information to Individual! Involved In your """ or the paymont for your car1uch as famllmember1 and friends. 1/Je may deny your teautllt. If we do agree, howover, we are bound by our agreement except when otherwl•e required by law.In emergenclos, or when the lnfonmotlon 11 nec01sary to treat you. Vou must mal<e your roquMIn wr lng to thPrlvaty Officer of Adair Drug. You mu1t de erlbe In a clear and concise fmhlon; (0 the InformatiOn you wl•h restricted; (10 whether vou are requesting to limour practice'• use,dioclooure or both: and (110 to whom you want the lim• to apply.

li:ON,.DINnAL li:OMMUNICAnON• • You have the right to requwt that Adair Drug communicate with you about your haoh and related 111ues In a particular manner,or at a certain location. For Instance, you may ail• that we contact you by mall,rather than by telephone,or at home,rather than wort>. In order to reaueot a type of confidential communication. you must maR& a written rollqumllo tho Privacy Officer •Pecllylng the
raqu..ted method ol contact, or tho location where you wl1h to be contacted. We will accommodalo rea•onable reque;tl.

INU•ICYION AND COPIII • Vou have tho right to Impact and obtain a copy of the Information hot Adair Drug may use to maRe dacl•lom obout your care,Including prescription and billing record1. Vou mUit 1ubmyour reque1t In wr lng to the Privacy Officer In order to Impact and/or
obtain a copy of your records. Wo may charge a foe for the coots of copying, moiling,labor and oupplles a11oclaled wh your raqu<)1t. We may deny your

request In certain llmfted drcumotancBi. You may re<tUO!aI

raulew of our denial, which will be conducted by another llcenlod profo11lonal chosen by us.


AIIIIINDMIN'f • You may ail• Adair Drug to amend your medical information If you bellaue 11Incorrect or Incomplete. You mo;oy ""'U"'t an amendment for c::ulong as the lnformcrt:lon Is bept by or for our pharmacy. Your request must be made In wrftlng and submttted to the Privacy Officer. Your mu•t provide us wh a reason that supports your reque;t for amendment. We will deny your raque;t vou fall to submyour reque.t and the
raason s.upport.lng your raqu,ut In wrtt.lng. Wa may deny your raquest If you ast.l u1. to amend Information that 11 accurate and complete; not part of the medical Information R&pt by or for Adair Drug:not part of the medical Information which you would be perm ed to ln1pect and copy: or not created by Adair Drug,unl"'' the Individual or entfty thai craotod the Information i1 not availablo to amend tho Information.

ACCOUNTING OP DltCLOIURII • You hove the right to reque;t an accounting of dl•closure•. An accounting of dliclo•ute lla lilt of certain disclosures Adair Drug hm modo of your medlcallnfonnotlon. In order to obtain an accounting of dl•clooure;,vou mu1t 1ubmyour request In w lng to the PriVacY Officer. All reque \1 for an accounting of dliclmur"' mUllstale a lime period that may not bu longar than sl• IHI<lrl and may not lncludo dotebe/ore March 11,201!.The lint reque•t within a 12 month period Is !rile, but we may charge vou for oddltlopnal reque1t• In the •ame 12 month
period. We will notify you of the cotts Involved,and you may withdraw your reque;t before you Incur any colts.
R1QHT TO A PAPER COP'/ 01' rHI$ NOriCE: Hm <""ontttlf!l(l to """""' a pcopy""""" fl(}/bof prlv<Ky p!TKI/<es. Vou may ask "'to fllv<> you a ccpy of th/J notkl>
at <mY 1/m<t T¢ !Jbtl>/fl apap11t ccpy of thll fl(}/11:<1, <Miact tiNI Privacy Offkl>r af Adalt Drug.

R/QHT' TO FILE A COMPLAINT: If you lllillhlvtJ your prlva(J! rightlii<7A bHn vlolalod, you may fl/o a romplaint with Adair 0/'Ufll>l' with thtt S«r«aty of thtt DttparlmMI
of H«fith ,t Human .l'mv"""' Hubtrlrt H. HumPhllOJI flulldlng. MO IA""""" .rw. W<>ffllngfan. D.C. 2020t To fils a cr>mplaint with <>Uri>I'(IQI!I.tat/<m IXIIlta<:l
thtt PrJvacy 0/fl((lr. AH t:< mplr:ilntl m<JJt btl 1ubmlttod In writ/Tiff. Hm wiN not btl nallnd f<>r fmnt"romplalnt.

RICHT TO PROVIDE AN AI.ITHORIZATION FOR OTHER USE$ AND DISCLOSURES- Adair Drur1 w/H"' miRI obtain a WlittM aut/tt:JrUI:It/<>1'1 f<>r ,_"'dJM,Jo<u"" tJDt Jcflmtdltld by this nr>tl<e rx not by appli<flbltl klw, Vou fr<'wl thtt fl(lht toM'<!""!!"u<horlzatkmI"'"pwvido to th I'O(I<Jrdintl thil UN> tmd dJM,itNUJW of your fl'lld/cfll Jnlormatk»t at QII1J..I t/rrH). \o'btr l'fJCII)Ct1tlon mU'It btfl Jn wt/tfnt:J, UptmiYKIIlpt of your wrfttef1 ltm, WB WIN no /itNif1W URI INJA>UI' m«<lt:t111 /ton l"((r
tho'-""' dt>striJ»d In thtt alii-Jon. 1H1<1bls ro taktl b«k aeydJM,Jo<IJI'O!I we ii<7A a """'*' wll:hVf'l.ll' ptnm/lskJn. -- ,_1- we
- """""""to -IOI<OI'dl of JIOUI" t:a/'0.
Do CONYACI INPORMAIIONs Yow may eontact the Privacy Officer lor Adair Drug by wrRing or calling: LaO.no Stephen;Se><ton,Prlvaey
Officer,Adair Drug,510 Bumeovlll• St., Sufte1,Columbia. KY 4272& Phone: (270) 384-9999. EFFECTIVE DATE: MARCH 11,2013

About Us

WHAT IS A GOOD NEIGHBOR?
A good neighbor is someone who cares about your community, your family, and your wellbeing. That’s Adair Drug, your local Good Neighbor Pharmacy. Adair Drug has been part of the local community since 2013, serving the residents of Columbia 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
    ADAIRDRUQ
    HIPAA NOTICE OF PRIVACY PRACTICE$

    THIS NOTICI DltCIIBit HOW MIDICAL INPOIMAIION ABOUT YOU MAY 81 USID AND DISCLOSID AND HOW YOU CAN Gil ACCIJJ TO IHit INPOIMAIION. PLIAJI IIVIIW II CAIIPULLY.

    A. OUR COMMITMINT TO YOUR PRIVACY
    Aolodr lh-111II oleolk•eol I• 11111hdodnlnt lh• p""'"IJI •l11•11• Meoll..llnl•...,...... In ••nol11dlnt •11• lt11tln•11, -...UI ......-•r41
    rqarolln1 pu anol lh•lr..tl111ent ••ol t•rul••• - p...,.ol•l•11••• lhtlt '"•'"'••• ••• .........11• H_.,-... law
    I• modnlodn lh• confldtllllnlftp of 11011r m..Ucnllnlor alton, to Provide 11011 with tht111.atct of 011r tqat ......., and prtvacp pracllat

    oenctl'lllnl 11•11• ..,.....,.Int..........,, ••"tt t•ll•w th• to""t ot •11• 11ollco of p""'"IJI pradl1•1 In ofhd .. lholhllo. I• 111111111....., lhlt llolkt pMiiloltl ptu ""'h tho loflowln1 ln...ttanl lnt....,atlono how ... onap lilt anol olltiiOI* "*"' oneolllnllnl•-atl••• ••••
    pl'lvaiJirlthtlln 11011r mMicel lnfol'lllatlon, and our oltolltatlonl concemlnt tho "'' and dllclot..,. of 11011r m..Ucallnfonnatlon. CHANOE! TO THI! NOTICE: tM tllrml of th" I'Wtlctl apply to all I'«<rdl t:tmtalnlntl JI<'Uf' mtldlcallnfcrmatk:m that C/lfl <1'0<¥t«<"' l'lta/f7fld 1/jJ Adair Drug. WI """""'th<l r/ghf.lo """""- <hr:mrlo, or,.,.;our notk•of pr/oJQ(;y proal=. Anv ""'""'" or am1mdm.ntlo lhli not/co will b<o off«ttv.for all of IMinflmm:ttk:m that ""'h<MI about ,you.. m well m any of your fTH!I(:'il(:(l/lrtlormatkm that ws mtlJItrtJ('Jf(t or malrtttJiff Iff thillutU!tl. Ws will prut o t:apy of out rurtJtnt tJtJtkti 111 oor phatmat':y lrt a p"'mlnfmt ica1tkm. You may""'""'t" """V of aur m<nt c;urront nat/co durlw anv visit Ia tho phr;rrma(v.

    •• HOW WI MAY U.l AND DIICLOSI YOUR MIDICAL INPORMATION
    Tho toll•wlnt par-epht oloec.U.. tho .utforont -•- map 1110 Bllol ollecl•to 11•11• Mooltc•l lntoro•••••• JIOI.. t• 11olo that ...h
    ,...,,..,.,""or dltcl•turo It not .......INlow. Ho-r, tht diHtrtnt -• we .,."""lttM •• ""411141 dltd••• !l*llrlnkrmatlon
    4et.ttlllllhlnet eelthe..e..-.,.
    IRIAIMINI • Adair Drug may uoa and dlsdooo your modlcallnformatlon to trolat you. For examplo, wo may use your modlcallnfoomatlon to di1pomo promlptlon modlcatlom to you or to advl•• you of poulblo 1ldo offocl• of your medicatlom. We may dl!ciOio your modicallnformatlon to
    another phormocllt acting on yo<r behalf or to a certlflod or llcen•ed he<>h care profoulonal re•pon•lblo for your care when they or we need to be
    obtaining pre•crlptlom or to a pharmacy you havo contacted requo1tlng tramfor of your pre1crlption records. In the cour>u of providing treatment to
    you,our pharamcy may use your name to reference your prescription• or other 1ervlce1you receive from u•. We may dlscl01e your medical Information to
    another penon that you have mbod to anllt you with obtaining our uuvlccu, such as a family member, closo pononal frlenor any other penon
    ldentlfled by you. We wlllllmft the Information disclosed to that which Is directly relevant to the per;on'slnvolvernent wfth your care. For example, we may disclose minimal Information to a penon that you have 1entlo our pharmacy to plcl:l up your prelcrlpllon•.

    PAYIIINI • Adair Drug may UHI and dlclose your medical Information to bill and collect payment for service• and Items we have provldod to you. For example,we may contact your heah Insurer or the manager of your prescr1ptlon drug benefit to certify that you are eligible for beneflt1 or the amount of your prescription co-payment. Wa may Lne and disclose your medlc.allnformatlon to obtain payment from other people who may ba re•ponsible to pay for your heah care,1uch cu family member;. We may u1e your rnedlcallnforrnatlon to bill you directly for 1ervlce1 and ern1. Plec11e nolelhat tho lnfonnatlon on or provided wh the bill may contain Information that Identifies you and the modlcatlons you are tablna.

    HilA&.hi C:A•I 0JOIU110tU • Adair Drug may use and dl1cl01e your mudieallnfonnatlon In the oporatlon of our buslne11. ThOle uses are Important to eniura that your receive qualtty cara and our pharmacy operate efficiently. For example, we may use and disclose your medical Information to evaluate the perfonnance of the pharamclsb providing treatment to you,to conduct coso-management onolysM for the 1ervlce1 we offer to our patient• and for the purpo1m of bu1lne11 planning,

    RIOUIRID IY LAW • Adair Drug may u1o of disclose medical information about you when required to do 10 by applicable law.

    PUILIC HIALIH ACTIYITIIt • Adair Drug may dl•dose your medlcallnforrnatlon to a public heah authory that 11 authorl ed by law to collect or receive such Information for the purpose of prll<Jel'lttng or controlling dl<ome,lnfury or dlmbllfty:preventing child abu1e or neglect:or preventing the sprec;cl of communicable diseases. We may also dlscl01e your modlcollnformatlon to a public heah authory !hot 11 authorlzod by law to collect or receive Information about the qual y.mfety, or effectlvenen of prescription and nonpre•crlptlon modlcotlom and modlcal dovlcm.

    AIU.I, NIOLICT, AND DOMitiiC VIOLINCI • Adair Drug may dlsclo•• your modlcallnformatlon to a government authorky that II authorilod by law to receive reports of aduft victims of abuse, neglect or domestic violence If we suspect you are a victim of meh obuse,neglect or dome1tl< vlolen<e. If we malooe such a dbclo•ure, we will inform yor or your pononal rcprc•cl'ltatlve of the report, unl"''we believe that by lnforrnlny;o<1 or your per;onal ropre•antallvo wt will be placing you at rlsof sarlou• harm.

    HIALYH OVIR.IOHI ACTIVIIIII • Adair Drug may dl!cl01e your medlcallnforrnatlon to a heah ovenlght agency for oversight actlv IEII authorized by law. Such over;lght actlvftle• lndudo lnvo•tlgatlons;ln<pectlon•: oudfts: survays:ilcomure and disciplinary action<;civil,administrative,and criminal procedures or action<: or other actlvftles nece11ary for the government to mon or government pr(lllrams,compliance wh civil right• law;,and
    the heafth care system In general. The Kentuchy Poard of Phaomacy Md Drug Control Branch of the Kentucl>y Coblnat for H..,h Sorvlcos ora ••amples
    of J.Qm• ;f th• health ov n,lght ag•n(:les t:Q which we dbclo1e medical lnfurmoth;;m.

    LAWIUITI AND SIMILAR PROCIIDINOI • Adolr Drug may use and dl•dose your medical Information In re pon•e to a court Qr adrnlnlltratlve order If you are Involved In a lawsuor >lmllar procHdlng.

    LAW INPORCIMINI •Adair Drug may disdoso your modic<Ollnformatlon too federal, <tate. or municipal law enfot'l;emont officer who••
    duty Is to enforce the laws of this state or the Un ed States relating to drugs and who 11 engaged In a <peclflc tnve•tlaatton Involving a de<lonated penon.


    ADAIR DRUCi
    HIPAA NOTICE OF PRIVACY PRACTICES

    JPICIALIIID GOVUNMINY PUNCIIONI • Adair Drug rnadl•clo•e your medltallnformatlon If you are a member ol U.S. or foreign mll ary forciH (incudlng veteran!) and If required by the appropriate mll ary command author leo, In add lon,wo may dl elo•• your medical lnfonmatlon to federal official• for Intelligence and natlonallecury actlvftl"' authorlted by law. We may dl1clooe your modlcallnfonmatlon to fodoral officials in order to protect the Pre;ldent,other officials or foreign headlol1tato,or to conduct lnveltlgatiom. We may dllciOie your medical lnfonmatlon to corroctlonallnltftutlons or law envorcement official• If you are an Inmate or under the cu>otdy of a law enforcement official. Disclosure for the;o purpotM would be ne<:eiiCiry. for tho lnot utlon to provide heafth care service< to you,(10 for the safety ond !eCUry Of the lmt utlon, and/or 010 to protect your haolth and 1afety or the haolth and oafoty of other Individuals.

    WORICIR'I COMPINIAIION AND OIHIR GOVIRNMINY ACIINCIU • Adair Drug may dloclooe our medical information to WorR&r'• Compenlallon and other govamment agencle; charged wfth the ra ponolbllftof providing medicalcare for ou, upon wr en reque;t by em authorl•ed repre entotlve of agency requmtlng •uch lrtfonmotlon.

    IRIAIMINT .II.LfiRNAIIVIt • Adair Drug moy use your medicalInformation to Inform you of haalth•related benemo and servlceo or altematlve treatments. therapl..,, provldon. or setting< of care that moy bo of lnter..t to YOl!. For example, we may contact you to provide reflll remlnden, to Invite you to a heah screening or to participate In a program we believe may be beneficial to your health.

    MARKUING • Adair Drug may communicate with you about a product or •ervlce and encourage you to purcha1e or use that product or
    1ervlce. These comm1.1nlcatlom mu1t e her talle place face-to•face wRh vou or concem products or •ervlce; of nominal value. If you do not want to receive marlffll:lng communication• plaa1e contact the Privacy Offlcor ot the phormocy.

    C. ¥0UI liGHTS IIGARDING ¥OUR MIDICAL INPOIMATION
    RIOUQnNG RIIIRICYIONS • You have the right to roquiHIa rmtrlctlon In Adair Drug's ulll or dl•dmure of vour rnec:llcallnformatlon lor treatment,pgyment,or health core operatlom. Addftlonally,yau have the right to request that we llmft our di1clooure of vour medical Information to Individual! Involved In your """ or the paymont for your car1uch as famllmember1 and friends. 1/Je may deny your teautllt. If we do agree, howover, we are bound by our agreement except when otherwl•e required by law.In emergenclos, or when the lnfonmotlon 11 nec01sary to treat you. Vou must mal<e your roquMIn wr lng to thPrlvaty Officer of Adair Drug. You mu1t de erlbe In a clear and concise fmhlon; (0 the InformatiOn you wl•h restricted; (10 whether vou are requesting to limour practice'• use,dioclooure or both: and (110 to whom you want the lim• to apply.

    li:ON,.DINnAL li:OMMUNICAnON• • You have the right to requwt that Adair Drug communicate with you about your haoh and related 111ues In a particular manner,or at a certain location. For Instance, you may ail• that we contact you by mall,rather than by telephone,or at home,rather than wort>. In order to reaueot a type of confidential communication. you must maR& a written rollqumllo tho Privacy Officer •Pecllylng the
    raqu..ted method ol contact, or tho location where you wl1h to be contacted. We will accommodalo rea•onable reque;tl.

    INU•ICYION AND COPIII • Vou have tho right to Impact and obtain a copy of the Information hot Adair Drug may use to maRe dacl•lom obout your care,Including prescription and billing record1. Vou mUit 1ubmyour reque1t In wr lng to the Privacy Officer In order to Impact and/or
    obtain a copy of your records. Wo may charge a foe for the coots of copying, moiling,labor and oupplles a11oclaled wh your raqu<)1t. We may deny your

    request In certain llmfted drcumotancBi. You may re<tUO!aI

    raulew of our denial, which will be conducted by another llcenlod profo11lonal chosen by us.


    AIIIIINDMIN'f • You may ail• Adair Drug to amend your medical information If you bellaue 11Incorrect or Incomplete. You mo;oy ""'U"'t an amendment for c::ulong as the lnformcrt:lon Is bept by or for our pharmacy. Your request must be made In wrftlng and submttted to the Privacy Officer. Your mu•t provide us wh a reason that supports your reque;t for amendment. We will deny your raque;t vou fall to submyour reque.t and the
    raason s.upport.lng your raqu,ut In wrtt.lng. Wa may deny your raquest If you ast.l u1. to amend Information that 11 accurate and complete; not part of the medical Information R&pt by or for Adair Drug:not part of the medical Information which you would be perm ed to ln1pect and copy: or not created by Adair Drug,unl"'' the Individual or entfty thai craotod the Information i1 not availablo to amend tho Information.

    ACCOUNTING OP DltCLOIURII • You hove the right to reque;t an accounting of dl•closure•. An accounting of dliclo•ute lla lilt of certain disclosures Adair Drug hm modo of your medlcallnfonnotlon. In order to obtain an accounting of dl•clooure;,vou mu1t 1ubmyour request In w lng to the PriVacY Officer. All reque \1 for an accounting of dliclmur"' mUllstale a lime period that may not bu longar than sl• IHI<lrl and may not lncludo dotebe/ore March 11,201!.The lint reque•t within a 12 month period Is !rile, but we may charge vou for oddltlopnal reque1t• In the •ame 12 month
    period. We will notify you of the cotts Involved,and you may withdraw your reque;t before you Incur any colts.
    R1QHT TO A PAPER COP'/ 01' rHI$ NOriCE: Hm <""ontttlf!l(l to """""' a pcopy""""" fl(}/bof prlv<Ky p!TKI/<es. Vou may ask "'to fllv<> you a ccpy of th/J notkl>
    at <mY 1/m<t T¢ !Jbtl>/fl apap11t ccpy of thll fl(}/11:<1, <Miact tiNI Privacy Offkl>r af Adalt Drug.

    R/QHT' TO FILE A COMPLAINT: If you lllillhlvtJ your prlva(J! rightlii<7A bHn vlolalod, you may fl/o a romplaint with Adair 0/'Ufll>l' with thtt S«r«aty of thtt DttparlmMI
    of H«fith ,t Human .l'mv"""' Hubtrlrt H. HumPhllOJI flulldlng. MO IA""""" .rw. W<>ffllngfan. D.C. 2020t To fils a cr>mplaint with <>Uri>I'(IQI!I.tat/<m IXIIlta<:l
    thtt PrJvacy 0/fl((lr. AH t:< mplr:ilntl m<JJt btl 1ubmlttod In writ/Tiff. Hm wiN not btl nallnd f<>r fmnt"romplalnt.

    RICHT TO PROVIDE AN AI.ITHORIZATION FOR OTHER USE$ AND DISCLOSURES- Adair Drur1 w/H"' miRI obtain a WlittM aut/tt:JrUI:It/<>1'1 f<>r ,_"'dJM,Jo<u"" tJDt Jcflmtdltld by this nr>tl<e rx not by appli<flbltl klw, Vou fr<'wl thtt fl(lht toM'<!""!!"u<horlzatkmI"'"pwvido to th I'O(I<Jrdintl thil UN> tmd dJM,itNUJW of your fl'lld/cfll Jnlormatk»t at QII1J..I t/rrH). \o'btr l'fJCII)Ct1tlon mU'It btfl Jn wt/tfnt:J, UptmiYKIIlpt of your wrfttef1 ltm, WB WIN no /itNif1W URI INJA>UI' m«<lt:t111 /ton l"((r
    tho'-""' dt>striJ»d In thtt alii-Jon. 1H1<1bls ro taktl b«k aeydJM,Jo<IJI'O!I we ii<7A a """'*' wll:hVf'l.ll' ptnm/lskJn. -- ,_1- we
    - """""""to -IOI<OI'dl of JIOUI" t:a/'0.
    Do CONYACI INPORMAIIONs Yow may eontact the Privacy Officer lor Adair Drug by wrRing or calling: LaO.no Stephen;Se><ton,Prlvaey
    Officer,Adair Drug,510 Bumeovlll• St., Sufte1,Columbia. KY 4272& Phone: (270) 384-9999. EFFECTIVE DATE: MARCH 11,2013
       
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    HIPAA Notice of Privacy Practice

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

    Store Location & Directions

    510 Burkesville Street Suite 1
    Columbia, KY, 42728
    (270) 384-9999

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    Pharmacy Hours

    Mon - Fri: 8:30am - 5:30pm;Sat: Closed;Sun: Closed;

    Store Hours

    Mon - Fri: 8:30am - 5:30pm;Sat: Closed;Sun: Closed;
     
     
     
    • HIPAA
      Notice of Privacy
    • About HIPAA’s Notice of Privacy and how it protects you.

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    MEDILANE DRUG CORP NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. LEGAL DUTY We are required by federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This notice takes effect April 14, 2003 and will remain in effect until we replace it. You may request a copy of our Privacy Practice Notice at any time. For more information or additional copies of this Notice, please contact us at the telephone number listed in the Company Information section at the top of this Notice. If and when permitted by applicable law, we have the right to change our privacy practices; if we do so, we will notify you in writing of these changes. USE AND DISCLOSURES OF HEALTH INFORMATION We are permitted by law, to use and disclose health information about you for reasons concerning treatment, payment, and healthcare operations. Examples: Treatment: We may disclose your health information to a physician or healthcare provider that is providing treatment or other healthcare services to you. Payment: We may use and disclose your health information to obtain payment for services that we provide to you. Operations: We may use and disclose your health information in connection with our healthcare operations, which include administration and planning and other tasks that help us improve that quality. Family and Friends: We may disclose your health information to a family member, relative or a friend that has been identified by you while you are present. If you are not present, professional judgment will be utilized to determine whether a disclosure is required or in your best interest. We will only disclose information that is believed to be relevant to the person's involvement with your healthcare of payment related to your health care. We may also disclose your health information in order to notify such persons of your location, general condition or death. As required by law: We must disclose your health information when required to do so by law. Victims of Abuse or Neglect: We may disclose your health information to authorities if reasonable belief is that you are a possible victim of abuse, neglect or domestic violence. We may disclose information to the extent necessary to avert additional serious threat to your health or safety or the health or safety of others. Public Health Activities: We may disclose your health information to public health authorities for the purpose of preventing or controlling disease or preventing injury; to report information to a health oversight agency that is responsible for ensuring compliance with governmental rules and regulations, such as Medicare and Medicaid. National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counter intelligence, and other national security activities. Appointment Reminders: We may contact you to provide you with appointment reminders, such as voice messages; including essential information such as time, location, and the name of the company/provider. Workers' Compensation: We may use or disclose your health information to the extent necessary to comply with state laws relating to workers' compensation. Disclosures Requiring your Authorization: For any reasons other than those listed in this notice, we may only use or disclose your health information with your written authorization. You authorization must also be obtained prior to using your health information for any marketing activity. YOUR RIGHTS TO YOUR PERSONAL HEALTH INFORMATION Access to Record: You may have access to your health information, with limited exceptions. Request must be made in writing, utilizing our Records Access Request Form. We may charge a reasonable fee to compensate for time and materials. Revocation of your Authorization: You make revoke your authorization to disclose your health information at any time. Request must be made in writing, using our Authorization Revocation form. Restriction of Information: You may request that we place restrictions on our use or disclosure of your health information. You must make you request in writing by sending us a letter that specifies the type of information to be restricted and to whom the information is to be restricted from. Requests should be sent directly to the address listed in the heading of this Notice. We will consider all requests: however are not required to agree to the request. We will respond to all such requests in writing. Disclosure Accounting: You may request a list of instances in which we (or our business associates) disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003. You must make your request in writing by sending us a letter that specifies the type of information and the time period involved. Requests should be sent directly to the address listed in the heading of this Notice. If you request this information more than once in a 12-month period, we may charge you a reasonable fee to compensate for our time and materials. Alternative Communication: You may request that we communicate with you about your health information by alternative means or to an alternative location. You must make your request in writing by sending a letter that specifies the alternative means of location and provide satisfactory explanation how payments will be handled under the alternative means or location you have requested. Requests should be sent directly to the address listed in the header of this Notice. Amendment: You have the right to request that we amend your health information. You must make your request in writing by sending a letter that explains why the information should be amended. Requests should be sent directly to the address listed in the header of this Notice. We will comply to your request unless we believe that the information to be amended is accurate and complete. Right to Receive Paper Copy of this Notice: Upon request, you may obtain a paper copy of this notice. QUESTIONS OR COMPLAINTS If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we have made about a request for access to your health information, a request you have made to amend or restrict the use or disclosure of your health information or a request you have made for us to communication with your by alternative means or locations, you may complain to us using the contact information listed in the header of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to the U.S. Department of Health and Human Services upon request. If you have any questions, concerns, or complaints about this Notice, please contact us.