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HIPAA Notice of Privacy Practice
DRUG SHOPPE INC.NOTICE OF PRIVACY PRACTICES

THIS NOTICE llESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAR FULLY,

A. OUB:.(:;OMMITMEN'( IO VOUR PR.. oruey Sl10ppt;, IM, ldl!lllcated \1:111'1 lntaln tl1e prluY l'lfyour medloall fOrmaU(In, In ccndu llng our bueiMt.r., we. will cre \li M orlla ranardlng you and tht; \rMtmentand &nl'lliee& we pll)UI (l
to you. Thnt.l'l records ro out property. HQWI'Iv l. we are raqulrt!rl by law to malnt:!IIM the confidl.!nMII\y of your medlo lln!Omla on, 10 provide you with lhl$ nollce olour legili duties and priv<"ty prBctlces oi:I!'IMrnlnQ your m dlealinlormrn1rm. d
to follow t otnrmor cur nolloDl vMy practl nt.ll'l ffeotat the tmn.
to 1!!1Jnmlll'lte, tlliB no QQ provlde6 you with thr.!OIIowinlmpQrtnntlnformatlon: hQw we may use an t. IOt.tl your m rlir.;'lll fom1atlol•, yr:o11r pt'lV2cy Qhtsln your medlcallnfoli'rl tlon, and o\lr nhllgatiOI16 concnr lhthe uao ndl ioaure ofyt111r
I'Mdlcellnform tlo .

()lumgnn To Thle NotiCII• T ll rmc orthl& nollr.r. P Iy to an I'GOQrdr. eontainlnYtlllf n'ltldlonllnformaikm ra creeted or rnt lned l:•y Drun Sho e. Inc. We r¢$1'lrv!t the rlpht \Q mvl !,chan e, Or :!llt1i!!nd our noUn('l of privacy nr< r.Ato. Any rt!'lvtslon or mQI'Idm!r•lto thla no lin will be e11ecllvo !Or ;'Ill of the lnforrm'rtlon !hBI we alraa y ;'1;\/ aooutyou, <tW ll aany of V(lllr l'l'll!!dlcatlnform tltu'L ti'IBI we mEIY mr.nlv&, create, or l'rl l t&lnIn the fulull'l. We will post tt eoy olour Qllrrnl'll nctlir.r.ln our pharmoo•., il'l o prominent lo tion. You may roqul'l\ o copy of our mot.t eurrent notlco duril'l9 3ny vlalti'.ltM ph rmncv

B. HOW W!tMAY'...l!§.WRJ:!lSCLOSE Yq,UB MEDICAL I E_ORMAT!Ori•The loiiOWI!'lg paragraphs do$r.tlbt!he dlfl'ereniw11ywe may uao <ll'ld dlr:eloae yow mfl:dleallnform!\llon, Pleaae no!D \l'u'lt Mch p rtl ulr UM or dlaclo llfl'! I MIIIBted below, l owev&r the dlffl'trc'lnt ways we are PM"I'Illll!id to uae and dlt.eiOM your mediMIIMfOrm tlon do 11'!11 wllhln one oltho 1!;'1\tlgoriea.
Trentl'!'lnllt:. Dl'tlShoppo In. may use en\1 dl tot: your medloi'llil'lfOm'l311on to !r1.1;'1t you. For examplo, Wl'l may uae yovr mMieBIInlo1ma on 1<1 penpraaorlptlon me lca onr. to you or to adul$('! you of posalbli'J: r.ldt errects ofylmlmedlc tlons, We my dlr.close yourm rlle llnformat1on \1:1 ;:tttother pl19rm r.1Si11eting on your b ; :Mif or to a certlfled ar lleenf.ed lleBIIh Q fl!: llrO!eaalcnal rospo" lble for your t:!li\'1 whn they orwl'! nt!!!ed to ob!flln llr etsroy lntrm(ltiM lo provldo trt': llt1e:nt to you. For xi'I!'I'LI1I. we my r.IOM your medlo llnf01'1'1'1atlon to anothnr pharmacy whom you may be uetflng prtlt.crlptions or IQ 1'1 Mrm cy you h< vl'l: eontacted requnr.flng tranaler of y0111 rescrlptlon rooordc. In the :; urt.of providing
tm tl't1en1IO you. tlf ph rmacy may tt&tl youI Mt'l:lil tc roforoMyour prescrlp (l!'ll; t:r other eetvlclil)ll'lu M elw from 11, Wt11ay dlsclo5o your medlcBIInform;:rtlon lo another pr')r'!;Ot'r that you h<1v:t l!ld to agslst you With obtaining Cnlr aei'VIGo, r.ueh 2n a family mr.n'lber, cloae por nn lli'il!ltld, or any ()!hnr peroon ldentlfioby you. We willlimit thtllnformatlon lo od to lhalwhlllh it. direcUy retev nt10 the to the pellilll'l:'f.l volvamentwllh your care. For /:'xii1:1'1JIIl, we m. dl lose mlnlmlill,nfOI'I'Mtlon to a p@rr.cn th.:tt you M1re nlto our pharm oy \1'1 piup your proSI':rl llon .
Pft)'men\- Drug Slloppe, •no, my ur.e t nd dl clon }'0111' medk:allnloontt!iOI'I: to bill and colll'ltlp.1yment tor S!lrviM nd ltemeii'!D h vprovided to yo1.1, For o .emple, WI) rny contact your hn lth Incurer or !lm m n3 er olyour pre ptlon dp1g
beneflt to !> rtlfy t11at you ro ollglblfor beneflor tn : mount of your l'f'Jt.crlpOon co-p9yn'll'!nl. we my uao nd dleeloee ycUI mMie llnformatlon 1(1: obtllin payment from 0111er peop1!1 whit moy be reapoMible to pay /Qr YJ'J11r heAIIh care,
such f. fllmlly m•Jmbort., We may use your T'll dleRiinlormflilon to bill you dlreclly for e:rvices end ltom. Ple3ee note lhi:1l t.hrt i Form tlon on !'II' rovwed wllh tho h)lt may cont ln II'II'Ormatlon th!lt ldr:mtlfl&you nd thmedlc uons yo11 tl'!
takinn,
He lth C to Operationa. Pr11g Shoppe, Inc. m<y uf.e ond dlaclos(l ynllr medlcallnformi!HOnln 111e operaticof our business, ThMt!! Uii!!B era lmnortM\to ensure tht yOIJ mcalve quality r.:m and our pho/ll'l"''':J.CY operates ('!fllelenuy. For o ;,rnple, we
may use and 1:1oe your med1Qs:'illnforma11on to evtt1t1 11': me perl'orm nnn ofttte phermacls!s tetllldlntreetl'l'lQnt to )lilu. to !:onduct Mt.t.msna emant Miyses for the Sl')nlwe ofl'er ltJ \'lllr p: tients Rnd fl)r te purposes ¢f bu lneaa
piMnl .
AddltlMalWeys WI! IVIy U!e:IDIBcto•IJ Yo1.1Motlleallntorrnntlon: In addition to tM w yiden flod ;'lhetv. Drug ShoppQ, l e. will •iSeldlaOIO tl your medlcalln !'l'l'lnlton es follow ;
Requ!rnd by l!IW•Orug Shoppe, Inc. m<rt ur.Ot' disclose mij lr.;!lllnformatlon bOIJt you w11en requlrerlto do too 1Jf appll ill1ltl \;WJ,
f'ubllr. Hn lth AtUvltleu- Owg Shoppe, Inc. may di O:)lilur medlr.< ll fOrmatlon toe Pll l\r. Mn1111 authority 1M\\.3Utho•1Zed by lt1W to collector teQ<l\lll'l uc111n!ormallrfor the purpoam Qf pr!ventlnll crcWiii'OIIIng dlae< oo, ln]IJ!Y or dl& bll•ty; provnntlng child abusor teet: or praviJnl\ng pread olcol'\11'r11Jnlcsble dtaeeetJ, Wn mey else diMI•)i4tl your medlcallnflii'I'Mtlon topubllr. M llllaud1orlty th<i.\ it. outllOrlliJd hy II'IIIJ to collector met!lve lnlorma11\'ln
:tboul 1e quality, ty. or enectlvmnCJr..of rescrlpUon end Mn.pre c!lpUon m o uonaM medicnl rlr.vlees.
Abuse, N Jglntrt, Mid Domeat!r. Vloll'l:l1te Dru)l Shoppn, lnt, m2y disclose your medical lnform< (ln Inqo\Jj)tnment tMrlty that Ia m1ihorld by taw to rec lllt'l t!ports of edtll\ vl tlmof sbuas, M lect or domosllviolence lfwo r.ur.p c\
lhalY(•U arevir.tlm of euc11 a\.luae, nnglr..elor domes; vl(llnl'l. If we make IJnh dl closure, Wij willlt Form you !,-r YOtlr t:r!.OMI rapraaent:itlvt: of t\1e report, 11niMt. wbellevl!l tMt hy lnlormlno y11u or )'OUr repres nt;'lflvi!l we will
bpijlilU at risk r:of Mrlou11arm.
Ha llh Ovor9lgl1t AdtvlttM•Dru(l S ctppn, Int. mey dtaotoo your medlcellnformt flol'lto e t1ealth ovl!lrr.lgMt qe11cy lorovemlght tlvilles au!horlzl'l:d by law Stich !JVI'll'. llls lncludl!llnvr.. flgallona,• lnspttt.IIOI'I .; audita; HM'!y; licensure rrd disciplinary ;;t.IIMt.: ctvll, admlnlslriltiVO, and crlmlnl prnMdures or actlon; nloiMr !!CIIvltles nlil l'! t. ry for \ll(r govornfnMito monitor oVl:lr menlprorem. r.o111 11ence with civil fiQill. Md tho hn l!h care ayst0m In nerat. Th Mluoky Board Q/ Ph; rm ey and Druo ConttoiBranch oltho KMtU¢ky C blnet lor Hn:tllh sen11cea ro ox:tril lor eome ol!!'In htJaltlloversight ; gi'!MIto which wn clorll!l medlv llnformtttlon.
Lnw ulta aM stmUr Pr'Otaedlnge•Dr\111 Shcppe, Inc. may uao tid dl claee your m!Jt it'lfOfT11!1Uon In mt.pon .e toe COllrtor tidrillnlctratlve on.lor, If you 3re lnvolverlln tllWsult or alnllr p)'Oceedln .
l.IIW l!:nforOC!II'IOHt- Orua Shoppl'!, l c. may dlscloao y ur medlc llnlorm tiota federal, at \rl, or munlclpellaw ol'lfnrt:l!!l'l'l lntot'llcerwhon duty Is to enlorothl'l 13\ftla olthla st lt. or t11e United St;M!'!latinto drug .ntl w110 ts eng gr:d
In specll'kl "' aUon lnV()Ivlng:. di!t lgneted po!iiM.
Spor.lallzOd C;ovemment l'nl'lttlon•OruShQppc, l!'lC. may dlacloso yl)llt medlcallnlorm ll(ln If you are a membl3r of U.S. or loflllnn mll\t ry forces (lnclu<ill'lg lll!l:terana) and lfrn ulred by the t ppro rbl!! mtll\€lrll ommand au\hQrl!h;t,In addltl11n, wtlMliY disclose YQtrr ,t edl allnlorma\lon \1'1I'Ode:ral omclela for lntf!lll nce and ntlt\QI'II t.e umy actlvlllo lllllo !ed by law, Wr; fl'lllY dlsc!Gse y(IC)r medtcallnfCJrmi'rtl¢1'1 to federal offlol lt.ll'l order to pm\t'lt.!lila President, n!hor omclala or brolgho t:!!: or state, or to Mduct tnveell tiMf,we: may dlacl('l&l!l y0111medlcallnform IIM to c mectlonaiiMtttullonor IBw onf¢rr. ment officl ls lfy 11 re an lnmaiD ot under tM cus\l'ldy or a law enloroorilMt ol!lcl t. Dlt. lo ure ror thea ;pui)'IO I!!would be no nt.t.:try: (I) lor the iMI\tution to pro lde hm< lth re cervlcee to yt'•U, (II) for the safety nd Mcurlty oftha IMfl\lllion, andfur (Ill) to prolect your he<'llth nd safety or thn httaltlland
: re• of olhor lndtvldiJ3ta.
Worl\el"!I'ColnpaM!lll'llon anOt:her Govammen1 Agnnala.DShoppo, Inc, my disclose YOIJr mndi allnlorm tlr:onIWorkere' Compensl;'dloand other noVI'lr ml!l:nt aQenclea r-hnl1!d w1111 the m$ OMtblltty olprovl lg medlcat Cflro
lor Vtlll, IIP\'In Wl'lt!l!irr request by : nd uthM:zed repreaon\;!lflvt'l of the anency rn 1JMIIQ such lnlorm tlon
TrRRtmo"t Altomadv9- Prug Sho pe, Inc. mfl';tt l'l your medlcellnform llon to 1nlo1T11 you of MIII1•rolated bom.1fitt. nd •lSf\llces or llrlm tlva treetmen, thl'lrBpleB, provldort.. or el!lnt:a ol!h:!lmay lie oli il'!IMIlo you. Por examplo, wmay oont!!Clyoulc provide renll remlr'l l'..10 i"tvlte you tohMith acreenlnQ or tn r lllelpate In a prngr;'lrn we believe may tm bnneflcl lto YO\Ir hl'l lll'l.
Mnrkotlng•D 1UQ ShQppn, Int. mtty commltnlr...tn with you at!out a prll:duelor SBf\llce and nncournge you to p111'11MMor U!•that produllt or ervlce. Than ommunlca11on& mut either taka pl r.ll f:tcMc•lace with you or concern prnriiJ t
c:tr r.n•viees of nomlnl v;;l11r.. lfyeu do nCJt l!f nl to rt elve marke ng r.Ortll'r1UMICetlona plean t.Mtl!118 !!'rlvMy OtQ tllnt the PhermM)',

Q,J.Q)JR RIGHTS PEG6BDING YOUR M,®ICAL INFORM T!Ql!
1\eQuestlng n'lltrictiOMS•You ht'IVthe ght to raquoM rMt ctlon In Druo SMoppe, Inc. usa or l r.IMIJre olyour mc IMilnformatllrn lorin';ltttmenpayment ¢r hft lth care oper lll'lM. Addltlon lly, y(lull:we the rlnht tQ !'I"! Ue6t U1 twe llrnllOr.Jf dl6cloaura of yt;•1rime:dlcat lnlorm;; ll10 lndiVIdumla lnVI.llvl'tIM your care oriM p...yment for your o m, tJellaslamlly mombnlor ltlenda, Wl:lrn otrequlred to .; gMt'! urlth your roqllMllfwe do a rill:l, hoWl!lver, weei'C bllund by our a ror.merrle:(CIIpt when Qt!'IIIMie required by li'IW. Iemergencies, or wn tile lnform!ltlon lr, Mee sary to treal yqu.ln ordjr to requo$1;!! t'I!! I C11on In Otlf 11.0 or disclosure of y0111medlcallnforr'l'l tlorr, you muat m kl!: your requestIn
w !lnQ to tm P1i!1.'!C)' Oi'llcer et Dt11g $ho pInc. Plherm lly, Your r.!!quest mut dMtrlbeln e clear en oMice raahlon: (I) th\'1: InfOrmation you wlh l'!r.tMctedj (Ill wh tM you are reQuiJ ijg to limit our prMII e•s use, dla I\'I: IJI. or bath; nd
(Ill) to r!ihi!lm vo•J w nt thn limllto apply.
CoMfldantlal ComrrlUmCil.Uans•You h1wo lhn right to request th:!lt Drug S110ppe, Inc, c(lri1mllnlcate with you bcu\ your 11ea1th enml td iacuea In a Pflr1in111:1r menner, or t eafil!ln locPtlon, Fm'i lance, you m;;y K 11\a.twa oon\ t.t you by mall,
rl'lthor than by 111eptmnn, or .alhome, relhor tM worK In order to mqueM a type ofconndMti:.t eommunlea\l n, yllu mustm;1ke a wrliiM r ueat to thl!l PrlvMy Ot'ncer at Drug Shoppe, tnc. apoolfylng the requoal\'l:d l'lli!ilhod of oont r.l, or lhe
toc IJ :; II where you wlah \1:1 hll OI'II cted. Our ph nnY will accommod<l\tJ rtl oo ble reql)ij !ll, You do not need to elvn 1'1 3 on for your r(lljUOt.l
ln p t:tiOl1111'ld Coplt:"••You l1 ve t11e rlaht to IMPand obtain e CQ\'!Y of the lnrormaUon tM:d Drug S11oppe, Inc. m<i.y ur.e to make rlct.ir.iOT'It. Bbout your o rn, IM Iudlng prescription recot'llB Elnd bllllnQIMorda, YCJu mut.t ubmi!YQ\Ir r ur.r.lln wrltlne to the P•lvacy Offinnr ; .1 In order to lnspl:!r.t ;'lndlor obtetn a copy Of your recorda. Wo n;y h: rge a fee for thn co .te ol copylna, rn \1\ng. labor nd Sllrplll'l3SBOclaled with your request. WI) 1'1'1deny your mq1JOt to Inspect ; d/or
copy In certl:lltlrrllti!:d circumataooo, You m y.110wevmr, rtl IJOt.\a reltiew of 011r dnnli'll. Tile review of cur dl!!nlel will b!l CQf1•lu ld by nother llll :tn l'l:d heellh care prctfl! t.lonal chosen hy 11t., but not by thQ pa on thatorlgln lly dMied your rnqiJI'It.t.
Amondment- You 1t13Y ask Oruo Shcpp0 1 1nc. to emend your r'lledle tlnlam lbnlfyou bellee It IlnOCrffl torlncompletrJ, You n'IMrequest n T'IlMdmentlor aa long M llle tntormmlon Ikept by or lor Qllr ph rmat:y. To rQqlsnd amondmr.nt.
yo11r request must M mMe In wrttlnomr.uhmltled to the Prlv; r.y Officer at Drug Shopp, lne. f.lharmacy, Vllu mul rovldE' us with :t 1'1!3Son that &\l orlr. your requs6t f<lr ;o.mendment. Wo will d ny your roqll<tt.\II you 1 11 to hmlt your requost (;)nd tr11: reason eupparllng your request) In wiiH. Alao. we tnfiY rlY your request lfyl!u us to emend lrtlatmolion lhfltla a o ll'! Md complel; nl'l\ plltlof the me l :tiiMormatlon koPIl)y or lor rlrun Sh(l l!!, Inc.: not p rt nl
11'1medlcalln lllTI:;!IIIOn Wllioh you would bo pt!'lrmltted to lnspMt l'ld copy;or not mn ll'\d lly \)'U\1 Sho r. lrie. unteaa lhel \v)di.ml or entity !ht rMiod \he tntorm Ua!'llnot available to l'l'tl!lnd the lnlorrnnflM.
AccountlnR of Dl lor;uros-You hf!V(l \hi'! right to request MeOIJt111ng of dlaclosl!l'l'l. An sccounflng 11f dlt. lo uresla e list ofr. rt ln dlsc!oauro$ Drug Shoppe, Inc. hM l'l'll!.de of your ml!ll'll t llnformatlon, Iord&r to obt ln n ctlununof
dlr. losurea, Y\llt m11\ ubmlt your requcM In w llng to thiJ Prlv r.y omcer at Drug SMo l!l. Inc. All roQuo tt. !Or an accounUnnllf dtMioauroa m11st. l to n time period tht m:f)' not belonQI'Jftlln alyears M may notlncluo clnles before Aprll14, 2003. Tile ratro uMt within a12•monlh pi!I Od Is tree of oMrgl'l:, but we may ch rgn you for add kiMI fl'tljUenl!: wlillln thtJ 101"rt'c11'l12•month porlod. Wl!l will notify you Of the costs lnvQIV!Jd wllh addltltml fl'! ue&ts, and yov m>\y withdraw your ''O unt.t beol m )IOU lnoor My eost&.
RIRhHa a P por Oop)• of Thin Notlcj!-You are onfliiOd to I'I!!Celve a p por apy Of our notice of r v ey pt'acllcea, Yo11 r'f1Y k ua 11.• glo )11)11 copy ofthla nofl l'l :tt : ny time. To oht:tln a paper copy 11:1 thlr. ncUca, con!Mithe P vacy Offir.l'!r n!Oru
Si10ppe,lno.
!Rh\ t::llo a Compl ln••If you bt!'llleve your prlu:!lr.y right11ave bmm vlot:tted, you may fllo ;11 r.om talnt with Dn1g Shoppe, Inc. or wh lhl'l Secretery olthl!l Dtl 3rtment oiHOI;'IIth nd HumBn Sorvletlf., Hubert H. Htll'r'l hrey eull lno, 7.00 lndeponrlnMI!I Avenue SW, W !ngton, OC (.0 01, To file a complt l lwltl'l our or anllatl :;, r.ont:tetthe F'rlvacy Offl or at Dru6hQIJPI'llne.All complaint.mulbe aubmlttod ltr writln. You will !'to!be penall erllr filltlg a compl lnt.
RlgM to Provide Pn Authollution ICJrOthnr U:!16ft and O!l!clo11 1rM•Dl'ltg Sl1oppe, In. will ot must obtain tt wmtM auil1orlza\ion tOllf.e:!! or dl!clcsuronot ldentl ed by thl.notice or nGt pM'I:'llttd by BPDIIG!l"lll: 111w. You havo thl'l: rigllt to revo o any uthotlu on you provldto ure ardlnn thn a11d dlacloauro of your medlcallnform<rfto111 eny me. '(Qur t'l!!vocaiiM must bt'lll\ writing. Upon re fllt oryourwrltron rovo .111on. we will no lon er use or diMioe your mQ IMI
l formaUon for \hn l'tl3cons deacrlbcd lro thl!! SUtl!orlza\lon, Of aur e. we ero 110 hlto take beck env dlt. lo ures we hauo II'Mdy made with ynuipt!'lrmlaalon, PloMn 1110 note thai wei ttm required tP mt iM recorde Q/ yllut m

gJ;QNTACT INFC>
You may contacllhe Privacy Officer for Drug Shoppe, Inc. at Dn1g Shoppe•6439 Taylor Mill Rd. Independence. KY 41051 859-356-3121.

Effective D te This Notice Is efteclive Aprll14, 2003

About Us

GET TO KNOW YOUR NEIGHBOR.
Ft. Mitchell Drug Shoppe has been part of the local community since 1977, serving residents of Ft. Mitchell and the surrounding area. As an independently owned and operated Good Neighbor Pharmacy, we believe in providing personalized attention, along with a comfortable environment and competitive prices. We take care of our patients and our community. Let us take care of you.

    HIPAA Notice of Privacy Practice
    DRUG SHOPPE INC.NOTICE OF PRIVACY PRACTICES

    THIS NOTICE llESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
    PLEASE REVIEW IT CAR FULLY,

    A. OUB:.(:;OMMITMEN'( IO VOUR PR.. oruey Sl10ppt;, IM, ldl!lllcated \1:111'1 lntaln tl1e prluY l'lfyour medloall fOrmaU(In, In ccndu llng our bueiMt.r., we. will cre \li M orlla ranardlng you and tht; \rMtmentand &nl'lliee& we pll)UI (l
    to you. Thnt.l'l records ro out property. HQWI'Iv l. we are raqulrt!rl by law to malnt:!IIM the confidl.!nMII\y of your medlo lln!Omla on, 10 provide you with lhl$ nollce olour legili duties and priv<"ty prBctlces oi:I!'IMrnlnQ your m dlealinlormrn1rm. d
    to follow t otnrmor cur nolloDl vMy practl nt.ll'l ffeotat the tmn.
    to 1!!1Jnmlll'lte, tlliB no QQ provlde6 you with thr.!OIIowinlmpQrtnntlnformatlon: hQw we may use an t. IOt.tl your m rlir.;'lll fom1atlol•, yr:o11r pt'lV2cy Qhtsln your medlcallnfoli'rl tlon, and o\lr nhllgatiOI16 concnr lhthe uao ndl ioaure ofyt111r
    I'Mdlcellnform tlo .

    ()lumgnn To Thle NotiCII• T ll rmc orthl& nollr.r. P Iy to an I'GOQrdr. eontainlnYtlllf n'ltldlonllnformaikm ra creeted or rnt lned l:•y Drun Sho e. Inc. We r¢$1'lrv!t the rlpht \Q mvl !,chan e, Or :!llt1i!!nd our noUn('l of privacy nr< r.Ato. Any rt!'lvtslon or mQI'Idm!r•lto thla no lin will be e11ecllvo !Or ;'Ill of the lnforrm'rtlon !hBI we alraa y ;'1;\/ aooutyou, <tW ll aany of V(lllr l'l'll!!dlcatlnform tltu'L ti'IBI we mEIY mr.nlv&, create, or l'rl l t&lnIn the fulull'l. We will post tt eoy olour Qllrrnl'll nctlir.r.ln our pharmoo•., il'l o prominent lo tion. You may roqul'l\ o copy of our mot.t eurrent notlco duril'l9 3ny vlalti'.ltM ph rmncv

    B. HOW W!tMAY'...l!§.WRJ:!lSCLOSE Yq,UB MEDICAL I E_ORMAT!Ori•The loiiOWI!'lg paragraphs do$r.tlbt!he dlfl'ereniw11ywe may uao <ll'ld dlr:eloae yow mfl:dleallnform!\llon, Pleaae no!D \l'u'lt Mch p rtl ulr UM or dlaclo llfl'! I MIIIBted below, l owev&r the dlffl'trc'lnt ways we are PM"I'Illll!id to uae and dlt.eiOM your mediMIIMfOrm tlon do 11'!11 wllhln one oltho 1!;'1\tlgoriea.
    Trentl'!'lnllt:. Dl'tlShoppo In. may use en\1 dl tot: your medloi'llil'lfOm'l311on to !r1.1;'1t you. For examplo, Wl'l may uae yovr mMieBIInlo1ma on 1<1 penpraaorlptlon me lca onr. to you or to adul$('! you of posalbli'J: r.ldt errects ofylmlmedlc tlons, We my dlr.close yourm rlle llnformat1on \1:1 ;:tttother pl19rm r.1Si11eting on your b ; :Mif or to a certlfled ar lleenf.ed lleBIIh Q fl!: llrO!eaalcnal rospo" lble for your t:!li\'1 whn they orwl'! nt!!!ed to ob!flln llr etsroy lntrm(ltiM lo provldo trt': llt1e:nt to you. For xi'I!'I'LI1I. we my r.IOM your medlo llnf01'1'1'1atlon to anothnr pharmacy whom you may be uetflng prtlt.crlptions or IQ 1'1 Mrm cy you h< vl'l: eontacted requnr.flng tranaler of y0111 rescrlptlon rooordc. In the :; urt.of providing
    tm tl't1en1IO you. tlf ph rmacy may tt&tl youI Mt'l:lil tc roforoMyour prescrlp (l!'ll; t:r other eetvlclil)ll'lu M elw from 11, Wt11ay dlsclo5o your medlcBIInform;:rtlon lo another pr')r'!;Ot'r that you h<1v:t l!ld to agslst you With obtaining Cnlr aei'VIGo, r.ueh 2n a family mr.n'lber, cloae por nn lli'il!ltld, or any ()!hnr peroon ldentlfioby you. We willlimit thtllnformatlon lo od to lhalwhlllh it. direcUy retev nt10 the to the pellilll'l:'f.l volvamentwllh your care. For /:'xii1:1'1JIIl, we m. dl lose mlnlmlill,nfOI'I'Mtlon to a p@rr.cn th.:tt you M1re nlto our pharm oy \1'1 piup your proSI':rl llon .
    Pft)'men\- Drug Slloppe, •no, my ur.e t nd dl clon }'0111' medk:allnloontt!iOI'I: to bill and colll'ltlp.1yment tor S!lrviM nd ltemeii'!D h vprovided to yo1.1, For o .emple, WI) rny contact your hn lth Incurer or !lm m n3 er olyour pre ptlon dp1g
    beneflt to !> rtlfy t11at you ro ollglblfor beneflor tn : mount of your l'f'Jt.crlpOon co-p9yn'll'!nl. we my uao nd dleeloee ycUI mMie llnformatlon 1(1: obtllin payment from 0111er peop1!1 whit moy be reapoMible to pay /Qr YJ'J11r heAIIh care,
    such f. fllmlly m•Jmbort., We may use your T'll dleRiinlormflilon to bill you dlreclly for e:rvices end ltom. Ple3ee note lhi:1l t.hrt i Form tlon on !'II' rovwed wllh tho h)lt may cont ln II'II'Ormatlon th!lt ldr:mtlfl&you nd thmedlc uons yo11 tl'!
    takinn,
    He lth C to Operationa. Pr11g Shoppe, Inc. m<y uf.e ond dlaclos(l ynllr medlcallnformi!HOnln 111e operaticof our business, ThMt!! Uii!!B era lmnortM\to ensure tht yOIJ mcalve quality r.:m and our pho/ll'l"''':J.CY operates ('!fllelenuy. For o ;,rnple, we
    may use and 1:1oe your med1Qs:'illnforma11on to evtt1t1 11': me perl'orm nnn ofttte phermacls!s tetllldlntreetl'l'lQnt to )lilu. to !:onduct Mt.t.msna emant Miyses for the Sl')nlwe ofl'er ltJ \'lllr p: tients Rnd fl)r te purposes ¢f bu lneaa
    piMnl .
    AddltlMalWeys WI! IVIy U!e:IDIBcto•IJ Yo1.1Motlleallntorrnntlon: In addition to tM w yiden flod ;'lhetv. Drug ShoppQ, l e. will •iSeldlaOIO tl your medlcalln !'l'l'lnlton es follow ;
    Requ!rnd by l!IW•Orug Shoppe, Inc. m<rt ur.Ot' disclose mij lr.;!lllnformatlon bOIJt you w11en requlrerlto do too 1Jf appll ill1ltl \;WJ,
    f'ubllr. Hn lth AtUvltleu- Owg Shoppe, Inc. may di O:)lilur medlr.< ll fOrmatlon toe Pll l\r. Mn1111 authority 1M\\.3Utho•1Zed by lt1W to collector teQ<l\lll'l uc111n!ormallrfor the purpoam Qf pr!ventlnll crcWiii'OIIIng dlae< oo, ln]IJ!Y or dl& bll•ty; provnntlng child abusor teet: or praviJnl\ng pread olcol'\11'r11Jnlcsble dtaeeetJ, Wn mey else diMI•)i4tl your medlcallnflii'I'Mtlon topubllr. M llllaud1orlty th<i.\ it. outllOrlliJd hy II'IIIJ to collector met!lve lnlorma11\'ln
    :tboul 1e quality, ty. or enectlvmnCJr..of rescrlpUon end Mn.pre c!lpUon m o uonaM medicnl rlr.vlees.
    Abuse, N Jglntrt, Mid Domeat!r. Vloll'l:l1te Dru)l Shoppn, lnt, m2y disclose your medical lnform< (ln Inqo\Jj)tnment tMrlty that Ia m1ihorld by taw to rec lllt'l t!ports of edtll\ vl tlmof sbuas, M lect or domosllviolence lfwo r.ur.p c\
    lhalY(•U arevir.tlm of euc11 a\.luae, nnglr..elor domes; vl(llnl'l. If we make IJnh dl closure, Wij willlt Form you !,-r YOtlr t:r!.OMI rapraaent:itlvt: of t\1e report, 11niMt. wbellevl!l tMt hy lnlormlno y11u or )'OUr repres nt;'lflvi!l we will
    bpijlilU at risk r:of Mrlou11arm.
    Ha llh Ovor9lgl1t AdtvlttM•Dru(l S ctppn, Int. mey dtaotoo your medlcellnformt flol'lto e t1ealth ovl!lrr.lgMt qe11cy lorovemlght tlvilles au!horlzl'l:d by law Stich !JVI'll'. llls lncludl!llnvr.. flgallona,• lnspttt.IIOI'I .; audita; HM'!y; licensure rrd disciplinary ;;t.IIMt.: ctvll, admlnlslriltiVO, and crlmlnl prnMdures or actlon; nloiMr !!CIIvltles nlil l'! t. ry for \ll(r govornfnMito monitor oVl:lr menlprorem. r.o111 11ence with civil fiQill. Md tho hn l!h care ayst0m In nerat. Th Mluoky Board Q/ Ph; rm ey and Druo ConttoiBranch oltho KMtU¢ky C blnet lor Hn:tllh sen11cea ro ox:tril lor eome ol!!'In htJaltlloversight ; gi'!MIto which wn clorll!l medlv llnformtttlon.
    Lnw ulta aM stmUr Pr'Otaedlnge•Dr\111 Shcppe, Inc. may uao tid dl claee your m!Jt it'lfOfT11!1Uon In mt.pon .e toe COllrtor tidrillnlctratlve on.lor, If you 3re lnvolverlln tllWsult or alnllr p)'Oceedln .
    l.IIW l!:nforOC!II'IOHt- Orua Shoppl'!, l c. may dlscloao y ur medlc llnlorm tiota federal, at \rl, or munlclpellaw ol'lfnrt:l!!l'l'l lntot'llcerwhon duty Is to enlorothl'l 13\ftla olthla st lt. or t11e United St;M!'!latinto drug .ntl w110 ts eng gr:d
    In specll'kl "' aUon lnV()Ivlng:. di!t lgneted po!iiM.
    Spor.lallzOd C;ovemment l'nl'lttlon•OruShQppc, l!'lC. may dlacloso yl)llt medlcallnlorm ll(ln If you are a membl3r of U.S. or loflllnn mll\t ry forces (lnclu<ill'lg lll!l:terana) and lfrn ulred by the t ppro rbl!! mtll\€lrll ommand au\hQrl!h;t,In addltl11n, wtlMliY disclose YQtrr ,t edl allnlorma\lon \1'1I'Ode:ral omclela for lntf!lll nce and ntlt\QI'II t.e umy actlvlllo lllllo !ed by law, Wr; fl'lllY dlsc!Gse y(IC)r medtcallnfCJrmi'rtl¢1'1 to federal offlol lt.ll'l order to pm\t'lt.!lila President, n!hor omclala or brolgho t:!!: or state, or to Mduct tnveell tiMf,we: may dlacl('l&l!l y0111medlcallnform IIM to c mectlonaiiMtttullonor IBw onf¢rr. ment officl ls lfy 11 re an lnmaiD ot under tM cus\l'ldy or a law enloroorilMt ol!lcl t. Dlt. lo ure ror thea ;pui)'IO I!!would be no nt.t.:try: (I) lor the iMI\tution to pro lde hm< lth re cervlcee to yt'•U, (II) for the safety nd Mcurlty oftha IMfl\lllion, andfur (Ill) to prolect your he<'llth nd safety or thn httaltlland
    : re• of olhor lndtvldiJ3ta.
    Worl\el"!I'ColnpaM!lll'llon anOt:her Govammen1 Agnnala.DShoppo, Inc, my disclose YOIJr mndi allnlorm tlr:onIWorkere' Compensl;'dloand other noVI'lr ml!l:nt aQenclea r-hnl1!d w1111 the m$ OMtblltty olprovl lg medlcat Cflro
    lor Vtlll, IIP\'In Wl'lt!l!irr request by : nd uthM:zed repreaon\;!lflvt'l of the anency rn 1JMIIQ such lnlorm tlon
    TrRRtmo"t Altomadv9- Prug Sho pe, Inc. mfl';tt l'l your medlcellnform llon to 1nlo1T11 you of MIII1•rolated bom.1fitt. nd •lSf\llces or llrlm tlva treetmen, thl'lrBpleB, provldort.. or el!lnt:a ol!h:!lmay lie oli il'!IMIlo you. Por examplo, wmay oont!!Clyoulc provide renll remlr'l l'..10 i"tvlte you tohMith acreenlnQ or tn r lllelpate In a prngr;'lrn we believe may tm bnneflcl lto YO\Ir hl'l lll'l.
    Mnrkotlng•D 1UQ ShQppn, Int. mtty commltnlr...tn with you at!out a prll:duelor SBf\llce and nncournge you to p111'11MMor U!•that produllt or ervlce. Than ommunlca11on& mut either taka pl r.ll f:tcMc•lace with you or concern prnriiJ t
    c:tr r.n•viees of nomlnl v;;l11r.. lfyeu do nCJt l!f nl to rt elve marke ng r.Ortll'r1UMICetlona plean t.Mtl!118 !!'rlvMy OtQ tllnt the PhermM)',

    Q,J.Q)JR RIGHTS PEG6BDING YOUR M,®ICAL INFORM T!Ql!
    1\eQuestlng n'lltrictiOMS•You ht'IVthe ght to raquoM rMt ctlon In Druo SMoppe, Inc. usa or l r.IMIJre olyour mc IMilnformatllrn lorin';ltttmenpayment ¢r hft lth care oper lll'lM. Addltlon lly, y(lull:we the rlnht tQ !'I"! Ue6t U1 twe llrnllOr.Jf dl6cloaura of yt;•1rime:dlcat lnlorm;; ll10 lndiVIdumla lnVI.llvl'tIM your care oriM p...yment for your o m, tJellaslamlly mombnlor ltlenda, Wl:lrn otrequlred to .; gMt'! urlth your roqllMllfwe do a rill:l, hoWl!lver, weei'C bllund by our a ror.merrle:(CIIpt when Qt!'IIIMie required by li'IW. Iemergencies, or wn tile lnform!ltlon lr, Mee sary to treal yqu.ln ordjr to requo$1;!! t'I!! I C11on In Otlf 11.0 or disclosure of y0111medlcallnforr'l'l tlorr, you muat m kl!: your requestIn
    w !lnQ to tm P1i!1.'!C)' Oi'llcer et Dt11g $ho pInc. Plherm lly, Your r.!!quest mut dMtrlbeln e clear en oMice raahlon: (I) th\'1: InfOrmation you wlh l'!r.tMctedj (Ill wh tM you are reQuiJ ijg to limit our prMII e•s use, dla I\'I: IJI. or bath; nd
    (Ill) to r!ihi!lm vo•J w nt thn limllto apply.
    CoMfldantlal ComrrlUmCil.Uans•You h1wo lhn right to request th:!lt Drug S110ppe, Inc, c(lri1mllnlcate with you bcu\ your 11ea1th enml td iacuea In a Pflr1in111:1r menner, or t eafil!ln locPtlon, Fm'i lance, you m;;y K 11\a.twa oon\ t.t you by mall,
    rl'lthor than by 111eptmnn, or .alhome, relhor tM worK In order to mqueM a type ofconndMti:.t eommunlea\l n, yllu mustm;1ke a wrliiM r ueat to thl!l PrlvMy Ot'ncer at Drug Shoppe, tnc. apoolfylng the requoal\'l:d l'lli!ilhod of oont r.l, or lhe
    toc IJ :; II where you wlah \1:1 hll OI'II cted. Our ph nnY will accommod<l\tJ rtl oo ble reql)ij !ll, You do not need to elvn 1'1 3 on for your r(lljUOt.l
    ln p t:tiOl1111'ld Coplt:"••You l1 ve t11e rlaht to IMPand obtain e CQ\'!Y of the lnrormaUon tM:d Drug S11oppe, Inc. m<i.y ur.e to make rlct.ir.iOT'It. Bbout your o rn, IM Iudlng prescription recot'llB Elnd bllllnQIMorda, YCJu mut.t ubmi!YQ\Ir r ur.r.lln wrltlne to the P•lvacy Offinnr ; .1 In order to lnspl:!r.t ;'lndlor obtetn a copy Of your recorda. Wo n;y h: rge a fee for thn co .te ol copylna, rn \1\ng. labor nd Sllrplll'l3SBOclaled with your request. WI) 1'1'1deny your mq1JOt to Inspect ; d/or
    copy In certl:lltlrrllti!:d circumataooo, You m y.110wevmr, rtl IJOt.\a reltiew of 011r dnnli'll. Tile review of cur dl!!nlel will b!l CQf1•lu ld by nother llll :tn l'l:d heellh care prctfl! t.lonal chosen hy 11t., but not by thQ pa on thatorlgln lly dMied your rnqiJI'It.t.
    Amondment- You 1t13Y ask Oruo Shcpp0 1 1nc. to emend your r'lledle tlnlam lbnlfyou bellee It IlnOCrffl torlncompletrJ, You n'IMrequest n T'IlMdmentlor aa long M llle tntormmlon Ikept by or lor Qllr ph rmat:y. To rQqlsnd amondmr.nt.
    yo11r request must M mMe In wrttlnomr.uhmltled to the Prlv; r.y Officer at Drug Shopp, lne. f.lharmacy, Vllu mul rovldE' us with :t 1'1!3Son that &\l orlr. your requs6t f<lr ;o.mendment. Wo will d ny your roqll<tt.\II you 1 11 to hmlt your requost (;)nd tr11: reason eupparllng your request) In wiiH. Alao. we tnfiY rlY your request lfyl!u us to emend lrtlatmolion lhfltla a o ll'! Md complel; nl'l\ plltlof the me l :tiiMormatlon koPIl)y or lor rlrun Sh(l l!!, Inc.: not p rt nl
    11'1medlcalln lllTI:;!IIIOn Wllioh you would bo pt!'lrmltted to lnspMt l'ld copy;or not mn ll'\d lly \)'U\1 Sho r. lrie. unteaa lhel \v)di.ml or entity !ht rMiod \he tntorm Ua!'llnot available to l'l'tl!lnd the lnlorrnnflM.
    AccountlnR of Dl lor;uros-You hf!V(l \hi'! right to request MeOIJt111ng of dlaclosl!l'l'l. An sccounflng 11f dlt. lo uresla e list ofr. rt ln dlsc!oauro$ Drug Shoppe, Inc. hM l'l'll!.de of your ml!ll'll t llnformatlon, Iord&r to obt ln n ctlununof
    dlr. losurea, Y\llt m11\ ubmlt your requcM In w llng to thiJ Prlv r.y omcer at Drug SMo l!l. Inc. All roQuo tt. !Or an accounUnnllf dtMioauroa m11st. l to n time period tht m:f)' not belonQI'Jftlln alyears M may notlncluo clnles before Aprll14, 2003. Tile ratro uMt within a12•monlh pi!I Od Is tree of oMrgl'l:, but we may ch rgn you for add kiMI fl'tljUenl!: wlillln thtJ 101"rt'c11'l12•month porlod. Wl!l will notify you Of the costs lnvQIV!Jd wllh addltltml fl'! ue&ts, and yov m>\y withdraw your ''O unt.t beol m )IOU lnoor My eost&.
    RIRhHa a P por Oop)• of Thin Notlcj!-You are onfliiOd to I'I!!Celve a p por apy Of our notice of r v ey pt'acllcea, Yo11 r'f1Y k ua 11.• glo )11)11 copy ofthla nofl l'l :tt : ny time. To oht:tln a paper copy 11:1 thlr. ncUca, con!Mithe P vacy Offir.l'!r n!Oru
    Si10ppe,lno.
    !Rh\ t::llo a Compl ln••If you bt!'llleve your prlu:!lr.y right11ave bmm vlot:tted, you may fllo ;11 r.om talnt with Dn1g Shoppe, Inc. or wh lhl'l Secretery olthl!l Dtl 3rtment oiHOI;'IIth nd HumBn Sorvletlf., Hubert H. Htll'r'l hrey eull lno, 7.00 lndeponrlnMI!I Avenue SW, W !ngton, OC (.0 01, To file a complt l lwltl'l our or anllatl :;, r.ont:tetthe F'rlvacy Offl or at Dru6hQIJPI'llne.All complaint.mulbe aubmlttod ltr writln. You will !'to!be penall erllr filltlg a compl lnt.
    RlgM to Provide Pn Authollution ICJrOthnr U:!16ft and O!l!clo11 1rM•Dl'ltg Sl1oppe, In. will ot must obtain tt wmtM auil1orlza\ion tOllf.e:!! or dl!clcsuronot ldentl ed by thl.notice or nGt pM'I:'llttd by BPDIIG!l"lll: 111w. You havo thl'l: rigllt to revo o any uthotlu on you provldto ure ardlnn thn a11d dlacloauro of your medlcallnform<rfto111 eny me. '(Qur t'l!!vocaiiM must bt'lll\ writing. Upon re fllt oryourwrltron rovo .111on. we will no lon er use or diMioe your mQ IMI
    l formaUon for \hn l'tl3cons deacrlbcd lro thl!! SUtl!orlza\lon, Of aur e. we ero 110 hlto take beck env dlt. lo ures we hauo II'Mdy made with ynuipt!'lrmlaalon, PloMn 1110 note thai wei ttm required tP mt iM recorde Q/ yllut m

    gJ;QNTACT INFC>
    You may contacllhe Privacy Officer for Drug Shoppe, Inc. at Dn1g Shoppe•6439 Taylor Mill Rd. Independence. KY 41051 859-356-3121.

    Effective D te This Notice Is efteclive Aprll14, 2003
    • Immunization

      Good Neighbor Pharmacy offers a variety of vaccines to keep you healthy. Talk to your pharmacist about the immunizations you may need.

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    • Prescription Savings Club

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    • Immunizations

      Immunizations are one of the most important ways you can protect yourself and others from serious diseases and infections. The immunization-trained pharmacist at your local Good Neighbor Pharmacy can administer a wide range of immunizations and vaccines, as well as make personalized recommendations that can keep you and your family safe throughout the year.

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    HIPAA Notice of Privacy Practice

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

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    2515 Dixie Highway
    Fort Mitchell, KY, 41017
    (859) 341-2000

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    Mon - Fri: 9:00am - 9:00pm;Sat: 9:00am - 5:00pm;Sun: 11:00am - 4:00pm;

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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.