Staten Island Pharmacy NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Staten Island Pharmacy is required to maintain the privacy of your “Protected Health Information” (PHI), and to provide you with notice of our legal duties and privacy practices with respect to PHI. PHI is information about you, including basic demographic information, that may identify you and 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 about you to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. This Notice also describes your rights with respect to the PHI about you. Staten Island Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for PHI we maintain. Upon request, we will provide a 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 agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact the Privacy Officer at 718-448-5200. 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. 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 Staten Island 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. We may charge you a fee for the costs of copying, mailing or other supplies necessary to grant your request (see State Rights Section). 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. 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 a rebuttal to your statement. To receive an accounting of disclosures of PHI: You have the right to receive an accounting of 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 certain disclosures such as disclosures 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 writing to the Privacy Office. 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 the 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 methods or at alternative locations: For instance, you may request that 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 your request in writing to the Privacy Officer. 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 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. State Rights ? New York You have the following additional rights with respect to PHI under New York State law: * You or your personal representative has the right to patient information within 10 days of receiving a written request. [N.Y. Pub. Health Law § 18(2)(s), (b), and (c).] However, we may deny access if we determine that the ?requested review of the information can reasonably be expected to cause substantial and identifiable harm to the subject or others which would outweigh the qualified person?s right to access to the information,? or would have detrimental effects. [N.Y. Pub. Health Law § 18(3)(s), (b), and (d).] We may also deny access under certain circumstances when the request is made by the parent or guardian of an infant or minor. The parent or guardian may not inspect or make copies of the infant?s patient information where we determine that access by the parent or guardian would have a detrimental effect on our professional relationship with the infant, or on the care and treatment of the infant, or on the infant's relationship with his parents or guardian.? [N.Y. Pub. Health Law § 18(3)(c).] * If you have a form of cancer, New York maintains a cancer registry, with mandatory reporting requirements, for the purpose of recognizing, preventing, curing and controlling diseases. We are required to report to the state health department no later than 180 days every case of cancer. [N.Y. Pub. Health Law § 2401.] * With respect to Genetic Information, genetic test generally cannot be performed on a biological sample taken from an individual without prior written informed consent of the individual. [N.Y. Civ. R. Law § 79-1(2).] All records, findings and results of an individual's genetic test are deemed confidential and may not be disclosed without the individual?s written informed consent. * With respect to HIV/AIDS, HIV testing generally requires the written informed consent of the subject of the test. The signed consent form must include an explanation of the protections afforded confidential HIV related information, including the circumstances under which, and the persons to whom disclosure of information may be required, authorized, or permitted by law, [N.Y. Pub. Health Law § 2781(1).] If we obtain confidential HIV related information in the course of providing health or social services, or pursuant to a release, we cannot disclose such information except, as specified in the statute, to: the protected individual or his representative; any person to whom disclosure is authorized pursuant to a release; an agent or employee of a health facility or health care provider under certain circumstances; a health care provider or facility when the information is necessary to care for the individual, the individual?s child, or one of the individual's contacts; a federal, state, county, or local health officer when such disclosure is mandated by federal or state law; third-party reimbursers; insurance institutions under certain circumstances; and others. [N.Y. Pub. Health Law § 2782.] * With respect to Sexually Transmissible Diseases, information about sexually transmissible diseases reported to state and local health officials are confidential except in so far as it is necessary to carry out the purposes of state laws on controlling sexually transmissible diseases. [N.Y. Pub. Health Law § 2306.] Reports of sexually transmissible diseases may be disclosed by court order in a criminal or family court proceeding as specified in the statute. * With respect to Substance Abuse, we are required to report to the state commissioner of health information about narcotic drug addicts or habitual users. Such information is kept confidential and may be used only for statistical, epidemiological or research purposes. [N.Y. Pub. Health Law § 3372.] Reports that originate in the course of a criminal proceeding may not be disclosed except; pursuant to a subpoena or court order; to an agency, department or official board authorized to regulate, license or supervise a person who is authorized to deal in controlled substances; to a central registry; or to another person employed by the health department for purposes of carrying out the provisions of New York state law on controlled substances. [N.Y. Pub. Health Law §3371.] Examples of How We May Use and Disclosure PHI The following categories describe and provide examples of different ways we use and disclosures 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 responsibility. We will bill you or a 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 healthcare operations. Example: Staten Island Pharmacy may use information n your health record to monitor the performance of the pharmacist providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and services 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 payor 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 identify, PHI relevant to that persons 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 its agents, PHI relative to adverse events with respect to drugs, food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement. Worker?s compensation: We may disclose PHI about you to the extent authorized by and to the extent necessary to comply with laws relating to worker?s compensation or other 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. As required by law: We must disclose PHI about you when required to do so by law. Health oversight activities: We may disclose PHI about you to an oversight agency for activities, authorized by law. The oversight activities include audits, investigations, and inspections as necessary for the 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 a 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 or disclose PHI about you for the following purposes: Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposals and established protocols to ensure the privacy of your information. Coroners, medical examiners and funeral directors: We may disclose 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 organization: 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 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 or 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 and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority. 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 violence: We may disclose PHI about you to a government authority such as a social service or protective services 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, or 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 Staten Island Pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above (or as otherwise permitted or required by law). You may revoke this 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 Staten Island Pharmacy's privacy practices, you may contact Lawrence Yakobzon. If you believe your privacy rights have been violated, you can file a complaint with Lawrence Yakobzon?? or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. The terms of this notice apply to all records containing your identifiable health information that are created or retained by our practice. We reserve the right to revise or amend our notice of privacy practices. Any revisions or amendments to this notice will be effective for all of your records we may create or maintain in the future. Our organization will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice during any office visit.
A good neighbor is someone who cares about your community, your family, and your wellbeing. That’s Staten Island Pharmacy, your local Good Neighbor Pharmacy. Staten Island Pharmacy has been part of the local community since 2012, serving the residents of Staten Island 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.