HIPAA Notice of Privacy Practices

Eastern States 
Compounding Pharmacy

338 Union Street
Littleton, NH  03561
(603) 444-0094

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.

All of us at Eastern States Compounding Pharmacy value your relationship with us, and we know that respect for your privacy is the foundation of that relationship.  We are committed to protecting the privacy of your protected health information (PHI) that is in our possession and only using and disclosing your PHI as necessary to proving you with health care products and services.  PHI is any information that we possess, use, and disclose that identifies you and relates to your past, current, or future physical and mental health condition or illness and the health care products and services that have been provided to you.

This “Notice of Privacy Practices” (Notice) has been created to help you understand our legal duties to protect your PHI and how we may use and disclose your PHI in relation to your past, present, and future physical or mental health condition or illness and its treatment.  We will mainly use and disclose your PHI in relation to the health care products and services that we provide you, such as dispensing your prescriptions.  Specifically, we will use and disclose your PHI as necessary to provide treatment to you, obtaining payment for health care products and services provided to you, and other health care operations and activities as described later in this Notice.  This Notice also describes the legal rights that you have related to your PHI that is in our possession.  We take the matters described in this Notice very seriously because of our relationship with you and the requirement that we comply with this Notice.

Your PHI will only be used and disclosed as described in this Notice.  Should a need for use and disclosure of your PHI occur that is not described in this Notice, we will obtain your written authorization before the use and disclosure.  At some future time, it may be necessary for us to revise this Notice.  If such becomes necessary, we will post the revised Notice in the pharmacy and, if you request, provide a written Notice to you.

Your Rights With Respect To Your PHI

  1.  You have the right to receive this written Notice of Privacy Practices describing how we will protect you PHI and your rights related to PHI at any time.
  1. You have the right to request a limitation on our use and disclosure of your PHI.  Please be aware that we may not be able to agree to your requested limitation if it results in our not being able to provide health care products and services to you or if we are required to use and disclose the PHI under federal or state law.  All requests for limitations must be submitted in writing.
  2. You have the right to review or receive photocopies of your pharmacy records, which include prescription and billing records.  We may, however, charge you’re a reasonable, cost-based fee for photocopies, together with any expenses for mailing, special courier, faxing, and supplies necessary to fulfill your request.  If we are unable to provide our records to you, we will provide you a written explanation of why we are not able to provide the records.  Depending on the reason, you may submit a written request for us to reconsider.
  3. You have the right to request that we amend you health information if it is incorrect or incomplete.  We may not be able to agree to your requested change if we no longer have the records or if the requested change would cause your PHI to become inaccurate.  If we are unable to agree to your requested change, we will notify you in writing.  You will then have the right to submit to us a written statement of disagreement, to which we may elect to further respond in writing to you.
  4. You have the right to request that we communicate with you about your PHI in a confidential manner and only to locations (such as a post office box) or by means (such as personal cellular telephone) specified by you.  All requests for confidential communications must be submitted in writing.
  5. You have the right to obtain an accounting of some of our disclosures of your PHI made after April 14, 2003.  This is a list of the disclosures made of your health information, other than for treatment, payment or health care operations, and other exceptions allowed by law.  Your request must specify a time period, which may not be longer than six years, and may not include dates before April 14, 2003.
  6. You have the right to file a complaint if you believe that we have violated your rights as described above, and to not fear retaliation or adverse action by us against you for exercising your right.  You can file the complaint with us directly, or with the United States Department of Health and Human Services (HHS).  Please be assured that we will work with you to resolve any complaint, including providing you with the address for filing a complaint with HHS.

    

IF YOU HAVE QUESTIONS ABOUT ANY OF YOUR RIGHTS AS DESCRIBED ABOVE, PLEASE CONTACT OUR
PHARMACY PRIVACY OFFICER AT THE ADDRESS OR TELEPHONE NUMBER OF OUR PHARMACY.

 

Ways That We May Use and Disclose Your PHI

  1. Treatment.  We have the right to use your PHI to dispense prescriptions to you.  We may disclose your PHI to all persons who are involved in dispensing your prescription including treating physicians, pharmacists, and other healthcare professionals.
  2. Payment.  We have the right to use and disclose your PHI so that your pharmacy services may be billed to, and payment collected from you, your insurance company, or a third party.
  3. Health Care Operations.  We have the right to use and disclose your PHI for pharmacy operations including activities that are necessary to run the Pharmacy and make sure you receive quality customer service.
  4. Prescription Refill Reminders and Health-Related Products and Services.  We have the right to use or disclose your PHI for prescription refill reminders, to tell you about health-related products or services, or to recommend possible treatment alternatives.
  5. Individuals Involved in Your Care or Payment for Your Care.  We have the right to use or disclose your PHI to a family member or friend who is involved in your medical care or payment for your care, provided you agree to this disclosure, or we give you an opportunity to object to the disclosure.  If you should be unavailable or unable to object, we have the right to use our best judgment to decide whether this disclosure is in your best interest.
  6. As Required by Law.  We will disclose your PHI when required by federal, state, or local law to do so.
  7. To Avert a Serious Threat to Health or Safety.  We have the right to use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.  However, any disclosure made would only be made to a person who is able to prevent the threat.
  8. Communications with you concerning your health and treatment.  We want to do whatever we can to assist you with maintaining your health and obtaining the most benefit from your treatment.  We routinely monitor your prescription medications for appropriateness, and take other steps to help you use your medication properly.  This may include making follow-up telephone calls by pharmacists, pharmacy interns, or other pharmacy staff members.   
  9. Public Health Risks.  We have the right to disclose your PHI for public health activities including those aimed at preventing or controlling disease, preventing injury, reporting reactions to medications or problems with products, and reporting the abuse or neglect of children, elders, and dependent adults.
  10. For Health Oversight Activities.  We have the right to disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities are necessary for the government of monitor the health care system, and include audits, investigations, inspections, and licensure.
  11. Lawsuits and Disputes.  We have the right to disclose your PHI in response to a court or administrative order if you are involved in a lawsuit or dispute.    We also have the right to disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.  This will only be done only if efforts have been made to tell you about the request (may include written notice), or to obtain an order protecting the information requested.
  12. Specialized Government Functions.  We have the right to disclose your PHI if : 1) you are a member of the armed forces, as required by military command authorities, 2) you are an inmate or in custody, to a correctional institution or law enforcement official, 3) in response to a request from law enforcement, under certain conditions, 4) for national security reasons authorized by law, and 5) the authorized federal officials to protect the President, other authorized persons, or foreign heads of state.
  13. Workers’ Compensation.  We have the right to disclose your health information for workers’ compensation or similar programs.
  14. Organ and Tissue Donation.  We have the right to disclose your PHI to organ procurement or similar organizations for purposes of donation or transplant.
  15. Coroners and Funeral Directors.  We have the right to release your PHI to a coroner or medical examiner in order, for example, to determine a person’s cause of death.  We also have the right to disclose your PHI to funeral directors consistent with applicable law in order to enable them to carry out their duties.
  16. Personal Representatives.  We have the right to disclose your PHI to a person legally authorized to act on your behalf including a parent, legal guardian, administrator or executor of your estate, or other individual authorized under applicable law.

 

Uses and Disclosures Not Contained in this Notice

If a use and disclosure of your PHI is not contained in this Notice, then we will obtain your written authorization before the use and disclosure.  You may have the right to refuse to authorize the use and disclosure, or if you grant the authorization, to revoke the authorization at any time.  If such authorization is request, we will provide you with a form that describes the proposed use and disclosure and your rights related to the request authorization.

 

Conclusion

HIPAA requires that we give you this “Notice of Privacy Practices” and make a good faith effort to obtain your written acknowledgment that you were given this Notice.  Upon giving you this Notice, you will be asked to sign a document acknowledging that you received this Notice.  We appreciate your cooperation in reviewing this Notice and in giving us your written acknowledgment.  Also, our state may from time to time enact laws that also provide you privacy and other rights in relation to your health care and your protected information.

Please consult our Pharmacy Privacy Officer if you have any questions or want more information concerning your health care and privacy rights under HIPAA or the laws of our state, or our privacy practices, or if you wish to file a complaint about our privacy practices or if you believe we have violated any of your rights as described in this Notice.

Again, thank you for allowing us the privilege of being your pharmacy, and we look forward to continuing to be of service to you.

NH Board of Pharmacy

Pharmacy License Number: 682