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Effective Date: April 14, 2003
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.
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Midland Pharmacy must take steps to protect the privacy of your "protected health information" hereinafter (PHI). PHI includes information that we have created or received regarding your health or payment for your health. It includes both your medical records and personal information such as your name, social security number, address, and other identifying information. Midland Pharmacy is required to maintain the privacy of your PHI, to follow the terms of this Notice, and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. Additional copies of this Notice may be obtained online at http://www.PBRx.com/Privacy.htm . To request a paper copy of this Notice, call 1-800-504-PBRx (7279)
How Midland Pharmacy May Use or Disclose Your PHI:
We protect the privacy of your health information. For some activities, we must have your written authorization to use or disclose your PHI. However, the law permits Midland Pharmacy to use or disclose your health information for the following purposes without your authorization:
· For Treatment: We may use your PHI to treat you. For example, if you are being treated for an injury, we may share your PHI with your primary physician so they can provide proper care. We may also use it to send you information about products or services that may be of interest to you.
· For Payment: We may use and disclose your PHI to collect payment for products and services. For example, we may contact your third party payor (i.e. insurer) to determine whether your program will pay for your prescription. We will bill you and/or a third party payor for the cost of the prescription dispensed to you. The information on or accompanying the bill may include your identification, as well as the prescriptions you are taking.
· For Health Care Operations: We will use and disclose PHI to carry out health care operations. For example, we may use information in your health record to monitor the quality of our Pharmacists performance, to train pharmacy personnel, or to ship prescriptions to you.
· As Required by Law: Midland Pharmacy will disclose your PHI when required to do so by local, state or federal law, including workers' compensation laws.
· Public Health and Safety Risks: We may use and disclose your PHI to an authorized public health authority or individual to (1) protect public health and safety; (2) prevent or control disease, injury, or disability; (3) report vital statistics such as births or deaths; (4) investigate or track problems with prescription drugs, foods, supplements and other health products; (5) post marketing surveillance to enable product recalls, repairs or replacements; and (6) to government entities authorized to receive reports regarding abuse, neglect, or domestic violence.
· Oversight Agencies: We may use and disclose your PHI to health oversight agencies for certain activities such as audits, investigations, inspections, and licensures.
· Legal Proceedings: We may disclose your PHI in the course of any legal proceeding in response to an order of a court or administrative agency and, in certain cases, in response to a subpoena, discovery request, or other lawful process.
· Law Enforcement To law enforcement officials in limited circumstances for law enforcement purposes. For example, disclosures may be made to identify or locate a suspect, witness, or missing person; to report a crime; or to provide information concerning victims of crimes.
· Military Activity and National Security: To the military as required by military command authorities when the patient is a member of the armed forces; to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law; and to authorized federal officials so they may provide protection to the president, other authorized persons, or foreign heads of state or conduct special investigations.
When Midland Pharmacy May Not Use or Disclose Your PHI:
Except as described in this Notice or as permitted by law, we will obtain your written authorization before using or disclosing PHI about you. You may revoke your authorization in writing at any time. You may send an email to Pharmacy@PBRx.com to revoke your authorization at any time or you may mail your revocation to: Privacy Division, Midland Pharmacy, 606 Midland Avenue, Staten Island, New York 10306. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.
You Have the Following Rights With Respect to Your Health Information:
· You have the right to request that we restrict how your PHI is used or disclosed in carrying out treatment, payment, or health care operations. We are not required to agree to the requested restrictions, but will accommodate reasonable requests. If we do agree to the requested restrictions, that agreement will be binding on us.
· You have the right to inspect and copy your PHI for as long as we maintain the health information. We may charge a reasonable fee for the costs of copying, mailing, or other supplies that are necessary to grant your request. In certain situations we may deny your request and will tell you why we are denying it. In some cases you may have the right to ask for a review of our denial.
· If you feel that the 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. You must include a reason that supports your request. In certain cases, we may deny the request. If the request for amendment is denied, you have the right to file a statement of disagreement with the decision, and we may give a rebuttal to your statement. We will include a copy of both statements in your file.
· You have the right to receive an accounting of disclosures of your PHI that we have made after April 14, 2003 for purposes other than (1) for Midland Pharmacy's treatment, payment, or health care operations, (2) to you or based upon your authorization and (3) for certain government functions. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. The time period for the requested accounting must be specified. This information will be provided free of charge.
· You have the right to request that our communications to you concerning your PHI be made by alternative means or to alternative locations. For example, you may wish us to communicate in some way other than calling your home telephone number. We will comply with a reasonable request for such an alternative.
If you would like to exercise one or more of these rights, you must send a written request to: Midland Pharmacy, 606 Midland Avenue, Staten Island, New York 10306 or by calling 1-800-504-7279. You may also send an email to Pharmacy@PBRx.com .
Changes to this Notice of Privacy Practices:
Midland Pharmacy reserves the right to change this Notice at any time. We reserve the right to apply the revised Notice to all PHI we already maintain, as well as any information we receive in the future. If we change any of the practices described in this Notice, we will post the revised Notice at http://www.PBRx.com/Privacy.htm
For More Information or to Report a Problem:
This Notice describes how we will treat your personal health information pursuant to the requirements of the Federal HIPAA privacy rules. State privacy laws may impose certain additional requirements. For a more complete description of state privacy issues, please refer to specific state privacy issues by scrolling down to locate your state. If you have questions or, would like additional information about our privacy practices, you may contact the Privacy Division by emailing Pharmacy@PBRx.com , by phone at (800)-504-7279 or by writing to: Privacy Division, Midland Pharmacy, 606 Midland Avenue, Staten Island, New York 10306. You may also opt to email a written complaint to Midland Pharmacy by emailing Pharmacy@PBRx.com . If you believe your privacy rights have been violated, you can file a complaint with Midland Pharmacy's Privacy Division or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint and Midland Pharmacy will maintain information in a manner consistent with company policies.
Midland Pharmacy
State Laws Addendum
ALABAMA We will not disclose your personal health records to anyone without your authorization, except where it is in your best interest or where the law requires the disclosure.
ARIZONA We will not disclose any confidential communicable disease related information unless the subject of that information has authorized us in writing to do so or unless state or federal law authorizes or requires the disclosure.
CALIFORNIA We may disclose your medical information as follows:
(a) to providers of health care, health care service plans, contractors or other health care professionals or facilities for purposes of diagnosis or treatment of the patient. This includes, in an emergency situation, the communication of patient information by radio transmission or other means between licensed emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and licensed emergency medical personnel at a health facility;
(b) to an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor or any other person or entity responsible for paying for health care services rendered to the patient to the extent necessary to allow responsibility for payment to be determined and payment to be made. If the patient is, by reason of a comatose or other disabling medical condition, unable to consent to the disclosure or medical information and no other arrangements have been made to pay for the health care services being rendered to the patient, the information may also be disclosed to a governmental authority to the extent necessary to determine the patient's eligibility for, and to obtain, payment under a governmental program for health care services provided to the patient. The information may also be disclosed to another provider of health care or health care service plan as necessary to assist the other provider or health care service plan in obtaining payment for health care services rendered by that provider of health care or health care service plan to the patient;
(c) to any person or entity that provides billing, claims management, medical data processing, or other administrative services for providers of health care or health care service plans or for any of the persons or entities specified above in paragraph (b). However, no information so disclosed may be further disclosed by the recipient in any way that would be violative of California laws governing the use and disclosure of medical information without authorization from the patient;
(d) to organized committees and agents of professional societies or of medical staffs of licensed hospitals, licensed health care service plans, professional standards review organizations, independent medical review organizations and their selected reviewers, utilization and quality control peer review organizations, contractor's or persons or organizations insuring, responsible for, or defending professional liability that a provider may incur, if the committees, agents, health care service plans, organizations, reviewers, contractors or persons are engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges;
(e) a provider of health care or health care service plan that has created medical information as a result of employment-related health care services to an employee conducted at the specific prior written request and expense of the employer may disclose to the employee's employer that:
i. is relevant in a law suit, arbitration, grievance, or other claim or challenge to which the employer and the employee are parties and in which the patient has placed in issue his or her medical history, mental or physical condition, or treatment, provided that information may only be used or disclosed in connection with that proceeding;
ii. describes functional limitations of the patient that may entitle the patient to leave from work for medical reasons or limit the patient's fitness to perform his or her present employment, provided that no statement of medical cause is included in the information disclosed;
(f) unless the provider of health care or health care service plan is notified in writing of an agreement by the sponsor, insurer, or administrator to the contrary, the information may be disclosed to a sponsor, insurer, or administrator of a group or individual insured or uninsured plan or policy that the patient seeks coverage by or benefits from, if the information was created by the provider of health care or health care service plan as the result of services conducted at the specific prior written request and expense of the sponsor, insurer, or administrator for the purpose of evaluating the application for coverage or benefits;
(g) to a health care service plan by providers of health care that contract with the health care service plan and may be transferred among providers of health care that contract with the health care service plan, for the purpose of administering the health care service plan. Medical information may not otherwise be disclosed by a health care service plan except in accordance with the provisions of this part;
(h) to an insurance institution, agent or support organization of medical information if the insurance institution, agent, or support organization has complied with all requirements for obtaining the information pursuant to the requirements of the California Insurance Code provisions;
(i) to an organ procurement organization or a tissue bank processing the tissue of a decedent for transplantation into the body of another person, but only with respect to the donating decedent for the purpose of aiding the transplant;
(j) to a third party for purposes of encoding, encrypting, or otherwise anonymizing data. However, no information may be further disclosed by the recipient in any way that would be unauthorized manipulation of coded or encrypted medical information that reveals individually identifiable medical information;
(k) for purposes of disease management programs and services, information may be disclosed to any entity contracting with a health care service plan or the health care service plan's contractors to monitor or administer care of enrollees for a covered benefit, provided that the disease management services and care are authorized by a treating physician or to any disease management organization that complies fully with the physician authorization requirements, provided that the health care service plan or its contractor provides or has provided a description of the disease management services to a treating physician or to the health care service plan's or contractor's network of physicians.
CONNECTICUT We will not sell your individually identifiable medical record information. We will not disclose information about pharmaceutical services rendered to you to third parties without your consent, except to the following persons:
(a) the prescribing practitioner or a pharmacist or another prescribing practitioner presently treating you when deemed medically appropriate;
(b) a nurse who is acting as an agent for a prescribing practitioner that is presently treating you or a nurse providing care to you in a hospital;
(c) third party payors who pay claims for pharmaceutical services rendered to you or who have a formal agreement or contract to audit any records or information in connection with such claims;
(d) any governmental agency with statutory authority to review or obtain such information;
(e) any individual, the state or federal government or any agency thereof or court pursuant to a subpoena; and
(f) any individual, corporation, partnership or other legal entity, which has a written agreement with the pharmacy to access the pharmacy's database, provided the information accessed is limited to data, which does not identify specific individuals.
FLORIDA We will not disclose your pharmacy records without your written authorization, except to:
(a) you;
(b) your legal representative;
(c) the Department of Health pursuant to existing law;
(d) in the event that you are incapacitated or unable to request your records, your spouse; and
(e) in any civil or criminal proceeding, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to you or your legal representative, by the party seeking the records.
GEORGIA Unless authorized by you, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities:
(a) the prescriber, or other licensed health care practitioners caring for you;
(b) another licensed pharmacist for purposes of transferring a prescription or as part of a patient's drug utilization review, or other patient counseling requirements;
(c) the Board of Pharmacy, or its representative; or
(d) any law enforcement personnel duly authorized to receive such information.
We may also disclose your confidential information without your consent pursuant to a subpoena issued and signed by an authorized government official or a court order issued and signed by a judge of an appropriate court. We will not disclose AIDS confidential information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
HAWAII We will not disclose any HIV/AIDS/ARC-related information, except in situations where the subject of the information has provided us with prior written consent allowing the release or where we are authorized or required by state or federal law to make the disclosure.
IOWA We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
IDAHO We will not release your identifiable prescription information to anyone other than you or your designee, unless requested by any of the following persons or entities:
(a) the Board of Pharmacy, or its representatives, acting in their official capacity;
(b) the practitioner, or the practitioner's designee, who issued your prescription;
(c) other licensed health care professionals who are responsible for the your care;
(d) agents of the Department of Health and Welfare when acting in their official capacity with reference to issues related to the practice of pharmacy;
(e) agents of any board whose practitioners have prescriptive authority, when the board is enforcing laws governing that practitioner;
(f) an agency of government charged with the responsibility for providing medical care for you;
(g) the federal Food and Drug Administration, for purposes relating to monitoring of adverse drug events in compliance with the requirements of federal law, rules or regulations adopted by the FDA; and
(h) the authorized insurance benefit provider or health plan that provides your health care coverage or pharmacy benefits.
INDIANA We will disclose your confidential information only when it is in your best interests, when the information is requested by the Board of Pharmacy or its representatives or by a law enforcement officer charged with the enforcement of laws pertaining to drugs or devices or the practice of pharmacy, or when disclosure is essential to our business operations.
KENTUCKY We will only use your information to provide pharmacy care. We will not disclose your patient information or the nature of professional services rendered to you without your express consent or without a court order, except to the following authorized persons:
(a) members, inspectors, or agents of the Board of Pharmacy;
(b) you, your agent, or another pharmacist acting on your behalf;
(c) another person, upon your request;
(d) licensed health care personnel who are responsible for your care;
(e) certain state government agents charged with enforcing the controlled substances laws;
(f) federal, state, or municipal government officers who are investigating a specific person regarding drug charges; and
(g) a government agency that may be providing medical care to you, upon that agency's written request for information.
MAINE We will not disclose your health care information for fundraising purposes or to coroners or funeral directors, without your authorization. We will only disclose patient identifiable communicable disease information to Department of Human Services for adult or child protection purposes or to other public health officials, agents or agencies or to officials of a school where a child is enrolled, for public health purposes. In a public health emergency, as declared by the state health officer, we may also release your information to private health care providers and agencies for the purpose of preventing further disease transmission.
MICHIGAN Unless authorized by you, we will not disclose your prescription or equivalent record on file, except to the following persons:
(a) you, or another pharmacist acting on your behalf;
(b) the authorized prescribed who issued the prescription, or a licensed health professional who is currently treating you;
(c) an agency or agent of government responsible for the enforcement of laws relating to drugs and devices; or
(d) a person authorized by a court order.
We will not disclose AIDS-related information about an individual except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
MINNESOTA We will not disclose your prescription orders or the contents thereof, except to:
(a) you, your agent, or another pharmacist acting on your behalf or your agent's behalf;
(b) the licensed practitioner who issued the prescription;
(c) the licensed practitioner who is currently treating you;
(d) a member, inspector, or investigator of the board or any federal, state, county, or municipal officer whose duty it is to enforce the laws of this state or the United States relating to drugs and who is engaged in a specific investigation involving a designated person or drug;
(e) an agency of government charged with the responsibility of providing medical care for you;
(f) an insurance carrier or attorney on receipt of written authorization signed by you or your legal representative, authorizing the release of such information; and
(g) any person duly authorized by a court order.
Unless we have obtained your oral or written consent, we will not disclose the nature of pharmaceutical services rendered to you, except as follows:
(a) pursuant to an order or direction of a court;
(b) to other pharmacies;
(c) to you; or
(d) drug therapy information to your physician.
MISSOURI Unless specifically authorized by you, we will not release your pharmacy records to anyone other than:
(a) you or any other person authorized by you to receive the information;
(b) the authorized prescriber who issued the prescription order, or a licensed health professional who is currently treating you;
(c) in response to lawful requests from a court or grand jury;
(d) a person authorized by a court order;
(e) to transfer medical or prescription information between pharmacists as provided by law; or
(f) government agencies acting within the scope of their statutory authority.
We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
MONTANA We will not disclose information concerning persons infected, or reasonably suspected to be infected with a sexually transmitted disease, except to:
(a) personnel of the Department of Public Health and Human Services;
(b) a physician who has obtained the written consent of the person whose record is requested; or
(c) a local health officer.
NEVADA We will not disclose the contents of your prescriptions or disclose any copies of your prescriptions, other than to you, except to:
(a) the practitioner who issued the prescription;
(b) the practitioner who is currently treating you;
(c) a member, inspector or investigator of the Board of Pharmacy, an inspector of the FDA, or an agent of the investigation division of the department of public safety;
(d) an agency of state government charged with the responsibility of providing medical care for you;
(e) an insurance carrier, on receipt of your written authorization or your legal guardian authorizing the release of information;
(f) any person authorized by an order of a district court;
(g) a member, inspector, or investigator of a professional licensing board that licenses the practitioner who orders the prescriptions filled at the pharmacy; and
(h) other registered pharmacists for the limited purpose of and to the extent necessary for the exchange of information regarding persons suspected of misusing prescriptions to obtain excessive amounts of drugs or failing to use a drug in conformity with the directions for its use, or taking a drug in combination with other drugs in a manner that could result in injury to that person.
We will not disclose any personal information about an individual who has, or is suspected of having, a communicable disease, without the individual's written consent, except as follows:
(a) for statistical purposes, as long as the identity of the person is not discernible from the information disclosed;
(b) in a prosecution for a violation or a proceeding for an injunction brought pursuant to the communicable disease laws;
(c) neglect of a child or elderly person;
(d) to any person who has a medical need to know the information for his own protection or for in reporting the actual or suspected abuse or the well-being of a patient or dependent person, as determined by the health authority in accordance with regulations of the state board of health;
(e) pursuant to specified statutes that require the reporting of certain test results;
(f) if the disclosure is made to the department of human resources and the person about whom the disclosure is made has been diagnosed as having AIDS or an illness related to HIV and is a recipient of or an applicant for Medicaid;
(g) to a fireman, police officer or person providing emergency medical services if the board has determined that the information relates to a communicable disease significantly related to that occupation and the information is disclosed in the manner prescribed by the state board of health; and
(h) if the disclosure is authorized or required by specific statute.
NEW HAMPSHIRE We will not use, release, or sell your identifiable medical information for the purpose of sales or marketing of services or products unless you have provided us with a written authorization permitting such activity. We will only disclose your professional records if:
(a) we have obtained your permission to do so;
(b) it is an emergency situation and it is in your best interest for us to disclose the information; or
(c) the law requires us to disclose the information.
NEW MEXICO Unless we receive a written consent from you, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities:
(a) pursuant to the order or direction of a court;
(b) to the prescriber or other licensed practitioner caring for you;
(c) to another licensed pharmacist where it is in your best interest;
(d) to the Board of Pharmacy or its representative or to such other persons or governmental agencies duly authorized by law to receive such information;
(e) to transfer a prescription to another pharmacy as required by the provisions of patient counseling;
(f) to provide a copy of a non-refillable prescription to you;
(g) to provide drug therapy information to physicians or other authorized prescribers for their patients; or
(h) as required by the provisions of the patient counseling regulations.
NEW YORK We may not give a patient a copy of a prescription for a controlled substance, and for copies of other types of prescriptions, we must indicate that the copy is for informational purposes only.
NORTH CAROLINA We will not disclose or provide a copy of your prescription orders on file, except to:
(a) you;
(b) your parent or guardian or other pers.
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