|
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.
Date of notice: 01/05/2006
Your privacy is very important to us. We
have created this privacy statement in order
to demonstrate our firm commitment to your
privacy. The following information is
provided so you understand our policy.
When you visit our web site no personal
information is gathered unless you provide
it to us. When you e-mail us personal
information, which may include medical,
personal information, or insurance
information, this is safeguarded under the
Privacy Guidelines under HIPAA (Health
Insurance Portability and Accountability Act
of 1996). The following is our Policy
Statement under these guidelines.
SECTION A: Uses and Disclosures of Protected
Health Information
1. Under applicable law, we are required to
protect the privacy of your individual
health information (information we refer to
in this notice as “Protected Health
Information”). We are also required to
provide you with this Notice regarding our
policies and procedures regarding your
Protected Health Information and to abide by
the terms of this notice, as it may be
updated from time to time.
We are permitted to make certain types of
uses and disclosures under applicable law
for treatment, payment, and healthcare
operations purposes. We may obtain
information to dispense prescriptions and
for the documentation of pertinent
information in your records that may assist
us in managing your medication therapy or
your overall health. For treatment purposes,
such use and disclosure will take place in
providing, coordinating, or managing
healthcare and its related services by one
or more of your providers, such as when your
pharmacist consults with your physician or a
specialist regarding your medications,
treatment or condition.
For payment purposes, such use and
disclosure will take place to obtain or
provide reimbursement for providing
pharmaceutical care services, such as when
your case is reviewed to ensure that
appropriate care was rendered. For
reimbursement purposes, your Protected
Health Information may be disclosed to one
or several intermediaries employed by your
plan sponsor including but not limited to
insurers, pharmacy or medical benefits
managers, claims administrators and computer
switching companies.
For healthcare operations purposes, such use
and disclosure will take place in a number
of ways, including for quality assessment
and improvement; provider review and
training; underwriting activities; reviews
and compliance activities; and planning,
development, management and administration.
Your information could be used, for example,
to assist in the evaluation of the quality
of care that you were provided.
We store some of your Protected Health
Information in electronic computer files,
and in written files. We backup our
electronic records periodically, and at
times keep financial records offsite, and
employ other precautions to safeguard the
integrity of your Protected Health
Information. In spite of these precautions
it is possible but unlikely that a computer
crash or other technological failure could
cause the loss of data. In addition
reasonable safeguards are employed to
protect your Protected Health Information
stored on electronic media.
We may contact you at times for information
that may be necessary to process billings on
your behalf, as well as requiring additional
healthcare information in an effort to
provide you with the service you have
requested.
We may use and disclose your Protected
Health Information, without your
authorization when we need to contact a
physician or physician’s staff and is
permitted or required to do so without
individual written authorization. We may use
and disclose your Protected Health
Information if we are contacted by another
pharmacy or medical provider who states they
have your request and consent to transfer
pharmacy or medical records to them.
From time to time we may employ the services
of business associates who may assist us in
one or more tasks and who may use, change or
create Protected Health Information.
Business associates are required to comply
with all the privacy regulations on your
behalf.
We may disclose Protected Health Information
about you without your authorization to
comply with workers compensation laws, as
required by law enforcement, legal
proceedings, public health requirements,
health oversight activities and as required
by law.
Other uses and disclosures will be made only
with your written authorization, and you may
revoke your authorization by notifying us as
described in Section B.
2. You may ask us to restrict uses and
disclosures of your Protected Health
Information to carry out treatment, payment,
or healthcare operations, or to restrict
uses and disclosures to family members,
relatives, friends, or other persons
identified by you who are involved in your
care or payment for your care. However, we
are not required to agree to your request.
3. You have the right to request the
following with respect to your Protected
Health Information: (i) inspection and
copying; (ii) amendment or correction; (iii)
an accounting of the disclosures of this
information by us (we are not required to
account to you for disclosures made for
treatment, payment, operations, disclosures
to you, disclosures to your care givers, for
notifications or as otherwise excluded by
law); and (iv) the right to receive a paper
copy of this notice upon request. We may
require you to pay for this request to cover
our costs of copying, labor and postage.
In addition, you may request, and we must
accommodate the request, if reasonable, to
receive communications of Protected Health
Information by alternative means or at
alternative locations.
4. We may use your name to reference your
prescriptions and/or pharmaceutical care
services. You may be required to sign a
signature log form to acknowledge receipt of
service, or E-mail Acknowledgement of
service, to acknowledge receipt of this
Notice and the disclosure of Protected
Health Information as outlined herein. This
information may be disclosed by us to other
persons who ask for you or your
prescriptions by name. You may restrict or
prohibit these uses and disclosures by
notifying a our representative orally or in
writing of your restriction or prohibition.
We are not required to honor those requests.
We are able to provide treatment services to
you even if you object to sign the
acknowledgment of the receipt of this Notice
or if we decide not to honor a request
regarding the information in this document.
In the event of an emergency or your
incapacity, we will do in our reasonable
judgment what is consistent with your known
preference, and what we determine to be in
your best interest. We will inform you of
any such uses or disclosures if uses and
disclosures would require your signed
authorization under such circumstances and
give you an opportunity to object as soon as
practicable.
5. We may disclose to one of your family
members, to a relative, to a close personal
friend, or to any other person identified by
you, Protected Health Information that is
directly relevant to the person’s
involvement with your care or payment
related to your care. In addition we may use
or disclose the Protected Health Information
to notify, identify, or locate a member of
your family, your personal representative,
another person responsible for care, or
certain disaster relief agencies of your
location, general condition, or death. If
you are incapacitated, there is an
emergency, or you object to this use or
disclosure, we will do in our judgment what
is in your best interest regarding such
disclosure and will disclose only the
information that is directly relevant to the
person’s involvement with your healthcare.
We will also use our judgment and experience
regarding your best interest in allowing
people to pick-up filled prescriptions, or
other similar forms of Protected Health
Information.
6. We reserve the right to change the terms
of this Notice and to make new Notice
provisions effective for all Protected
Health Information we maintain. You may
receive a copy of this Notice by contacting
us as outlined in Section B or upon the
receipt of our care services.
7. If you believe that your privacy rights
have been violated, you may complain to us
at the location described in Section B or to
the Secretary of the Department of Health
and Human Services, Hubert H. Humphrey
Building, 200 Independence Avenue SW,
Washington, DC 20201. You will not be
retaliated against for filing a complaint.
Section B: Contacting Us
To make this request please contact us in
writing at the address listed on the web
site, or e-mail us at: privacy@merlinmed.com.
|
