“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.”
Effective April 14, 2003, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires Cannon Pharmacy (CP) to maintain the privacy of your Protected Health Information (PHI). PHI is your identifying health information as it pertains to your past, present, or future physical and/or mental health condition(s) and the associated heath care services provided.
Here at CP, we have committed our practice to utilizing your health information, in complete confidence, to ensure that your pharmacy and health care needs are met. In cooperation with the new federal HIPAA regulations, CP has developed this Notice of Privacy Practices (Notice) to explain how we may use and disclose your PHI. This notice informs you of your individual right pertaining to your PHI and how this pharmacy practices and legally maintains the privacy of your PHI.
CP may disclose PHI about you provided we have your written consent, unless otherwise described in this Notice. CP’s privacy practices and Notice are subject to change as determined necessary by CP. In the event of such a change, the current revision will be posted on the pharmacy window and is also available per request. In some cases, CP may deem it necessary to utilize or disclose PHI on an individual basis which may not be addressed in this notice. In such an event, the individual will be required to fill out a special authorization form for CP’s use until the individual revokes the use of the form in writing.
The Use or Disclosure of PHI
The following describes instances wherein the pharmacy is legally permitted to use and disclose PHI. CP will use PHI for:
- Treatment. It is necessary to utilize this information we obtain from you and/or your health care provider(s) to provide, manage, or coordinate your health care. We may contact you to provide refill reminders, information about medicines or new therapeutic products, treatment alternatives, disease-state information, and other services.
- Payment. It is necessary to utilize this information to bill and collect payments for the services provided to you. PHI (including medication names) may be attached to the accompanying bill as we attempt to collect from you, a third-party payer, your insurer, the Department of Social Service, and/or etc.
- Health Care Operations. It may be necessary to utilize this information to conduct business activities. This assists efforts of improving our practice as we measure the quality of our service and the performance of our staff. It also allows us to monitor drug usage and inventory levels.
The following describes instances wherein the pharmacy may find it necessary or may be required by law to use or disclose PHI about you without your written consent. CP may disclose to:
- Individuals involved in your care giving. Using their professional judgment, health professionals such as pharmacists may disclose to a family member, other relative, close personal friend, or any other person you identify, PHI relevant to that person’s involvement in your care or care-related payment.
- Business Associates. We may disclose to business associates that assist and perform certain services or functions on behalf of CP including accounting and prescription delivery services. We require our business associates to safeguard PHI.
- Food and Drug Administration (FDA). We may disclose to the FDA, or those involved with the FDA, PHI relative to adverse events with respect to drugs, food, supplements, products, or post marketing surveillance information to enable product recalls, repairs, or replacement.
- Law Enforcement Agents. We may disclose for law enforcement purposes as required by law or in response to a subpoena or legal process; or when required to do so by law.
- Worker’s Compensation. We may disclose as authorized by and as necessary to comply with laws relating to worker’s compensation or programs established by law.
- Public Heath. We may disclose to public health to assist in preventing or controlling disease, injury, or disability.
- Disaster / Emergency Officials. We may disclose as authorized by law to a public or private entity to assist in disaster relief efforts.
- Coroners, Medical Examiners, and Funeral Directors. We may disclose to these entities consistent with the law to allow them to carry out their duties including identifying a deceased person or the cause of death.
- Specialized Government Functions. We may disclose for specialized government functions including military activities, national security, protective services, and correctional institutions and for law enforcement custodial situations.
- Organ Donation Specialists. We may disclose to organ donor organizations engaged in the procurement, banking, or trans-plantation of organs for the purpose of tissue donation or transplant.
- Research Programs. We may disclose to any research, approved by an institutional review board, provided the researcher has established a protocol to protect your PHI.
- Authorities of Abuse / Violence. We may disclose to a government authority if it is reasonably believed you are a victim of abuse, neglect, or domestic violence.
- Court or Judicial Proceeding. We may disclose in response to a court or administrative order, a subpoena, or other lawful process provided that proper documentation has been presented to CP.
- Health Oversight Agencies. We may disclose to oversight agencies for activities, authorized by law, such as audits, investigations, and inspections.
- Avert a Serious Threat to Health and Safety. We may disclose when necessary to prevent a serious threat to the health and safety of you, another person, or the public.
- Notification. We may disclose to communicate your location and general condition to a family member, personal friend, or another person responsible for your care.
- Fundraising. We may contact you for fundraising efforts.
- Other uses. CP will obtain your written authorization for all other uses and disclosures of PHI not mentioned in this notice. At any time, you may revoke an authorization in writing at which time we will stop using and disclosing from there forth.
- Incidental Disclosures. We make reasonable efforts to avoid unintended oral disclosures of your PHI. Considering the confinements of the pharmacy’s counseling area, the pharmacist will attempt to make counseling conversations private. Albeit, some customers may overhear these conversations. If your wish is for a more private counseling, please inform us so other arrangements can be made.
Your Health Information Rights
The following addresses your rights regarding your PHI. You are given the right to:
- Request a restriction on several uses and disclosures of PHI. You can request additional restrictions by filing with us the form, Request for Restriction of Uses and Disclosures. We are not required to accommodate such a request.
- Request an amendment of PHI. If you feel that the PHI the pharmacy has maintained about you is incorrect or incomplete, you can request it to be changed by filing with us the form, Request for Amendment to PHI. Be sure to include a reason that supports your request. If we should happen to deny your request, you have the right to file a statement of disagreement. This denial will be further reviewed by a designated third party or as recommended by the Secretary of the U.S. Department of Health and Human Services.
- Inspect and obtain a copy of your PHI. You have the right to access and obtain a copy of your PHI contained in the pharmacy, for as long as the pharmacy maintains your PHI, by filing with us the form, Request for Access to Records. We may deny this request, but you have the right to further review. CP may charge a clerical processing fee.
- Request communications of PHI by alternative means or locations. You have the right to request that we communicate confidentially with you using an address of phone number other than that of your residence. However, state and federal laws require the pharmacy to have an accurate address and phone number in the event of an emergency. You can request this communication arrangement by filing with us the form, Request for Alternative Arrangements. We will accommodate all reasonable requests. In the case of an emergency, we will contact you as we find it necessary.
- Receive an accounting of disclosures of PHI. You have the right to receive an accounting of certain disclosures we have made of your PHI on or after April 14, 2003. You can request this accounting by filing with us the form, Request for Accounting of Disclosures. Certain uses and disclosures will be excluded including those made for treatments, payments, or health care operation purposes, those made directly to you or the people who are involved in your care, or those extending beyond six years. We will notify you if we find it necessary to charge a fee for this service at which time your request may be modified.
- Obtain additional paper copies of this Notice. You may request additional copies of this Notice by contacting us, even if you initially agreed to receive the Notice electronically. Copies are available for pick up at the pharmacy during regular business hours; or they can be mailed to you.
CP reserves the right to revise or change this Notice at any time. The revision will be applied to all PHIs received before its effective date. The revised Notice will be posted in the pharmacy and will be made available, upon request, to all individuals.
Questions or Complaints
For further information or questions regarding the Health Insurance Portability and Accounting Act of 1996, please contact us at CP. If you feel that your privacy rights have been violated, you may file a complaint with the pharmacy by contacting Brian Freeman at:
1706 S. Cannon Blvd
Kannapolis, NC 28083
If you wish to file a complaint with the Secretary of HHS, you can write a letter to the address below. By doing so, the pharmacy will not retaliate against you.
The U.S. Dept. of Health and Human Services
200 Independence Ave, S.W.
Washington, DC 2020
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