NOTICE OF PRIVACY PRACTICES - RITZMAN PHARMACIES,
INC.
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
SECTION A: Uses and Disclosures of Protected
Health Information
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 (referred to
as 'PHI') 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. For treatment purposes, such uses and disclosures
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 appropriate
care was rendered. For reimbursement purposes, your PHI may be disclosed
to one or several intermediaries employed by your plan sponsor including
but not limited to insurers, pharmacy 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; planning, development, management
and administration. Your information could be used, for example,
to assist in the evaluation of the quality of care you were provided.
In addition, we may contact you to provide refill
reminders, health screenings, wellness events, inoculations, vaccinations
or information about treatment alternatives or other health-related
benefits and services that may be of interest to you. In addition,
we may disclose your health information to your plan sponsor. In addition,
we may contact you for the purpose of fund raising activities, unless
you object.
We may use and disclose your PHI, without your authorization,
when the pharmacy needs to contact a physician or physicianís staff
and is permitted or required to do so without individual written consent
or authorization. We may use and disclose your PHI if we are contacted
by another pharmacy who states they have your request and consent to
transfer pharmacy 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 PHI. Business
associates are required to comply with all the privacy regulations on
your behalf.
We may disclose PHI 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 at
any time by notifying us as described in Section B, except to the extent
the Pharmacy has already taken action in reliance on a previously signed
authorization form.
You may ask us to restrict uses and disclosures of
your PHI 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.
You have the right to request the following with respect
to your PHI: (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) receipt
of a paper copy of this notice upon request. The Pharmacy
may require patients to make requests for access to their PHI in writing.
In addition, you may request, and we must accommodate
the request, if reasonable, to receive communications of PHI by alternative
means or at alternative locations. To make this request please
contact us as described in Section B.
The Pharmacy may charge for supplies, labor and the
postage involved in preparing PHI for your request. If you desire
a price quote for this service you must request one. You have
the right to withdraw your request of the PHI prior to the delivery.
We may use your name to reference your prescriptions
and pharmaceutical care services. You may be required to sign a signature
log form or to acknowledge receipt of service, to acknowledge receipt
of this notice and the disclosure of PHI as outlined herein. We may
disclose this information to other persons who ask for you or your prescriptions
by name. You may restrict or prohibit these uses and disclosures
by notifying a pharmacy representative orally or in writing of your
restriction or prohibition. We are not required to honor those requests.
If you request our services, we are able to provide treatment services
to you, even if you object to signing the acknowledgment of the receipt
of this notice or if we decide not to honor a request regarding the
information in this document while noting your requests and refusals
in our records. 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 under such circumstances
and give you an opportunity to object as soon as practicable.
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, PHI that is directly relevant to the personís involvement with
your care or payment related to your care. In addition, unless
you object, we may use or disclose the PHI 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 what
in our judgment is in your best interest regarding such disclosure and
will disclose only the information that is directly relevant to the
personís 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 similar forms of PHI.
We reserve the right to change the terms of
this notice and to make new notice provisions effective for all PHI
we maintain. You may receive a copy of this notice by contacting
us as outlined in Section B or upon the receipt of pharmacy care services.
If you believe that your privacy rights have been
violated, you may file a complaint with 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 Ave SW, Washington,
DC 20201. You will not be retaliated against for filing a complaint.
SECTION B: Contacting Us
You may contact us for further
information at:
Ritzman Pharmacies, Inc.
Larry Fligor, Privacy Officer
8614 Hartman Road
Wadsworth, Ohio 44281
330-335-2318 x219
|
