HIPAA NOTICE OF PRIVACY PRACTICES

Updated September 2013

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND/OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

When this Notice of Privacy Practices (“Notice”) refers to “we” or “us,” it is referring to Boothwyn Apocathary, Inc.

And all of the pharmacists who provide health care services and the employees of our pharmacy. We are required by law to maintain the privacy of your protected health information (“PHI”), to follow the terms of this Notice, and to give you this Notice setting forth our legal duties and privacy practices concerning your PHI. This Notice describes how we may use and/or disclose your PHI. Additionally, this Notice explains the rights you have with respect to your PHI and certain obligations we must abide by in accordance with the law. We reserve the right to amend this Notice. If we make any material revisions to this Notice, we will post a copy of the revised Notice in the pharmacy or otherwise provide a copy to you.

• USE AND DISCLOSURE OF YOUR PHI– We will use your PHI for treatment, payment, and health care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization. The following lists examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will only be made with your explicit written authorization, which you may revoke at any time by providing us with written notice of your revocation.

1. For Treatment – We may use and/or disclose your PHI in order to provide you with prescription and supply services. We may disclose your PHI to other pharmacists, pharmacy technicians, and health care providers that are involved in your care. You will receive an individual notice and an opportunity to opt out of any subsidized treatment communications.
2. For Payment – We will use and/or disclose your PHI in order to obtain payment for the health care services we provide to you. We may also need to disclose your PHI to receive prior approval from your health plan or to determine if your health plan will cover a certain prescription or service.
3. For Health Care Operations – We may disclose your PHI in connection with the management of our pharmacy. For example, we can use your PHI to conduct or arrange for audits, including fraud and abuse detection and compliance programs. Additionally, we may use your PHI for our business management and general administrative activities.
4. For Prescription Refill Reminders, Treatment Alternatives, or Health-Related Benefits – We may use and/or disclose your PHI to contact you to remind you about prescription refills, to tell you about treatment options or alternatives, or about health-related benefits or services that may be of interest to you.
5. To Family Members, Relatives, or Close Friends – Unless you object to such disclosure, we may disclose your PHI to your family members, relatives or close personal friends, or any other persons identified by you as being involved in your treatment or payment for your medical care. If you are not present to agree or object to our disclosure of your PHI to a family member, relative, or friend, we may exercise our professional judgment to determine whether the disclosure is in your best interest. If we decide to disclose your PHI to your family member, relative or close personal friends, or other individual identified by you, we will only disclose the PHI that is relevant to your treatment or payment.
6. Other Permitted and Required Uses and Disclosures – We may use your PHI without obtaining your authorization and without offering you the opportunity to agree or object as follows:

1. as required by law, provided, however, that the use or disclosure will be made in compliance with applicable law;
2. to a public health authority that is authorized by law to collect or receive such information or to a foreign government agency that is acting in collaboration with a public health authority;
3. to a health oversight agency for oversight activities authorized by law, including audits and inspections, and civil, administrative, or criminal investigations, proceedings, or actions;
4. to a public health authority or to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence;
5. for judicial or administrative proceedings or law enforcement purposes;
6. to a coroner or medical examiner to perform duties authorized by law;
7. to funeral directors, consistent with applicable law, as necessary to carry out their duties;
8. to organ procurement organizations or similar entities for the purpose of facilitating organ, eye, or tissue donation and transplantation;
9. for research purposes;
10. to avert a serious threat to health or safety, so long as the disclosure is only to a person who is reasonably able to prevent or lessen such threat;
11. for specialized government functions, such as national security activities;
12. to a correctional institution or law enforcement custodian; and
13. to the extent necessary to comply with laws relating to workers’ compensation.

• YOUR RIGHTS AS OUR PATIENT – As our patient, you have a number of rights associated with your PHI. The following describes your specific rights.

1. You have the right to request restrictions or limitations on how we use and/or disclose your PHI; however, we do not have to agree to your requested restriction or limitation (except for transactions you paid for in full out-of-pocket). Your written request must specify: (1) if you would like to restrict or limit our use, disclosure, or both; (2) what information you would like to restrict or limit; and (3) to whom you want the limitation or restriction to apply (e.g., your spouse). If we agree to a restriction or limitation of your PHI, the restriction or limitation will not prevent us from disclosing your PHI as follows: (1) to you if you request access to your PHI or if you request an accounting of disclosures; (2) for purposes required or permitted by law; or (3) in the case of an emergency.
2. You have the right to request receipt of PHI from us by alternative means or via alternative locations. For example, you may want to receive communications about your prescriptions at a different address than your home address. If you wish to receive confidential communications via alternative means or locations, please submit your request in writing to the Privacy Officer and set forth the alternative means by which you wish to receive communications or the alternative location at which you want to receive such communications. We will accommodate all reasonable requests.
3. You have the right to access, inspect and obtain a copy of your PHI, including any electronic PHI; provided, however, you are not entitled to access certain PHI exempted under HIPAA. To the extent we maintain electronic PHI, upon request, we will provide you with a copy of your PHI in the format requested. If we do not have your PHI in our possession, we will provide you with the appropriate contact information when your request is received. If you request a copy of your PHI, you will receive a response to your request in a timely fashion but may be charged a reasonable, cost-based fee to cover copy costs and postage. In some limited circumstances, we may deny your request for access to PHI, in which case you may request for the denial to be reviewed. If access is ultimately denied, you are entitled to a written explanation with the reason(s) for the denial.
4. You have the right to receive an accounting of disclosures of your PHI made by us, including disclosures to or by our business associate(s), for a period of six (6) years prior to the date on which you request an accounting of disclosures or such lesser period as you indicate. You will receive one request annually free of charge, and thereafter, we may charge you a reasonable, cost-based fee for each subsequent request for an accounting of disclosures within the same twelve-month period. We will notify you of the cost for an accounting of disclosures, and you may choose to withdraw or modify your request before we charge you.
5. If you believe we have PHI about you, that is incorrect or incomplete; you may make a written request to us stating the reasons to support any requested amendment. You have the right to request an amendment to your PHI for so long as we maintain your PHI. If we do not have your PHI in our possession, we will provide you with the appropriate contact information when we receive your request. We will respond to your request for an amendment no later than sixty (60) days after we receive your request. However, we may deny your request for an amendment if, for example, we determine that the PHI you requested was not created by us or is already accurate and complete. You may respond to our denial by filing a written statement of disagreement, but we have the right to rebut your disagreement. If this occurs, you have the right to request that your original request, our denial, your statement of disagreement, and our rebuttal be included in future disclosures of your PHI.
6. You have the right at any time to obtain a paper copy of this Notice, even if you receive this Notice electronically. If you have received an electronic copy of this Notice but wish to obtain a paper copy of this Notice, please send your request in writing to the Privacy Officer at the address listed below.
7. Your PHI will not be used for fundraising purposes or sold without your prior authorization.
8. If you need any additional information about this Notice or wish to exercise any of your rights set forth in this Notice, please contact the Privacy Officer at the following address: Boothwyn Apocathary, Inc., 221 Gale Lane, Kennett Square, Pa, 19348 | 1-800-476-7496 / 1- 888-985-9223
9. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services without retaliation.

State Rights – Pennsylvania

You have the following additional rights with respect to PHI under Pennsylvania State law:

• You or your designee, including your attorney, have the right to access and copy your medical charts and records maintained by us, without the use of a subpoena duces tecum, for your own use. [42 Pa. Cons. Stat. Ann. § 6155.1]. As of 2002, copying fees may not exceed $16.24 for searching for and retrieving the records, $1.09 per page for paper copies for the first 20 pages, 820 per page for pages 21 through 60, and 280 per page for pages 61 and thereafter; $1.62 per page for copies from microfilm; plus the actual cost of postage, shipping or delivery. [ 42 Pa Cons. Stat. Ann. §§ 6152 and 6155; 31 Pa. Bulletin Doc. No 01- 2142 (where, in accordance with statutory authority, the Secretary of Health adjusted copying costs to reflect changes in the consumer price index).] No other charges for the retrieval, copying, shipping, or delivery are permitted without prior approval of the requestor.
• With respect to cancer, we are required to report cases of cancer to the Department of Health. [Pa. Stat. Ann. Tit. 35 § 5636.] These reports are confidential and are not open to public inspection or dissemination. [Id.] The information may be collected and analyzed by the Department and its contractors, as well as researchers, who are subject to strict supervision to ensure that the use of the reports is limited to specific research purposes.
• With respect to HIV/AIDS, Pennsylvania’s Confidentiality of HIV-related information Act governs the confidentiality of HIV-related information in the course of providing any health or social services or pursuant to the patient’s authorization may disclose or be compelled to disclose that information without the patient’s written consent. [Pa. Stat. Ann. Tit. 35, § 7607.]
• With respect to substance Abuse, The Pennsylvania Drug and Alcohol Abuse Control Act requires that all patient records prepared or obtained pursuant to state and local programs for the treatment of drug and alcohol abuse and the information contained therein are confidential and may not be disclosed without the patient’s consent. [ Pa. Stat. Ann. tit. 71, § 1690.108.] Even with the patient’s consent, this information may only be released to medical personnel for purposes of diagnosis and treatment of the patient or to the government or other officials exclusively for the purpose of obtaining benefits due to the patient as a result of his alcohol or drug dependency.

Effective Date April 14, 2003 – Updated April 2011 – Last Update September 2013. Source: PharmCAP