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HIPAA PRIVACY INFORMATION
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Old Port Pharmacy, Inc.

HIPAA

Notice of Privacy Practices

 

 

Effective Date:  October 1, 2006

 

 

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

 

Who Follows This Notice?

  • All Old Port Pharmacy employees, staff, and business associates.

Our Pledge Regarding  information:

We understand that information about you and your health is personal.  We are committed to protecting information about you.  We create a record of the care and services you receive.  We need this record to provide you with quality care and to comply with certain legal requirements.

 

This notice will tell you about the ways in which we may use and disclose information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of information.

 

We are required by law to:

 

  • Make sure the information that identifies you is kept private.
  • Give you this notice of our legal duties and privacy practices with respect to information about you.
  • Follow the terms of the notice that is currently in effect.

How We May Use and Disclose information About You

The following categories describe different ways that we use and disclose information.  For each category of uses or disclosures we will explain what we mean and try to give some examples.  Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

 

  • Individuals Involved in your Care or Payment for Your Care.  We report or release information about you as authorized on the Release of Information Form that is signed by you at the time of Prescription pick-up .  For example a friend or family member who is involved in your medical care may receive information if they are designated by you to do so.

 

  • As Required By Law.  We will disclose information about you when required to do so by federal, state or local law.  For example, if there is a federal government audit of prescription insurance claims, we would release the required information.

Special Situations

  • Public Health Risks.  We may disclose information about you for public health activities.  These activities generally include notifying the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.  We will only make this disclosure if you agree or when we are required or authorized to do so by law.

 

  • Health Oversight Activities.  We may disclose information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

 

  • Lawsuits and Disputes.  If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court or administrative order.  We may also disclose information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to tell you about the request or to obtain an order protecting the information requested.

 

  • Law Enforcement.  We may release  information if asked to do so by a law enforcement official:

 

    • In response to a court order, subpoena, warrant, summons or similar process.
    • To identify or locate a suspect, fugitive, material witness, or missing person.
    • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.
    • About a death we believe may be the result of criminal conduct.
    • About criminal conduct in the community.
    • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

 

  • National Security and Intelligence Activities.  We may release information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

 

  • Protective Services for the President and Others.  We may disclose information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

 

  • Inmates.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release information about you to the correctional institution or law enforcement official.  This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Your Rights Regarding information About You

You have the following rights regarding information we maintain about you:

 

  • Right to Inspect and Copy.  You have the right to inspect and request a copy of information that may be used to make decisions about your care.

 

To inspect and request a copy information that may be used to make decisions about you, you may ask the pharmacist on duty, or submit your request in writing to the OLD PORT PHARMACY Privacy Manager (195 Middle St., Portland, Maine 04101 or privacy@oldportrx.com).  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

 

We may deny your request to inspect and copy in certain very limited circumstances.  If you are denied access to information, you may request that the denial be reviewed.  Another health care professional chosen by OLD PORT PHARMACY will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

 

  • Right to Amend.  If you feel that information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for Old Port Pharmacy.

 

To request an amendment, you may either ask the pharmacist on duty, or you may submit your request in writing to the OLD PORT PHARMACY Privacy Manager (195 Middle St., Portland, Maine 04101 or privacy@oldportrx.com).  In addition, you must provide a reason that supports your request.

 

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that:

 

    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.

 

    • Is not part of the information kept by or for OLD PORT PHARMACY .

 

    • Is not part of the information that you would be permitted to inspect and copy.

 

    • Is accurate and complete.

 

  • Right to an Accounting of Disclosures.  You have the right to request an “accounting of disclosures.”  This is a list of the disclosures we made of information about you.

 

To request an accounting of disclosures, you must submit your request in writing to the OLD PORT PHARMACY Privacy Manager (195 Middle St., Portland, Maine 04101 or privacy@oldportrx.com).  Your request must state a time period that may not be longer than six years and may not include dates before October 1, 2006 as this was our date of opening.  Your request should indicate in what form you want the list (for example, on paper, electronically).  The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

 

  • Right to Request Restrictions.  You have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment or health care operations.  You also have the right to request a limit on the information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.

 

We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

 

To request restrictions, you must submit your request in writing to the OLD PORT PHARMACY Privacy Manager (195 Middle St., Portland, Maine 04101 or privacy@oldportrx.com).  In your request, you must tell us (1) what information your want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

 

  • Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail.

 

To request confidential communications, you must submit your request in writing to the OLD PORT PHARMACY Privacy Manager (195 Middle St., Portland, Maine 04101 or privacy@oldportrx.com).  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.

 

  • Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

 

You may obtain a copy of this notice at our website, www.oldportrx.com.

 

To obtain a paper of this notice, contact the Old Port Pharmacy Privacy Manager (195 Middle St., Portland, ME. 04101 or privacy@oldportrx.com).

Changes to This Notice

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice on the OLD PORT PHARMACY website and have it on file at OLD PORT PHARMACY. The notice will contain on the first page, in the top right-hand corner, the effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with OLD PORT PHARMACY or with the Secretary of the Department of Health and Human Services.  To file a complaint with OLD PORT PHARMACY, contact the OLD PORT PHARMACY Privacy Manager at 195 Middle St., Portland, ME. 04101, by phone 207-772-2164 or privacy@oldportrx.com.  All complaints must be submitted in writing.

 

You cannot be penalized for filing a complaint.

Other Uses of information

Other uses and disclosures of information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.