BURNHAM DRUGS
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.
PLEASE REVIEW IT CAREFULLY.
In accordance with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Burnham Drugs is required to inform you of it's practices in relation to the Protected Health Information (PHI) that it maintains to you. PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition and related health services. HIPAA requires minimum standards that a covered entity, such as Burnham Drugs, must maintain in relation to your PHI. The Notice of Privacy Practices is being given to you to help you understand how Burnham Drugs meets those standards. This Notice of Privacy Practices (Notice) describes how we may use and disclose PHI to carry out treatment, payment, or health care operations and for other specified purposes that are permitted or required by law. This Notice also describes your rights with respect to PHI about you.
Burnham Drugs is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to PHI about you:
Obtain a paper copy of the Notice upon request.
You may request a copy of the Notice at any time.
Request a restriction on certain uses and disclosures of PHI.
You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to Burnham Drugs, P.O. Box 8647, Moss Point, MS 39562.
Inspect and obtain a copy of PHI.
You have the right to access and copy PHI about you contained in a designated record set for as long as the Pharmacy maintains the PHI. The designated record set usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to Burnham Drugs, P.O. Box 8647, Moss Point, MS 39562. We may charge you a fee for the costs of copying, mailing, and supplies that are necessary to fulfill you request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI.
If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it, you may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to Burnham Drugs, P.O. Box 8647, Moss Point, MS 39562. You must include a reason that supports your request. In certain cases, we may deny you request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give rebuttal to your statement.
Receive an accounting of disclosures of PHI.
You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to family members or friends involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a written request to Burnham Drugs, P.O. Box 8647, Moss Point, MS 39562. Your request must specify the time period, but may not be longer that 6 years. The first accounting you request within a 12 month period will be proved free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Examples of How We May Use and Disclose PHI
The following are descriptions and example of ways we may use and disclose PHI:
We will use PHI for treatment.
As it pertains to Burnham Drugs, treatment means providing medications, supplies, durable medical equipment, or other items as ordered by your physician. Treatment also includes coordination and consultation with your physician and other healthcare providers. We will document in n you record information related to the medication, services, and supplies provided to you.
We will use PHI for payment.
Payment purposes consist of activities required to obtain reimbursement from your insurance carrier for the services ordered by your physician and provided to you by Burnham Drugs. This includes but is not limited to, eligibility determination, billing and collection activities, and obtaining documentation required by your insurer.
We will use PHI for health care operation.
Example: The pharmacy may use information in you health record to monitor the performance of the pharmacists providing the treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide. We are likely to use or disclose PHI for the following purposes:
Business associates: There are some services provided by us through contracts with business associates. When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect PHI about you, we require the business associate to appropriately safeguard the PHI.
Communication with individuals involved in you care or payment for your care: Health professions such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to that person's involvement in your care or payment related to your care.
Health-related communications: We may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Food and Drug Administration (FDA: We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products, and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Worker's Compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker's compensation or similar programs established by law.
Public Health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law Enforcement: We may disclose PHI about you to law enforcement purposes as required by law or in response to a valid subpoena or other legal process.
As required by law: We must disclose PHI about you when required to do so by law, as required by law or in response to a valid subpoena or other legal process.
Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs and compliance with civil rights laws.
Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena discovery request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request or obtain an order protecting the requested PHI.
We are permitted to use or disclose PHI about you for the following purposes:
Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Coroner, Medical examiners and Funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.
Organ or Tissue Procurement Organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Fundraising: We may contact you as part of fundraising efforts.
Notification: We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or other person responsible for your care, your location, and your general condition.
Correctional Institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or it's agents when necessary for your health and the health and safety of others.
To avert a serious threat to health or Safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Veteran: If you are a member of the armed forces we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.
National Security and Intelligence Activities: We may release PHI about you to authorized federal officials for intelligence, counter intelligence, and other national security activities authorized by law.
Protective Services for the President ad others: We may disclose PHI 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.
Victims of abuse, neglect or domestic violence: We may disclose PHI about you to a government authority, such as social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.
Other uses and Disclosures of PHI
Burnham drugs will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke authorization in writing at any time except to the extent that action has already occurred.
For more information or to report a problem
If you have questions or would like additional information about the Pharmacy's privacy practices, you may contact Burnham Drugs Privacy Officer at Burnham Drugs, P.O. Box 8647, Moss Point, MS 39562. If you believe your privacy rights have been violated, you can file a complaint with the Burnham Drugs Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Effective date
This Notice is effective as April 14, 2003.
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