HIPAA COMPLIANCE POLICIES AND PROCEDURES PHI Privacy of Individually Identifiable Health Information Bernie?s Pharmacy 4100 Lake Otis Parkway Suite #200 Anchorage, Alaska 99508 POLICY ESTABLISHED APRIL 14, 2003 HOW THE PHARMACY MAY USE AND DICLOSE YOUR PHI The following is an accounting of the ways that the pharmacy is permitted, by law, to use and disclose your PHI. Use and disclosures of PHI for Treatment: We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care. Uses and disclosures of PHI for Payment: The pharmacy will disclose your PHI to obtain payment or reimbursement from insurers for your health care services. Uses and disclosures of PHI for Health Care Operations: The pharmacy will use your PHI to conduct quality assessments, improvement activities, and evaluate the pharmacy workforce. The following is an accounting of additional ways in which the pharmacy is permitted or required to use or disclose PHI about you without your written authorization. Uses and disclosures as required by law: The pharmacy is required to use or disclose PHI about you as required and as limited by law. Uses and disclosure for Public Health Activities: The pharmacy may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability. Uses and disclosure about victims of abuse, neglect or domestic violence: The pharmacy may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence. Uses and disclosures for health oversight activities: The pharmacy may use or disclose PHI about you to a health oversight agency for oversight activities that it is authorized by law to conduct Uses and disclosures for specialized government functions: The pharmacy may use or disclose PHI about you for specialized government functions including; military and veterans activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations Disclosure for workers? compensation: The pharmacy may disclose PHI about you as authorized by and to the extent necessary to comply with workers? compensation laws or programs established by law. Disclosures for disaster relief purposes: The pharmacy may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts. Disclosures to business associates: The pharmacy may disclose PHI about you to the pharmacy?s business associates for services that they may provide to or for the pharmacy. OTHER USES AND DISCLOSURES The pharmacy may contact you for the following purposes: Refill reminders: The pharmacy may contact you to remind you of your prescription upon such time they are ready to be refilled. Information about treatment alternatives: The pharmacy may contact you to notify you of alternative treatments and/or products. Health related benefits or services: The pharmacy may use your PHI to notify you of benefits and services the pharmacy provides. Disclosures for law enforcement purposes: The pharmacy may disclose PHI about you to law enforcement officials for authorized purposes. Uses and disclosures about the deceased: The pharmacy may disclose PHI about the deceased, or prior to, and in reasonable anticipation of an individual?s death, to coroners, medical examiners, and funeral directors. Uses and disclosures for research purposes: The pharmacy may use and disclose PHI about you for research purposes with a valid waiver of authorization from the research board. Otherwise, the pharmacy will request a signed authorization by the individual for all other research purposes. FOR ALL OTHER USES & DICLOSUERS The pharmacy will obtain a written authorization from you for all other uses and disclosures of PHI, and the pharmacy will only use or disclose pursuant to such an authorization. In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure . Please contact HIPAA Privacy Officer Disclosures to business associates: The pharmacy may disclose PHI about you to the pharmacy?s business associates for services that they may provide to or for the pharmacy. THE FOLLOWING ARE A LIST OF Y OUR RIGHTS IN RESPECT TO YOUR PHI. Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of the pharmacy?s uses and disclosures of your PHI; however, the pharmacy is not required to accommodate a request. If you wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from the pharmacy and return The completed form to the pharmacy or return to HIPAA Privacy Officer. The right to inspect and/or obtain a copy your PHI: You have the right to request access and/or obtain a copy of your PHI that is contained in the pharmacy for the duration the pharmacy maintains PHI about you. If you wish to inspect or obtain a copy your PHI, please obtain a form, Request for Access to Records, from the pharmacy and return the completed form to the pharmacy or return to HIPAA Privacy Officer. There may be a reasonable cost-based charge for photocopying documents. You will be notified in advance of incurring such charges, if any. The right to amend your PHI: You have the right to request an amendment of the PHI the pharmacy maintains about you, if you feel that the PHI the pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services, or their appropriate designee, to review such a denial. If you wish to amend your PHI files, please obtain a form, Request for Amendment to PHI, from the pharmacy and return the completed form to the pharmacy or return to HIPAA Privacy Officer. The right to receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by the pharmacy. If you wish to receive an accounting of disclosures your PHI, please obtain a form, Request for Accounting of Disclosures, from the pharmacy and return the completed form to the pharmacy or return to the HIPAA Privacy Officer. You should be aware, however, that such an accounting excludes uses and disclosures made for treatment, payment, or health care operations purposes. The right to receive additional copies of the Pharmacy?s Notice of Privacy Practices: You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically. If you wish to receive a paper copy of this request, please ask a pharmacy workforce member and they will provide you with a copy. REVISIONS TO THE NOTICE OF PRIVACY PRACTICES The pharmacy reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The revised Notice will be available, upon request, to all individuals. The pharmacy will also post the revised version of the Notice in the pharmacy COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with the pharmacy and/or to the Secretary of HHS, or their designee. If you wish to file a complaint with the pharmacy, please contact HIPAA Privacy Officer. If you wish to file a complaint with the Secretary, please write to: The U.S Department of Health and Human Services 200 Independence Ave, S.W. Washington, D.C. 20201 The pharmacy will not take any adverse action against you as a result of your filing of a complaint. CONTACT INFORMATION If you have any questions on the pharmacy?s privacy practices or for clarification on anything contained within the Notice, please contact: Bernie?s Pharmacy Inc Attn: HIPAA Privacy Officer 4100 Lake Otis Parkway Suite 200 Anchorage, Alaska 99508