Dear Patient, This notice describes how medial information about you may be used and disclosed and how you can get access to this information. Please review it carefully. This pamphlet contains information about the privacy of your prescription information. Hallers Pharmacies takes great care to safeguard your medical information. A new government regulation requires us to inform you of your rights. That is also why we require a signature that indicates that you were informed and that this pamphlet was received. GSB Pharmacies is required by law to protect and maintain the confidentiality of Protected Health Information (?PHI?) and to provide you with notice of legal duties and privacy practices with respect to PHI. PHI is information that can potentially identify you and that relates to your past, present or future physical or mental health or condition and related health care services. 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 purposes that are required or permitted by law. The Notice also describes your rights with respect to your PHI. We are required to provide this notice and its terms to you by the Health Insurance Portability and Accountability Act (?HIPAA?) We will not use or disclose your PHI without your written authorization, except as described in this Notice. We reserve the right to modify our policies and this notice to make the new Notice effective for all PHI we maintain, which will be made available to you upon request. How GSB Pharmacies may use and disclose your protected health information: The following examples describe some of the ways we may use and disclose your protected health information. The examples given are not representative of all categories nor are they intended to cover every possible use of information in a category. We may use your protected information for some administrative or quality assurance activities. For example, we may use your health information to gauge the performance of the pharmacies? staff in providing service to you. This information will be used to continually improve the quality of health care you receive at our pharmacies. We may disclose health information to business associates if they need to receive this information to provide a service to us and will agree to abide by specific HIPAA rules relating to the protection of health information. GSB Pharmacies are permitted to disclose your protected health information for the following reasons. However, we may never have reason to disclose this information. We may disclose your health information to the following entities: To government authority, such as a social service or protective services agency, if GSB has reason to believe the patient is a victim of abuse, neglect, or domestic violence, but only to the extent required by law, if the patient agrees to the disclosure, or if the disclosure is allowed by law and Hallers Pharmacy believes it is necessary to prevent serious harm to the patient or to 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 the patient. To authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law; To authorized federal officials so they may provide protection to the president, other authorized persons, or foreign heads of state or conduct special investigations; As required by military command authorities, when the patient is a member of the armed forces, and to appropriate military authority about foreign military personnel; When necessary to prevent a serious threat to the patient?s health and safety or the health and safety of the public or another person; To a correctional institution or its agents, if a patient is or becomes an inmate of such an institution, when necessary for the patient?s health or the health and safety of others; To contact the patient for the purpose of fundraising; To notify, or assist in notifying, a family member, a personal representative, or another person responsible for the patient?s care, of the patient?s location, or general condition; To organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant, consistent with applicable law; To a coroner or medical examiner when necessary, for example, to identify a deceased person or determine the cause of death, or to funeral directors consistent with applicable laws to carry out their duties; To researchers when their research has been approved by an institutional review board that has received the research proposal and established protocols to ensure the privacy of the patient?s information; Whenever required to do so by law; As authorized by and as necessary to comply with laws relating to worker?s compensation or similar programs established by law; In response to a court order, administrative order, subpoena, discovery request, or other lawful process by another person, involved in a dispute involving a patient, but only if efforts have been made to tell the patient about the request or to obtain an order protecting the health care information; To health oversight agencies (medical licensing boards, e.g.) for activities authorized by law such as audits, investigations, and inspections necessary for GSB Pharmacies licensure and for the government to monitor the health care system, etc.; To public health or legal authorities charged with preventing or controlling disease, injury, or disability; To the Food and Drug Administration (FDA) relative to adverse events regarding drugs, foods, supplements, and other health products or to post marketing surveillance to enable product recalls, repairs, or replacement; AUTHORIZED USE AND DISCLOSURE We will obtain your written authorization before using or disclosing protected health information about you for purposes other than those listed above or otherwise permitted or required by law. You may revoke an authorization in writing at any time. Such revocations must be made in writing. Forms for making revocations, which are available in our pharmacies, should be completed and sent to GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536. Upon receipt of written revocation, we will stop using or disclosing protected health information about you, except to the extent that we have already taken action in reliance on the Authorization. THE PATIENT?S RIGHTS RESTRICTION REQUESTS You have the right to request that we modify how your PHI is used or disclosed in carrying out treatment, payment, or medical operations. Such requests must be made in writing to GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536. We are not required to agree to the requested restrictions, that agreement will be binding on us. ALTERNATIVE MEANS OF COMMUNICATION You have the right to request that our communications to you concerning your PHI be made by alternative means or at alternative locations. For example, you may want us to communicate to you in some other way than mailing to your home address or calling your home telephone number. Such requests must be made in writing to GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536. We will comply with a reasonable request for such an alternative. ACCESS You have the right to inspect and/or procure a copy of your protected health information. You have the right to access and copy protected health information about you contained in the designated record set for as long as we maintain your protected health information. The designated record set usually will contain prescription and billing records. To receive a copy of your protected health information, write to GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536. Forms for making Access requests are available in our pharmacies. We may charge you a fee for the costs of copying, mailing, or other supplies that are necessary to grant your request. We may also deny your request to inspect and copy in limited circumstances. If you are denied access to your protected health information, in most cases you may request that the denial be reviewed. HEALTH CARE INFORMATION AMENDMENTS If you feel that the protected health information 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 protected health information. A request for an Amendment must be made in writing. Forms for making such requests, which are available in our pharmacies, should be completed and sent to GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536. ACCOUNTING For most purposes other than treatment, payment, or health care operations, you have the right to receive an accounting of disclosures we made, on or after April 14, 2003, of your protected health information. The accounting will exclude disclosures we may have made directly to you, disclosures to friends and family members involved in your care, and disclosures for purposes you specifically authorized in writing. The right to receive an accounting is subject to certain other restrictions, exceptions, and limitations. A request for an accounting must be made in writing. Forms for making such requests, which are available in our pharmacies, should be completed and sent to GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536. The time period for the requested accounting must be specified and it may not be longer than six years. The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for the cost of providing additional accountings within that period. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time. NOTICE OF PRIVACY PRACTICES You have the right to receive a paper copy of this Notice from us upon request even if you have already received the Notice electronically (for example, on the Internet). GSB PHARMACIES DUTIES: CSB Pharmacies takes its responsibility for maintaining your protected health information in confidence very seriously. Protected health information means information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. It also includes basic demographic information. We are required by law to maintain the privacy of protected health information and to provide you with a Notice of Privacy Practices including our legal duties with respect to protected health information. In addition, Hallers Pharmacy is required to abide by the terms of the Notice currently in effect. We reserve the right to change terms of our Notice and to make the new Notice provisions effective for all protected health information that we maintain. When we make changes in our Notice, copies will be available on request in all our pharmacies. FOR MORE INFORMATION OR TO REPORT A PROBLEM If you have questions or would like additional information about our privacy practices, you may contact us at GSB Pharmacies and Medical Supply, ATTN: Privacy Officer, 37323 Fremont Boulevard, Fremont, CA 94536 or by calling 510-797-2772. Forms for filing a written complaint to Hallers Pharmacies are available at our pharmacies. If you believe your privacy rights have been violated, you can file a complaint with Hallers Pharmacies? Privacy Office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. Effective Date This Notice of Privacy Practices is effective as of April 14, 2003.