Harford Pharmacy 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. UNDERSTANDING YOUR PATIENT PRESCRIPTION RECORDS: This pharmacy is required by law to maintain the privacy of Protected Health Information (PHI) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. This information used for the purposes of prescription dispensing, counseling, billing, and communication among any and all health professionals who may contribute to your care and for other specified purposes that are permitted or required by law. Understanding what information is retained in your records and how the information may be used will help you to ensure its accuracy, and enable you to relate to who, when, where, and why others may be allowed access to your PHI. State and federal laws will govern PHI, whichever is more stringent. UNDERSTANDING YOUR HEALTH INFORMATION RIGHTS: You have the following rights with respect to PHI about you. You may request a copy of this notice at any time. You have the right to request additional restrictions on disclosure of your PHI, but we are not required to agree to those restrictions. You have the right to access and copy PHI about you contained in this pharmacy by contacting our privacy officer. We have the right to charge you for the cost of reproduction of your PHI. If you are denied access to your PHI, you may have the right to appeal this decision to the Secretary of Health and Human Services or his representative. You have the right to confidential communications between this pharmacy and yourself and to have those communications made by alternative means or alternative locations. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it by contacting our privacy officer. You have the right to receive an accounting of the disclosures we have made of your PHI for most purposes other than treatment, payment, or health care options. Other disclosures excluded are direct disclosures to yourself, family, or friends involved in your care. Other than activity that already has occurred, you may revoke any further authorization to use or disclose your health information. OUR RESPONSIBILITIES: This pharmacy is required to maintain privacy of your health information and to provide you with notice of our legal commitment and privacy practices with respect to the information we collect and maintain about you. This pharmacy is required to abide by the terms of this notice and notify you if we are unable to grant your requested restrictions or reasonable desires to communicate to your PHI by alternative means or alternative locations. Other than for reasons described in this notice, this pharmacy agrees not to use or disclose your PHI without your authorization. This pharmacy reserves the right to change its practices and to effect new provisions regarding PHI. If such changes are made, you will be notified upon dispensing your next prescription. Our Privacy Policy may also be posted in the pharmacy for public viewing. EXAMPLES OF HOWE WE MAY USE AND DISCLOSE YOUR PHI: TREATMENT- PHI will be used by the pharmacist to dispense medication, for cognitive services, or any other patient related services provided to you and may be shared with other health care professionals involved in your care. PAYMENT-Your PHI will be used for payment from your insurer or pharmacy benefit manager to determine payment to this pharmacy and the amount of any co-payment. This information on or accompanying the bill may include your PHI. HEALTH CARE OPERATIONS-The pharmacy staff in this facility may use your PHI to provide the highest level of pharmaceutical care b y monitoring the performance of the pharmacist treating you. It also may be shared with the payer of health services provided. BUSINESS ASSOCIATES- Some or your entire PHI may be subject to disclosures through contracts for services to assist this pharmacy in providing health care. To protect your PHI, we will require these Business Associates to follow the same standards held by this pharmacy through terms detailed in a written agreement. An example of a Business Associate would be our relationship with our pharmacy computer system vendor. COMMUNICATIONS WITH INDIVIDUALS OTHER THAN YOURSELF- We may use professional judgment to disclose to a family member, other relative, close personal friend, or any other 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 other health related benefits, and services for you at the telephone number or address that you authorized regarding such communications. FOOD AND DRUG ADMINISTRATION- This pharmacy may report and disclose PHI relative to adverse events with respect to drugs, food, supplements, products, and product defects for surveillance information to enable product recalls, repairs, or replacements to the FDA or any other Health Oversight Agency. WORKERS COMPENSATION- This pharmacy will release your PHI to the extent authorized by law or authorized by you in matters for worker�s compensation. PUBLIC HEALTH- We may disclose PHI, as required by law, 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 for law enforcement purposes as required by law in response to a valid subpoena or other legal process. CORRECTIONAL FACILITIES- If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the safety of others. AS REQUIRED BY LAW-We must disclose PHI about you when required to do so by law. WE RESERVE THE RIGHT TO AMEND OR CHANGE THIS NOTICE- If we change or amend this notice, you will be notified the next time you get a prescription from this pharmacy. COMPLAINTS- You have the right to file any complaints in writing on our complaint form or your own letter regarding your PHI to the designated privacy officer of this pharmacy or to the Secretary of Health and Human Services of the United States. This complaint will be handled without any retaliation to you for filing the complaint. THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2003 For more information please contact Ed Tristani, Harford Pharmacy at (410) 838-0990 HARFORD PHARMACY 1510 CONOWINGO ROAD BEL AIR, MD 21014 SUBJECT: hipaaediprivacyandsecurit.doc Page 2 of 3 PAGE 1 OF 3