Miller's Pharmacy 101 S. Broad St. Kalida, Ohio 45853 419-532-3489 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. USE AND DISCLOSURE OF HEALTH INFORMATION Our practice may use your health information for purposes of providing you treatment, obtaining payment and conducting health care operations. Your health information may be used and disclosed for these purposes while you are our patient. We have established policies to guard against unnecessary disclosure of your health information. The following represents the circumstances under which your health information may be used and disclosed: Conducting Health Care Operations: Our practice may use and disclose health care information for our own operations in order to assist in everyday functions, and as necessary to provide quality care to all our patients. We have defined our health care operations include such activities as: * Health assessments and quality improvement activities * Activities designed to improve wellness and quality of life. * Care coordination between patient and other health care professionals. * Contact of health care professionals and patient about treatments, alternatives, and other related areas. * Professional review and performance evaluations. * Training programs including those in which student interns or practitioners in health care learn under our supervision and guidance. * Training of non health care professionals. * Accreditation, certification, licensing or credentialing activities. * Review and auditing, including compliance reviews, medical reviews, legal services, financial services, and compliance programs. * Business planning and development including cost management and planning related analyses and formulary development. * Business management and general administrative activities of the practice. For example, our practice may use your health information in combination with our other patients in evaluating how to more effectively serve our entire network of patients. We may disclose your health information to our professional staff and contracted personnel for training purpose, or to evaluate staff performance. We may contact you as a reminder about an upcoming appointment, or contact you or your family as a reminder of our services available to you (unless you tell us you do not want to be contacted). Obtaining Payment: Upon receiving care, our practice may include health information about you in invoices sent for the purpose of collecting payment from your health plan. For example, we may be required by your insurance company to provide information about your health care status so that reimbursement will be made. We also may need to obtain prior approval from your insurance company or may need to explain to them your need for the services we will be providing. Providing Treatment: We may use your health information to coordinate health care within our own practice, and with others involved in your care, such as specialists and other health care professionals. For example, doctors involved in your care will need information about your symptoms in order to prescribe appropriate medications and treatments. We also may disclose your health care information to individuals outside our practice involved in your care, including family members and others whom you have designated, pharmacists, suppliers of medical equipment, health care professionals and others involved in your coordination of care. AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION Other than what is stated in this brochure, our practice will not disclose your health information other than with your written authorization. If you or your representative give us authorization to use or disclose your health information, you may revoke that authorization at any time. There are federal privacy rules which allow health care providers to use or disclose your health information without authorization from you for a number of reasons. When Legally Required. We will disclose your health information when it is required to do so by any Federal, State or local law. When There Are Risks To Public Health. We may disclose your health information for public activities for the purpose of: * Preventing or controlling disease, injury or disability, reporting disease, vital events such as birth or death and conducting public health surveillance, investigations and interventions. * Reporting adverse events, product defects, tracking products or enabling product recalls, repairs and replacements and conducting post-marketing surveillance and compliance with requirements of the Food and Drug Administration. * Notifying a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease. * Supplying information to employer about an individual who is a member of the workforce as legally required. Reporting Abuse, Neglect or Domestic Violence. We are allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence. Our practice will make this disclosure only when required or authorized by law or when the patient agrees to the disclosure. Conducting Health Oversight Activities. We may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, we may not disclose health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits. Research Purposes. We may, under some circumstances, use your health information for research. Before we disclose any of your health information for such purposes, the project will be subject to an extensive approval process. We will ask your permission if any researcher will be granted access to your individually identifiable information. Specified Government Functions. In certain circumstance, the Federal regulations authorize us to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determination and inmates and law enforcement custody. In Connection With Judicial And Administrative Proceedings. Our practice may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process. Law Enforcement Purposes. Our practice may disclose your health information to a law enforcement official for law enforcement purposes as follows: * As required by law for reporting certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process. * For the purpose of identifying or locating a suspect, fugitive, material witness or missing person. * Under certain limited circumstances, when you are the victim of a crime. * To a law enforcement official if we have a suspicion that your death was the result of criminal conduct including criminal conduct at our place of business. * In an emergency in order to report a crime. Coroners and Medical Examiners. Our practice may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law. Funeral Directors. Our practice may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, we may disclose your health information prior to and in reasonable anticipation. Organ, Eye, Or Tissue Donation. Our practice may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating donation and transplantation. In the Event Of A Serious Threat To Health Or Safety. Our practice may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your safety or to the health and safety of the public. Workers' Compensation. Our practice may release your health information for workers' compensation or similar programs. YOUR RIGHTS: with respect to your health information. You are entitled to the following rights regarding your health information: Right to request restrictions. You have the right to request restrictions on certain uses and disclosures of your health information. You may request a limit on the disclosure of your health information to someone who is involved in your care. However, our practice is not required to agree to your request if it will negatively affect your care. If you wish to make a request for restrictions, please contact the Privacy Official. Right to receive confidential communications. You have the right to request that our practice communicates with you in a certain way. For example, you may ask that we only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive to receive confidential communications, please contact the Privacy Official. We will require that you provide any reason for your request and we will attempt to honor your reasonable requests for confidential communications. Right to a paper copy of this notice. You or your representative have a right to a separate paper copy of this Notice at any time even if you have received this Notice previously. To obtain a separate paper copy, please contact the Privacy Official or any staff member at our practice. A copy of our Notice of Privacy Practices will be displayed on our website if one is maintained by our practice. Right to amend health care information. If you or your representative believes that your health information records are incorrect or incomplete, you may request that these records are amended. That request may be made as long as the information is maintained by this practice. We require the request for an amendment of records to be made in writing to the Privacy Official. We may deny the request if it is not in writing or does not include a reason for the change. The request may also be denied if your health information records were not created by health care professionals within our practice, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the information you are permitted to inspect or copy, or if, in the opinion of health care professionals within our practice, the records are accurate and complete. Right to Inspect and copy halt information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information must be made to the Privacy Official. Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by our practice for reasons other than for treatment or health operations. The request for an accounting must be made in writing to the Privacy Official. The request should specify the time period for the accounting (starting on April 14, 2003). Accounting requests may not be made for periods of time in excess of six years. OUR DUTIES Our practice is mandated by law to maintain the privacy of your health information and to provide you or your representative this Notice informing you of our duties and privacy practices. We are required by law to abide by terms of this Notice which is subject to occasional amendment. We reserve the right to change the terms of our Notice and to make any changes effective for all health information in our possession. If our practice changes this Notice, a copy of the revised Notice will be provided to you or your designated representative with comments regarding the nature of the change. You or your representative have the right to express complaints to this practice and to the Secretary of health and Human Services if you believe that your privacy rights have been violated. Any complaints regarding privacy violation should be made in writing to the Privacy Official. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against for filing a complaint. CONTACT PERSON Our contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the Privacy Official. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE PRIVACY OFFICIAL or owner/operator. EFFECTIVE DATE: April 14, 2003 Rev. 01/08/03