NOTICE OF PRIVACY PRACTICES Scott Family Pharmacy, LLC Effective April 14, 2003 By law, every Pharmacy is required by law to maintain the privacy of ?Protected Health Information? (?PHI?) and to provide individuals with notice of those legal duties and privacy practices with respect to PHI. PHI is the information that may identify an individual and relates their past, present, and future health or condition and associated health care services. This ?Notice of Privacy Practices? explains how a pharmacy may use and disclose PHI to carry out treatment, payment or health care operations and for other pre-determined purposes that are permitted or required by law. The notice also explains the rights of an individual with respect to the PHI about them. We, Scott Family Pharmacy, will not use or disclose your PHI without your written authorization, except as stated in this Notice. However, we reserve the right to change our practices along with this Notice and in turn make the Notice effective for all obtained PHI. Upon request, we will make the revised Notice available to all interested parties. INDIVIDUAL HEALTH INFORMATION RIGHTS With respect to your PHI, you have the following rights: Upon request, to obtain a paper copy of the Notice. At any point in time, you have the right to request a copy of the Notice, even if you previously agreed to receive an electronic version. Please contact Craig Scott to acquire a paper copy. To request guidelines on certain uses and disclosures of your PHI. Additional restrictions may be requested by an individual on use or disclosure of their PHI by submitting a written request to Craig Scott. The Pharmacy is not required to agree with those limitations. To attain and inspect a copy of PHI. As long as the Pharmacy maintains the PHI. Individuals have the right to access and copy their PHI contained in a designated record set. Prescription and billing information is usually included in the designated record set. To inspect or copy your PHI, please send a written request to Craig Scott. Fees may be applied to cover the costs of copying, mailing supplies that are necessary to fulfill a request. In certain limited circumstances, requests for copies or inspection of PHI may be denied. In such cases, review of the denial may be requested. Receive an accounting to disclosures of PHI. After April 14th, 2003 individuals have the right to receive an accounting of their PHI covering most disclosures above and beyond treatment, payment, or health care operations. Disclosures made directly to the individual or those involved with their health care, authorized by the individual, or for the purpose of notification will be excluded. Certain other exceptions, restrictions and limitations may apply. Please submit a written request for PHI accounting to Craig Scott. A specific time period, of no more than six years, must be included. The initial request for an accounting, within a 12 month frame, will be provided at no charge. Additional accountings will have associated fees. Individuals requesting an accounting will be notified in advance of the charges and will have the option to modify or cancel their request. To request communications of PHI by alternative methods or at alternative locations. An individual may request a written response about their medical details or that it be sent to an alternative address. Please submit a written request to receive a confidential PHI communication to Craig Scott. Please include how and where to be contacted. EXAMPLES OF THE USE AND DISCLOSURE OF PHI The following are descriptions and examples of the use and disclosures of PHI. The use of PHI for treatment. An example would be the use of pharmacist obtained information to dispense prescribed medications. This information may come from the patient or caregiver, the prescribing physician, the insurance provider, and/or other healthcare providers that have been utilized. The use of PHI for payment. An example would be contacting the pharmacy benefit or insurer to confirm payment for an individual's prescription and the amount of the co-pay. The pharmacy bills either the individual or a third-party payer for the cost of prescription medications. An individual's prescription or personal identifying information may be included on or with the bill. The use of PHI for health care operations. An example would be the use of health record information to monitor the performance and treatment . A pharmacy is likely to use or disclose PHI for the following purposes: Business associates: Some services provided are the result of contracts with business associates. To insure that the associates can perform the duties we've contracted them for and to bill the individual or a third party payer for services rendered. Communication with individuals involved in your care or payment for your care: Using their judgment, pharmacists and other professional health care givers may disclose relevant PHI regarding the personal care or payment. Health-related communications: A pharmacy may contact an individual to provide information about treatment alternatives, health care related benefits or services of interest, or refill reminders. Food and Drug Administration (FDA): To enable the FDA to recall, repair, or replace products. Workers? Compensation: An individual's PHI may be disclosed by the pharmacy if authorized or if necessary to act in accordance with any laws regulating workers' compensation or similar law established programs. Law Enforcement: As required by law for law enforcement purposes, a valid subpoena, or other legal Process. Health Oversight Activities: For any law authorized activities. Such activities include audits, investigations, and inspections deemed necessary. Judicial and Administrative Proceedings: PHI may be disclosed to an administrative or court order if an individual is involved in a lawsuit or dispute. A pharmacy is allowed to use or disclose PHI for the following purposes: Research Coroners, medical examiners, and funeral directors Organ or tissue procurement organizations Correctional Institution To avert a serious threat to health or safety Military and veterans National Security and Intelligence Activities Protective services for the President and others Victims of abuse, neglect, or domestic violence ADDITIONAL USES AND DISCLOSURES OF PHI Additional purposes, beyond those previously discussed or as authorized or allowed by law, may cause the pharmacy to request an individual?s written authorization for PHI disclosure or use. FOR ADDITIONAL INFORMATION OR TO REPORT A PROBLEM Please contact Craig Scott at Scott Family Pharmacy, LLC, with additional questions or for more information about the Pharmacy's privacy practices.