Main Source Pharmacy HIPAA Privacy Practice
Main Source Pharmacy is committed to protecting your privacy and personal health information (“PHI”). PHI is information about you, including basic demographic information, that may 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 about you to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The notice also describes your rights under federal and state law relating to your PHI.
Main source Pharmacy is required to abide to the terms of this notice, which explains our legal duties and privacy practices with respect to PHI that we collect and maintain. We will not use or disclose PHI about you without your written authorization, except as described in this notice. We reserve the right to change the privacy practices outlined in this notice, and make the new notice effective for PHI we maintain. Should we make such a change, we will display the revised notice to you online, and make it available to you upon request.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to PHI about you as a patient. These rights include:
Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact us at email@example.com or call 631-760-1114
Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to firstname.lastname@example.org. We are not required to agree to those restrictions.
Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as the Pharmacy maintains the PHI. The designated record set usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to email@example.com or speak to Our Pharmacy’s Privacy Officer by calling 631-760-1114. We may charge you a fee for the costs of copying, mailing, postage, or other supplies that are necessary to fulfill your request. Upon receiving your request to access your PHI, we are required to respond to you no later than 30 days after the receipt of your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI. If you feel that PHI 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 PHI. To request an amendment, you must send a request to firstname.lastname@example.org or call 631-760-1114 and speak to the Privacy Officer. You must include a reason that supports your request. We will respond to your request within 60 days with up to 30-day extension, if needed. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we give a rebuttal to your statement.
Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exemptions, restrictions, and limitations. To request an accounting, you must submit a request send a request to email@example.com or call 631-760-1114 and speak to the Privacy Officer. Your request must specify the time period, but may not be longer than six years. We are required to provide you the accounting within 60 days and with one 30-day extension, if needed.
Request communications of PHI by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing, or at a different residence or post office box. To request confidential communication of PHI about you, you must send a request to firstname.lastname@example.org or call 631-760-1114 and speak to the Privacy Officer. Your request must state how or where you would like to be contacted. We will attempt to accommodate all reasonable requests, and will not request an explanation from you to the basis for your request.
We are likely to use or disclose PHI for the following purposes:
Business associates: There are some services provided by us through contracts with business associates. When these services are contracted for, we may disclose PHI about you to our business associates so that they can perform the job we have asked them to do and bill you or your third-party payor for services rendered. To protect PHI about you, we require the business associate to appropriately safeguard the PHI.
Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any 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 or other health-related benefits and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Worker’s compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Public health: As required by law, we may disclose PHI 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 or in response to a valid subpoena or other legal process.
As required by law: We must disclose PHI about you when required to do so by law.
Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI.
We are also permitted to use or disclose PHI about you for the following purposes:
Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law lo carry out their duties.
Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Notification: We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Correctional institution: 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 health and safety of others.
To avert a serious threat to health or safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.
National security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or 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 you.
OTHER USES AND DISCLOSURES OF PHI
The Pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided above or as otherwise permitted or required by law. You may revoke this authorization in writing at any time. Upon receipt of the written revocation we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions or would like additional information about the Pharmacy’s privacy practices, you may send a request to email@example.com or call 631-760-1114 and speak to the Privacy Officer. If you believe your privacy rights have been violated, you have the right to report a complaint to firstname.lastname@example.org or call 631-760-1114 and speak to the Privacy Officer, or to the Secretary of Health and Human Services. Rest assured, there will be no retaliation for filing a complaint regarding our privacy practices.
Please do not hesitate to contact us, if you would like to review the personal information that we hold about you, or if you have any questions about our policies, our websites and apps, or how we collect, use and disclose information, using the information below:
ATTN: Privacy Officer
c/o Main Source Pharmacy
347 Main Street
Huntington, NY 11743
Effective as of January 1st 2018