Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The company is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide to individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is 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, the provision of health care products and services to you or payment for such services.
References to “Support Source”, “we,” “us,” and “our” include Support Source and the members of its affiliated covered entity. An affiliated covered entity is defined as a group of organizations under common ownership or control who designate themselves as a single affiliated covered entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). For a list of the members of the affiliated covered entity please contact our privacy officer.
Our organization is dedicated to maintaining the privacy of your identifiable health information and therefore all employees and members are all bound to follow the terms of this Notice of Privacy Practices (“Notice”). This means that by law we are required to maintain the confidentiality of Protected Health information that identifies you. This Notice describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. This Notice also describes your rights with respect to PHI about you.
We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. The potential revised and updated Notice is available upon request through our privacy officer.
To summarize this notice provides you with the following important information:
· How we may use and disclose your Protected Health Information
· Your privacy rights in you Protected Health Information
· Our obligations concerning the use and disclosure of your Protected Health Information
· How we may use and disclose your Protected Health Information
The following categories describe different ways that we may use and disclose your Protected Health Information except where prohibited by federal or state laws that require special privacy protections. Not every permissible use or disclosure will be listed in the Notice. Some types of Protected Health Information, such as genetic information, alcohol and/or substance abuse records, HIV information, and mental health records may be subject to different confidentiality protections under appropriate state or federal law and we will abide by these special protections. These categories include examples of such uses or disclosures for each category. For additional information about special state laws, please feel free to contact our privacy officer.
Treatment. Our pharmacy may use your PHI to provide and coordinate the treatment, medications and services you receive. For example, our pharmacy may disclose PHI to pharmacists, prescribers, nurses, technicians and other professionals involved in your care in order to help us optimize your treatment.
Payment. Our pharmacy may use your PHI in order to bill and collect payment for the services and items we provide to you and for other payment activities related to the services that we provide. For example, our pharmacy may contact your insurer, pharmacy benefit manager, or other third-party payer to determine to what degree it will pay for health care related costs. By doing so we will be able to determine the cost of your co-payment and prescription. The information that is transmitted to your payer and accounts receivable department may include information that identifies you, as well as information about the services that were provided to you including the medications that you are being prescribed. Our pharmacy may disclose your PHI to other health care providers or HIPAA compliant covered entities for payment activities.
Health Care Operations. Our pharmacy may use and disclose your PHI to support our business activities. These activities include but are not limited to review and assessment of the quality of the services and products we provide you in addition to the outcomes of your therapy. Our pharmacy may disclose your PHI to attorneys and auditors dispatched by the government and/or payers. We may also disclose and use your PHI to monitor the performance of our staff and employees, including the health care professionals employed by our organization. Interns and students may also use your PHI for educational purposes.
We may also disclose your PHI to other HIPAA covered entities that have provided services to you in order to improve their quality and effectiveness. All disclosed PHI will be to entities that have had a relationship with you and pertains to that relationship. In some cases your information will be deidentified, meaning all your personal information will be removed so that the information transmitted cannot identify you.
In addition to the categories above, we may also use and disclose your Protected Health Information (“PHI”) without your prior authorization for the following purposes:
Business Associates. Our pharmacy may contract you with third parties to perform certain services. These services are delegated to contractors and include but are not limited to billing services, copy services and/or consulting services. For example, we may provide PHI to a claims submission service that ensures that our claims are submitted in the appropriate form to the appropriate payers. To protect you, we require the business associate to appropriately protect your health information.
Communication with individuals involved in your care and payment for your care. Our pharmacy may disclose your PHI to family members, relatives, or other individuals responsible for your care and/or payment for your care. If a person has the authority by law to make health care decisions for you, we will generally regard that person as your
“personal representative” and treat them the same way we would treat you with respect to your PHI.
Food and Drug Administration (“FDA”). Our pharmacy may disclose to persons under the jurisdiction of the FDA or the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post-marketing surveillance information to enable project recalls, repairs, or replacement.
Refill reminders. Our pharmacy may contact you to provide refill reminders or communication with you about a prescription that is prescribed to you so long as any payment we receive for making the communication is reasonably related to our cost of making the communication.
Workers compensation. Our pharmacy may disclose your PHI as authorized by and as necessary to comply with laws relating to workers compensation or similar programs.
Public Health. Our pharmacy may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law Enforcement. Our pharmacy may disclose your PHI for law enforcement purposes as required by law or in response to a valid subpoena or other legal process. For example, if law enforcement presents a valid subpoena or court order, limited information can be provided to them according to this Notice.
As required by law. Our pharmacy must disclose your PHI when required by law.
Health oversight activities. Our pharmacy may disclose your PHI to an oversight agency for activities authorized by law such as state boards of pharmacy and the U.S. Drug Enforcement Administration (“DEA”). 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.
Judicial and administrative proceedings. If you are involved in a lawsuit or dispute, our pharmacy may disclose your PHI in response to a court administrative order. Our pharmacy may disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if the efforts have been made by the requesting party to tell you about the request or to obtain an order protecting the requested PHI.
Notification. Our pharmacy may use or disclose your PHI to notify or assist in notifying a family member, personal representative or other individual involved in your care of information regarding you location and general condition.
Coroners, medical examiners and funeral directors. Our pharmacy may disclose you PHI to a coroner or medical examiner for identification purposes, determining cause of death or for other reasons authorized by law. Other personnel may use this information to perform their duties.
Correctional institution. If you are or become an inmate of a correctional institution, our pharmacy may disclose to the institution or its agents, your PHI for your health and the health and safety of others such as the public and other persons.
Military and veterans. If you are a member of the armed forces, our pharmacy may release your PHI as require by military command authorities.
To avert a serious threat to health or safety. Our pharmacy may use or disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public and other persons.
Victims of abuse, neglect or domestic violence. Our pharmacy may use or disclose your PHI 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. Our pharmacy will only disclose information to the extent required by law, if you agree to the disclosure or if the disclosure is allowed by law and our pharmacy believes it is necessary to prevent serious harm to you or other persons, or the law enforcement or public official that is to receive your information represents it is necessary.
The pharmacy must receive your authorization before using or disclosing your Protected Health Information (“PHI”) for purposes other than those listed above or as other permitted or required by law:
Specific uses or disclosure notices. Our pharmacy will obtain your written authorization for the use or disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI, except in limited circumstances where applicable law allows such uses or disclosure without your authorization.
Fundraising. Our pharmacy will use or disclose your PHI as permitted by applicable law, we may contact you to provide you with information about fundraising efforts for various disease-state programs or other related efforts
Other uses and disclosures of Protected Health Information. Our pharmacy will obtain your written authorization before using or disclosing your PHI for purposes other than those described in this Notice or otherwise permitted by law. You have the right to revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.
The pharmacy offers you the right to object to any uses and disclosures listed below:
Family and friends involved in your care. Unless you object, we may disclose your PHI to a member of your family or an individual who guarantees or is otherwise responsible for payment for your care.
Your health information rights:
Obtain a paper copy of the Notice upon request. You may request a copy of this notice at any time. To obtain a paper copy of this Notice please contact us through our website, in person, on the phone or by mail to our pharmacy. If mailing please direct to our privacy officer. Some health care providers may retain copies of this Notice for your use and review.
Request a restriction on certain uses and disclosures of Protected Health Information. You have the right to request additional restrictions on our use or disclosure of your PHI that we maintain by sending a mailed formal request to our pharmacy’s privacy officer. Our pharmacy is not required to agree to accept your restrictions unless the disclosure is to a health plan for purposes of carrying out payment or health care operations and is not otherwise required by law and your PHI pertains solely to a health care item or service for which you or a person on your behalf has paid in full. In the event that we accept your request for PHI restrictions, we will abide as it is related to your PHI on a going forward basis.
Inspect and obtain a copy of your Protected Health Information. You have the right to access and inspect or obtain a copy of your PHI. Our pharmacy will maintain records containing your PHI, in the case that this record is in an electronic format, you have the right to request it in this format. To access or copy your PHI you are required to send or deliver a formal written request to our pharmacy’s privacy officer. You may ask us to send a copy of your PHI to other individuals or entities that you designate in writing. Our pharmacy can deny your request to inspect and copy in certain limited circumstances. In the case that you are denied access, you may request that the denial be reviewed.
Request an amendment of Protected Health Information. If you feel that PHI that has been maintained about you is incomplete or incorrect, you may request an amendment. To request an amendment, you must send or deliver a formal written request to our pharmacy’s privacy officer. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we will provide you with reasons as to the denial of your request.
Receive an accounting of disclosures of Protected Health Information. You have the right to receive an accounting of certain disclosures we have made of your PHI for most purposes. These disclosures can be delivered to you or other individuals involved with your care. To request an accounting of disclosures of PHI you must submit a written request to our pharmacy’s privacy officer.
Request communications of Protected Health Information by alternative means or at alternative locations. You have the right to request that we communicate with you about health matters in a certain way or at an alternative location. For example, you may request that we contact you at a different residence, via e-mail or by other means. If you request an electronic means of communication we cannot guarantee the security and protection of your PHI. In order to receive alternative communications please submit a written request to our pharmacy’s privacy officer. Our pharmacy will make all attempts to reasonably accommodate your needs. In the case that communication via the means you request has failed, we will attempt to contact you via the information we have.
For more information or to report a problem:
If you have questions or would like additional information regarding our pharmacy’s privacy practices, you may contact us in person or by mail addressed to our pharmacy. Please direct all correspondence to our privacy officer. If you believe your privacy rights have been violated, you may submit a complaint via our complaint form by phone, mail or other means. There will be no retaliation for filing a complaint.
Right to change terms of this notice: We may change the terms of this Notice at any time. In the event our pharmacy changes this Notice, we may make the new notice terms effective for all your PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice for your access. If you would like to request a new notice upon revision please communicate with our privacy officer.