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 Health Information:
We at Evers Pharmacy understand the importance of maintaining the privacy of your protected health information. "Protected health information" is information about you, including demographic information, that can reasonably be used to identify you and that relates to your past, present or future physical or mental health or condition, the provision of health care to you or the payment for that care. This Notice of Privacy Practices ("Notice") describes our privacy practices and your rights regarding your protected health information.
Your Health Information Rights
Inspect and obtain copies of your protected health information records, with some limited exceptions. We will provide you a copy of your protected health information in the form and format requested, if it is readily producible in such form and format, or if not, in a readable hard copy or electronic form or such other form and format as agreed to by Evers Pharmacy and you. You may request that we transmit the copy of your protected health information directly to another person, provided your request is in writing, signed by you, and you clearly identify the designated person and where to send the copy of the protected health information.
• request an amendment to your protected health information records in writing if you believe it is incorrect or incomplete.
• obtain an accounting of disclosures of your protected health information for the time period no longer than six years prior to the date of your request (three years for certain disclosures from an Electronic Health Record if required by regulation). We are not required to account for disclosures for treatment, payment, or health care operations purposes, among others. Depending on the compliance date required by law for a particular record, an accounting of the disclosures from an Electronic Health Record may include disclosures for treatment, payment or healthcare operations. The first list of disclosures you request within a 12-month period will be free. For additional lists, we may charge for the costs of providing the list. We will notify you of the cost involved and
you may choose to withdraw or modify your request at that time before any costs are incurred.
• request that communications be sent to you by alternative means or at an alternative address if receipt of the communications could endanger you.
• request restrictions on certain uses and disclosures of your protected health information, but we are not required to agree to such 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 the protected health information pertains solely to a health care item or service for which you, or a person on your behalf other than a health plan, have paid the covered entity out of pocket in full.
• request a paper copy of this Notice, even if you had previously agreed to receive an electronic copy.
• receive written notification of a breach where your unsecured protected health information has been accessed, used, acquired, or disclosed to an unauthorized person as a result of such breach, and which compromises the security or privacy of your protected health information. Unless specified in writing by you to receive the notification by electronic mail, we will provide such written notification by first-class mail or, if necessary, by such other substituted forms of communication allowable under the law.
• exercise any of these rights by contacting our Privacy Official. See the contact information at the end of this Notice.
• maintain the privacy of your protected health information as described in this Notice.
• provide you with this Notice as to our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information.
• follow the privacy practices described in this Notice while it is in effect.
• use and disclose your protected health information for treatment, payment and health care operations and for other permitted purposes as described more fully below.
• accommodate reasonable requests you may have regarding communicating protected health information to you by alternative means or to an alternative address.
• reserve the right to charge you a reasonable fee for services requested, to the ex tent allowed by law. Examples of Use and Disclosures for Treatment, Payment and
We use and disclose your protected health information for treatment.
For example: A prescription sent to us may be used for the purposes of filling and dispensing the prescription. We may need to consult with your health care providers regarding your prescription if our systems indicate an adverse drug interaction or to suggest alternative treatment options. We may exchange your protected health information electronically for treatment and other permissible purposes. We use and disclose your protected health information for pharmacy operations. For ex ample: We may use your protected health information to perform quality assessment activities. This information will then be used in an effort to continually improve the quality and effectiveness of the services we provide. We use and disclose your protected health information for payment. For example: We use and disclose your protected health information in order to receive payment for prescription drugs and services provided to you. We may contact your health plan, pharmacy benefit manager or other third party payer to determine whether it will pay for your drug and the amount of your co-pay responsibility established by law.
Other Permitted Uses or Disclosures:
As Required by Law: We must disclose protected health information about you when required to do so by law.
Public Health Activities:
We may disclose protected health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. We may also disclose protected health information relative to adverse events with respect to drug products and product defects or post marketing surveillance information as required by the Food and Drug Administration.
Health Oversight Activities:
We may disclose protected health information to an appropriate health oversight agency for activities authorized by law.
Judicial and Administrative Proceedings:
We may disclose protected health information for law enforcement purposes and judicial or administrative proceedings as required or permitted by law or in response to a valid subpoena.
Coroners, Funeral Directors, Organ Donation:
We may release protected health information to coroners or funeral directors as necessary to allow them to carry out their duties. We may also disclose protected health information in connection with organ or tissue donation.
Under certain circumstances, we may disclose protected health information for research purposes, provided certain measures have been taken to protect your privacy.
To Avert a Serious Threat to Health and Safety:
We may disclose protected health information about you, with some limitations, when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person.
There are some services we provide through contracts with business associates. Examples include software or technology vendors we may utilize to provide technical support, attorneys providing legal services to us, accountants, consultants and others. When such a service is contracted, we may share your protected health information with such business associate and may allow our business associate to create, receive, maintain, or transmit your protected health information on our behalf, in order for the business associate to provide services to us, or for the property management and administration of the business associate. In addition, our business associate may re-disclose your protected health information to business associates that are subcontractors in order for the subcontractors to provide services to the business associate. The subcontractors will be subject to the same restrictions and conditions that apply to the business associates. Whenever such an arrangement involves the use or disclosure of your protected health information, we will have a written contract that contains terms designed to protect the privacy of your protected health information.
We may contact you to provide you refill reminders or information about treatment alternatives or other healthrelated benefits and services that may be of interest to you.
Communication with Family:
In certain situations, health professionals, using their best judgment, may disclose protected health and/or payment information to a family member, other relative, close personal friend or any other person involved in your care or payment for care.
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof, health information necessary for your health and the health and safety of others.
Military and Veterans:
If you are a member of the armed forces, we may release protected health information about you as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate military authority.
National Security and Intelligence Activities:
We may release protected health information 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 protected health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.
Victims of Abuse, Neglect or Domestic Violence:
We may use and disclose protected health information to report suspected abuse, neglect, or domestic violence. For example, we may disclose protected health information 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 may make these disclosures to the extent required or permitted by law.
We may contact you to raise funds for our benefit. You have the right to opt out of receiving such communications.
Limited Data Set and De-identified Information:
We may use or disclose your protected health information to create a limited data set or de-identified information, and use and disclose such information as permitted by law.
Other Uses or Disclosures with an Authorization:
The following uses and disclosures will be made only with your written authorization as required by HIPAA: (i) most uses and disclosures of psychotherapy notes (to the ex tent maintained by Evers Pharmacy); (ii) uses and disclosures of protected health information for marketing purposes, including subsidized treatment communications, except face-to-face communications or other marketing permitted by HIPAA without authorization; (iii) disclosures that constitute a sale of protected health information; and (iv) other uses or disclosures not described in this Notice. You may revoke an authorization at any time in writing, except to the extent that we have already taken action in reliance on the information disclosed. Unless otherwise permitted by applicable laws or rules or by your written authorization, we will not directly or indirectly receive remuneration in exchange for your protected health information. When using or disclosing your protected health information or requesting your protected health information from another covered entity, we will make reasonable efforts to limit such use, disclosure, or request, to the extent practicable, to the minimum necessary to accomplish the intended purpose of such use, disclosure, or request, respectively. State law may be more stringent and may restrict or prohibit certain uses or disclosures identified in this Notice. If more stringent state laws apply, they will be included in an addendum to this Notice.
Health Information Security:
Evers Pharmacy requires its employees to follow the security policies and procedures that limit access to protected health information about members to those employees who need it to perform their job responsibilities. Evers Pharmacy maintains physical, administrative and technical security measures to reasonably and appropriately safeguard your protected health information.
Changes to this Notice:
We reserve the right to change our practices and to make the new provisions effective for all information we have about you. You may request a copy of our current notice at any time by contacting the Privacy Official using the contact information at the end of this Notice. We also post a copy of our current Notice on our website at
If you believe your privacy rights have been violated and would like to file a complaint, you may file your complaint in writing with us at the contact information below and/or with the Secretary of the Department of Health and Human Services. There will be no retaliation for filing a complaint.
Contact the Privacy Official:
If you have questions or would like to ex ercise any of the rights as described above, you may contact the Privacy Official in writing at Evers Pharmacy, 142-02 Rockaway Blvd, Jamaica, NY 11436 or by calling (888) 93-EVERS