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Privacy Notice

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. If you have any questions about this notice, please contact us.

Our Obilgations -

We are required by law to:

  • Maintain the privacy or protected health information.
  • Give you this notice of our legal duties and privacy practices regarding health information about you.
  • Follow the terms of our notice that is currently in effect.

How We May Use and Disclose Health Information -

Described as follows are the ways we may use and disclose health information that identifies you ("Health Information"). Except for the following purposes, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice's privacy officer.

Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

Payment. We may use and disclose Health Information so that we or others may bill and receive payment form you, an insurance company, or a third party for the services you received. For example, we may give your health plan information so that they will pay for your medications.

Health Care Operations. We may use and disclose Health Information for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our company. for example, we may use and disclose information to make sure the pharmacy care you receive is of the highest quality. We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operations activities.

Health-Related Benefits & Services. We may use and disclose Health Information to remind you that you have medications which require refill, or are ready for pick-up. Messages of a non-sensitive nature related to your health care, including, but not limited to, test results, may be left on your answering machine, voicemail, or with a household member. Discretion will be used. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may by of interest to you.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend.

Research. Under certain circumstances, we may use and disclose Health Information for research. For example, a reasearch project may involve comparing the health of patients who received one treatment to those who received another for the same condition. Before we use or disclose Health Information for research, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for similar purposes, as long as they do not remove or take a copy of any Health Information.

Special Situations -

As required by law. We will disclose Health Information when required to do so by international, federal, state or local law; examples follow:

To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.

Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions and services. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other that as specified in our contract.

Organ & Tissue Donation. If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement, or other entities engaged in procurement; banking or transportation of organs, eyes, or tissues to facilitate organ, eye, or tissue donation; and transplantaion.

Military & Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Worker's Compensation. We may release Health Information for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; report reactions to medications or problems with products; notify people of recalls of products they may be using; inform a person who may have been exposed to a disease or may be at risk for contacting or spreading disease or condition. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits & Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information 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 to obtain an order protecting the information requested.

Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is 1) in response to a court order, subpoena, warrant, summons, or similar process; 2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; 3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person's agreement; 4) about a death we believe may be the result of criminal conduct; 5) about criminal conduct on our premises; and 6) in an emergency to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors. We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.

National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, or other authorized persons or foreign heads of state, or to conduct special investigations.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be made if necessary: 1) for the institution to provide you with health care; 2) to protect your health or safety, or the health and safety of others; 3) for the safety and security of the correctional institution.

Your Rights -

You have the following rights regarding Health Information we have about you:

Right to Inspection & Copy. You have a right to inspect and/or request a copy of Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records. To inspect and/or request a copy of this, you must make your request, in writing to Freedom Pharmacy. Standard fees for copying records will apply.

Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by of for our office. to request an amendment, you must make your request, in writting, to Freedom Pharmacy.

Right to Accounting of Disclosure. You have the right to request a list of certain disclosures we made of the Health Information for purposes other than treatment, payment, and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writting, to Freedom Pharmacy.

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to Freedom Pharmacy. We are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Request Confidential Communication. You ahve the right to request that we communicate with you about medical matters in a certain way, or at a certain location. For example, you can ask that we contact you by mail or at work. To request confidentail communication, you must make your request, in writting, to Freedom Pharmacy. Your request must specifiy how or where you wish to be contacted. We will try to accomodate reasonable requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time. We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Meryl Biszick. All complaints must be made in writing. You will not be penalized for filing a complaint.