THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY THE SANTA MONICA HOMEOPATHIC PHARMACY, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Pharmacy is required by law to maintain the privacy of the health information it maintains about its customers (also known as “Protected Health Information” or “PHI”) and to provide its customers 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. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, obtain payment or perform our 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. The Pharmacy will follow the practices described in this Notice. Except as described in this Notice, we will not use or disclose PHI about you without your written authorization. We reserve the right to change our practices and this Notice. In the event that we revise this Notice, the new Notice provisions will be effective for all PHI we maintain. We will provide you with a revised Notice upon request.
EXAMPLES OF HOW WE MAY USE AND DISCLOSE YOUR PHI
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, of information regarding your location and your general condition.
To avert a serious threat to your 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.
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 must obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. For example, in limited circumstances, state or federal law (that provides special privacy protections for certain types of highly sensitive health information) may require the Pharmacy to obtain your authorization to use or disclose sensitive health information. You may revoke an authorization in writing at any time. Upon receipt of a 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.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to your PHI that we maintain:
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, or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.”
Request a restriction on certain uses and disclosures of PHI. You have the right to request certain restrictions on our use or disclosure of your PHI that we maintain. To request such a restriction, please provide a written request in person or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.” We are not required to agree to accept your requested restrictions unless the disclosure is to a health plan for purposes of carrying out payment or health care operations and the information pertains solely to a health care item or service for which you have paid the Pharmacy out of pocket in full. In the event that we do grant your request, however, we will abide by the restriction as it relates to your PHI on a going-forward basis.
Inspect and obtain a copy of PHI. You have the right to inspect or obtain a copy of PHI about you that is contained in a “designated record set” for as long as the Pharmacy maintains your PHI in the designated record set. The designated record sets we maintain include your customer contact information, records about drugs and services provided to you, and billing records. To inspect or copy PHI about you, you must send a written request in person or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.” We may charge you a fee for the costs of copying, mailing, and supplies that are necessary to fulfill your request. We may deny your request in certain limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed.
Request an amendment of PHI. If you feel that the 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 in a designated record set. To request an amendment, you must send a written request in person or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.” You must include a reason that supports your request for amendment. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may provide a rebuttal to your statement.
Receive an accounting of disclosures of PHI. You have the right to receive an accounting of certain disclosures we have made of PHI about you for most purposes other than treatment, payment, and health care operations. The accounting will exclude certain disclosures, such as those 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 exceptions, restrictions, and limitations. To request an accounting, you must submit a written request in person or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.” Your request must specify the time period for which the accounting is requested, which may not be longer than six years. The first accounting you request within a twelve-month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Request communications of PHI by alternative means or at alternative locations. You may request that we contact you concerning your PHI by alternative means and/or at alternative locations. For example, you may request that we contact you about medical matters only in writing or at a different residence. To request to receive communications of your PHI by alternative means or at alternative locations, you must submit a written request in person or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.” Your request must state how or where you would like to be contacted. We must accommodate all reasonable requests. We will not ask you to provide a reason for your request.
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 contact us in person or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.” If you believe your privacy rights have been violated, you may submit a complaint via the contact information address set forth above. There will be no retaliation for filing such a complaint.
RIGHT TO CHANGE TERMS OF THIS NOTICE
We may change the terms of this Notice at any time. If we change 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 on our website. You also may obtain any new notice by contacting us through our website, in person, or by mail addressed to our pharmacy location and directed to “Attention: HIPAA Privacy Official.”
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