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VALUE
CENTER PHARMACY & WELLNESS CENTER
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!
SECTION
A: Uses and Disclosures of Protected Health Information
Under applicable law, we are required to protect the privacy of
your individual health information (information we refer to in this
notice as "Protected Health Information"). We are also required
to provide you with this notice regarding our policies and procedures
regarding your Protected Health Information (referred to as "PHI")
and to abide by the terms of this notice, as it may be updated from
time to time. We are permitted to make certain types of uses and
disclosures under applicable law for treatment, payment, and healthcare
operations purposes. For treatment purposes, such uses and disclosures
will take place in providing, coordinating, or managing healthcare
and its related services by one or more of your providers, such
as when your pharmacist consults with your physician or a specialist
regarding your medications, treatment or condition. For payment
purposes, such use and disclosure will take place to obtain or provide
reimbursement for providing pharmaceutical care services, such as
when your case is reviewed to ensure appropriate care was rendered.
For reimbursement purposes, your PHI may be disclosed to one or
several intermediaries employed by our plan sponsor including but
not limited to insurers, pharmacy benefits managers, claims administrators
and computer switching companies. For healthcare operation purposes,
such use and disclosure will take place in a number of ways, including
for quality assessment and improvement, provider review and training,
underwriting activities, review and compliance activities; planning
development management and administration. Your information could
be used, for example, to assist in the evaluation of the quality
of care you were provided. In addition, we may contact you to provide
refill reminders, health screenings, wellness events, inoculations,
vaccinations or information about treatment alternatives or other
health-related benefits and services that may be of interest to
you. In addition, we may disclose your health information to your
plan sponsor. We may contact you for the purpose of fund raising
activities, unless you object. We may use and disclose your PHI
without your authorization, when the pharmacy needs to contact a
health care provider or staff member and is permitted or required
to do so without individual written consent or authorization. We
may use and disclose your PHI if we are contacted by another pharmacy
who states they have your request and consent to transfer pharmacy
records to them. We may disclose PHI about you without your authorization
to comply with workers compensation laws, as required by law enforcement,
legal proceedings, public health requirements, health overnight
activities and as required by law. From time to time, we may employ
the services of business associates who may assist us in one or
more tasks and who may use, change or create PHI. Business associates
are required to comply with all the privacy regulations on your
behalf. We may use your PHI to bill third parties for products and
services you have received as the law allows. These third parties
are agents whom pay on your behalf. Therefore, the use of PHI by
these third parties is governed by your contracts with these parties.
Other uses and disclosures will be made only with your written authorization
and you may receive your authorization at any time by notifying
us as described in Section B, except to the extent the Pharmacy
has already taken action in reliance on a previously signed authorization
form; You may ask us to restrict uses and disclosures of your PHI
to carry out treatment, payment, or healthcare operations. However,
we are not required to agree to your request. You have the right
to request the following with respect to your PHI: (i) inspection
and copying; (ii) amendment or correction; (iii) an accounting of
the disclosures of this information by us; (We are not required
to account to you for disclosures made for treatment, payment, operations,
disclosures to you, coordination of treatment and communications
or as otherwise excluded by law); and (iv) receipt of the paper
copy of this notice upon request. The Pharmacy will require patients
to make requests for access to their PHI in writing. In addition,
you may request, and we must accommodate the request, if reasonable,
to receive communications of PHI by alternative means or at alternative
locations. To make this request please contact us as described in
Section B. The Pharmacy may charge for supplies, labor and the postage
involved in preparing PHI for your request. If you desire a price
quote for this service you must request one. You have the right
to withdraw your request of the PHI prior to the delivery. We may
use your name to reference your prescriptions and pharmaceutical
care services. You may be required to sign a signature log form
or to acknowledge receipt of service, acknowledge receipt of this
notice and the disclosure of PHI. You may restrict or prohibit these
uses and disclosures by notifying a pharmacy representative or in
writing of your restriction or prohibition. We are not required
to honor those requests. If you request our services, we are able
to provide treatment services to you, even if you object to signing
the acknowledgement of the receipt of this notice or if we decide
not to honor a request regarding the information in this document
while noting your requests and refusals in our records. In the event
of an emergency or your incapacity, we will do in our reasonable
judgment what is consistent with your known preference, and what
we determine to be in your best interest. We will inform you of
any such uses or disclosures under such circumstances and give you
an opportunity to object as soon as practicable. We will also use
our judgment and experience regarding your best interests in allowing
people to pick-up prescriptions. If you are incapacitated, there
is an emergency, or you object to this use or disclosure, we will
do what in our judgment is in your best interest regarding such
disclosure and will disclose only the information that is directly
relevant to the person's involvement with your healthcare. We reserve
the right to change the terms of this notice and to make new notice
provisions effective for PHI created or maintained after the effective
date of such changes. You may receive a copy of this notice by contacting
us as outlined in Section B or upon the receipt of pharmacy care
services. If you believe that your privacy rights have been violated
you may file a complaint at the Pharmacy, mail a complaint as described
in Section B, or contact the Secretary of the Department of Health
and Human Services. You will not be retaliated against for filing
a complaint.
SECTION B:
Contacting Us
You may
contact us for further information at:
VALUE CENTER PHARMACY & WELLNESS CENTER
Attn: Privacy Officer
2157 Eastridge Center
Eau Claire,
WI 54701
This notice
is effective 4/01/03
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