U-Save Pharmacy
3611 2nd Ave
P.O. Box 3243
Kearney, NE 68848
Voice (308) 234-1973
Fax (308) 234-1974
Eric J Hamik R.P. Privacy Officer
www.valueexpressrx.com
eric@valueexpressrx.com
NOTICE
OF PRIVACY PRACTICES (NOPP)
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” PHI). 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 your plan sponsor including but not limited to insurers, pharmacy benefits
managers, claims administrators and computer switching companies.
For
healthcare operations 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, reviews 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. In
addition, 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 physician or physician’s staff 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 that they have your request and consent to transfer pharmacy records to them.
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 disclose PHI about you without your authorization to comply with workers compensation
laws, as required by law enforcement, legal proceedings, public health requirements,
health oversight activities and as required by law.
Other
uses and disclosure will be made only with your written authorization, and you may revoke
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 other healthcare operations, or to restrict uses and disclosures to family members,
relatives, friends or other persons identified by your who are involved in your care or
payment for your care. 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, disclosures to your care givers, for
notifications or as otherwise excluded by law); and (iv) receipt of a paper copy of this
notice upon request. The Pharmacy may 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, to acknowledge receipt of this notice and the
disclosure of PHI as outlined herein. We may
disclose this information to other persons who ask for you or your prescriptions by name. You may restrict or prohibit these uses and
disclosures by notifying a pharmacy representative orally or in writing of your
restriction or prohibition. We are not
required to honor these requests. If you
request our services, we are able to provide treatment services to you, even if you object
to signing the acknowledgment 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
know 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 predictable.
We
may disclose to one of your family members, to a relative, to a close personal friend, or
to any other person identified by you, PHI that is directly relevant to the person’s
involvement with your care or payment related to your care.
In addition, unless you object, we may use or disclose the PHI to notify,
identify, or locate a member of your family, your personal representative, another person
responsible for care, or certain disaster relief agencies of your location, general
condition, or death. 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 will also use our judgment an
experience regarding your best interest in allowing people to pick-up filled
prescriptions, or similar forms of PHI.
We
reserve the right to change the terms of this notice and to make new notice provisions
effective for all PHI we maintain. 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 with us
at the location described in Section B or to the Secretary of the Department of Health and
Human Services, Hubert H. Humphrey Building, 200 Independence Ave SW, Washington, DC
20201. You will not be retaliated against for
filing a complaint.
Section
B: Contacting us
You
may contact us for further information at:
U-Save Pharmacy
3611 2nd Ave
P.O. Box 3243
Kearney, NE 68848
(308)
234-1973
This
notice is effective 4/14/03
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