Dear Assured Rx Customer,
Respecting your privacy is a top priority at Assured Rx Pharmacy. We believe that maintaining your privacy, as well as maintaining and improving your health, deserve the utmost concern and care. Concern for your right to privacy goes hand in hand with our focus on maintaining and improving your health. Effective April 14, 2003, health care providers must comply with a new set of federal regulations. These regulations are a part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which addresses your right to privacy and the handling of Protected Health Information (PHI).
One of the new regulations requires that all of our patients receive our Notice of Privacy Practices prior to providing health care services. We are also required to ask each patient to sign an acknowledgment, indicating the receipt of this notice. We wish to insure you that there will be no delay in receiving any health care services. This is why we are asking you to read the enclosed Notice of Privacy Practices. Once you are done reading the Notice of Privacy Practices, please print and sign the acknowledgement form, and return it by mail, or fax, to:
13555 Automobile Blvd, Suite 230, Clearwater, FL 33762
Fax: (888) 209-4962
If you have questions regarding this letter or privacy issues in general, please contact the pharmacy at : (888) 987-9977
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT OUR PATIENTS MAY BE USED AND DISCLOSED AND HOW OUR PATIENTS CAN GET ACCESS TO THIS INFORMATION. PLEASE, REVIEW IT CAREFULLY.
SECTION A: Uses and Disclosures of Protected Health Information (PHI)
Under applicable laws, we are required to protect the privacy of a patient's individual health information (information we refer to in this notice as PHI). We are also required to provide all patients with this notice regarding our policies and procedures concerning a patient's PHI. Furthermore, we must abide by the terms of this notice, as it may be updated from time to time. However, patients are not required to be warned of any updates to this notice, and it is up to the patient to stay current with any updates or changes. We are permitted to make certain types of uses and disclosures of PHI under applicable law for the purpose of treatment, payment, and healthcare operation. We may obtain information to dispense prescriptions. Information may be used for the documentation of pertinent information in a patient's record(s) that may assist us in effectively managing education therapy to improve a patient's overall health. For treatment purposes, such use and disclosure will take place in providing, coordinating, and/or managing healthcare and its related services by other health care providers. Such instances include, but are not limited to when a pharmacist consults with a physician or a specialist regarding a patient's medication(s), treatment, or condition.
For payment purposes, use and disclosure of PHI will take place to acquire reimbursement for providing pharmaceutical care and services. An example of this is when a patient's case is reviewed to ensure that appropriate care was rendered. For reimbursement purposes, PHI may be disclosed to one or several intermediaries employed by a patient's plan sponsor. The intermediaries include, but are not limited to insurers, pharmacy accounting managers, claims administrators, and computer switching companies.
For healthcare operations purposes, such use and disclosure will take place for a number of reasons. These reasons include quality assessment and improvement, provider review and training, underwriting activities, reviews and compliance activities; planning, development, management, and administration. PHI could be used, for example, to assist in the evaluation of the quality of care that a patient is provided. We store some PHI in electronic computer files. We backup our electronic records daily and employ other precautions to safeguard the integrity of PHI. In spite of these precautions it is possible but highly improbable that a computer crash or other technological failure could cause the loss of data. In addition, reasonable safeguards and securities are implemented to protect all PHI stored in an electronic media. We may contact a patient to provide refill reminders, health screenings, wellness events, inoculations, vaccinations, information about treatment alternatives, or other health-related benefits and services that may be pertinent. In addition, we may disclose PHI to a patient's plan sponsor, or we may contact the patient for the purpose of remaining balances. We may use and disclose PHI, without authorization, when the pharmacy needs to contact a physician or physician's staff. Furthermore, we are permitted and required to do so without an individual's written authorization, as stated in the previous paragraphs. We may use and disclose a patient's PHI if we are contacted by another pharmacy who states they have a 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. We may disclose PHI about a patient without authorization so that we may comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, and health oversight activities. Other uses and disclosures will be made only with a patient's written authorization, of which the patient may revoke authorization by using the contact information provided in Section B. Patients may ask us to restrict uses and disclosures of their PHI while carrying out treatment, payment, or healthcare operations. A patient may also ask us to restrict uses and disclosures to family members, relatives, friends, or particular others identified by the patient as being involved in payment for the patient's care. However, we are not required to agree to a patient's request. A patient has the right to request the following with respect to PHI: (a) inspection and copying;(b) amendment or correction; (c) an accounting of the disclosures of this information by us (we are not required to account for disclosures made for treatment, payment, operations, disclosures to a patient, disclosures to a patient's care giver(s), for notifications, or as otherwise excluded by law); and (d) a receipt of a paper copy of this notice, upon request. We reserve the right to require payment for any request to cover our costs of copying, labor, and/or postage. We must accommodate a request, if reasonable, to receive communications of PHI by alternative means or at alternative locations. To make this request, please use the information provided in Section B. We may use a patient's name to reference prescriptions and pharmaceutical care services. Patients may be required to sign a signature log to acknowledge receipt of service. This signature acknowledges receipt of the Notice of Privacy Practices and the disclosure of PHI as outlined herein.
We may disclose this information to certain people requesting a patient or a patient's prescriptions by name. Patients may restrict or prohibit these uses and disclosures by notifying a pharmacy representative orally or in writing. We are able to provide treatment services to a patient even if that patient objects to signing the acknowledgment of the receipt of this notice or if we decide not to honor a request regarding PHI. In the event of an emergency or a patient's incapacity, we will do in our reasonable judgment what is consistent with a patient's known preference, and what we determine to be in a patient's best interest. We will inform a patient of any such uses or disclosures if such uses or disclosures require a signed authorization. We may disclose PHI to any family member, relative, close personal friend, or any other person identified by the patient. Such people include, but are not limited to those who are involved with care or payment. In addition, we may use or disclose the PHI to notify, identify, or locate family member, personal representative, another person responsible for health care, or certain disaster relief agencies of general condition or death of a patient. If a patient is incapacitated, there is an emergency, or a patient objects to this use or disclosure, we will do, in our judgment, what is in the patient's best interest regarding said disclosure. We will disclose only the information that is directly relevant to a person's involvement with the patient's healthcare. We reserve the right to change the terms of this notice and to make new notice provisions effective for all PHI. A patient may receive a copy of this notice by contacting us as outlined in Section B or upon the receipt of pharmacy care services. If a patient believes that his/her privacy rights have been violated, that patient may submit complaint(s)by contacting 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 Avenue SW, Washington, DC 20201. Please note that a patient will not be retaliated against for filing a complaint.
Section B: Contacting Us
13555 Automobile Blvd, Suite 230 Clearwater, FL 33762