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.
THIS NOTICE DESCRIBES:
- HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
- YOUR RIGHTS WITH RESPECT TO YOUR MEDICAL INFORMATION
- HOW TO EXERCISE YOUR RIGHT TO GET COPIES OF YOUR RECORDS AT LIMITED COST OR, IN SOME CASES, FREE OF CHARGE
- HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY, OR SECURITY OF YOUR MEDICAL INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION, INCLUDING YOUR RIGHT TO INSPECT OR GET COPIES OF YOUR RECORDS UNDER HIPAA. YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH THE PRIVACY OFFICE AT PRIVACYOFFICER@ADELAIDEAPOTHECARY.COM IF YOU HAVE ANY QUESTIONS.
Effective Date: March 31, 2023
When this Notice refers to "we" or "us" or "Adelaide," it is referring to Adelaide Apothecary, LLC.
The policies outlined in this Notice apply to all of your health information generated by Adelaide, whether recorded in your medical record, invoices, payment forms, or other ways. We are required by the Health Insurance Portability and Accountability Act (“HIPAA”) to provide you with this Notice to help you understand how we may use or share Protected Health Information (“PHI”) about you that we obtain to provide services to you. The policies also apply to the PHI gathered from other health care providers or organizations by any Adelaide employee, independent contractor or volunteer who participates in your care, including information we receive pursuant to Adelaide's participation in health information exchanges, accountable care organizations, or clinically integrated networks.
- We are required by law to maintain the privacy and security of your PHI.
- We are required to provide you with this Notice describing our legal duties and privacy practices concerning your PHI. We reserve the right to change the terms of this Notice and to make those changes applicable to all PHI that we maintain. Any changes to this Notice will be posted on our website and will be available from us upon request.
- We are required to abide by the terms of this Notice. We will not use or share your information other than as described herein unless you tell us we can in writing. If you tell us we can, you may change your mind at any time and let us know in writing if you change your mind.
- We are required by law to notify you if there is a breach of any of your PHI which was unsecured and that compromised the privacy or security of your PHI.
You have certain rights with regard to the PHI we maintain about you. This section explains your rights and some of our responsibilities to help you. You have the right to request to:
- Inspect or obtain a paper or electronic copy of your PHI contained in clinical, billing, or other records. You also have a right to direct that your health information be sent to a third party in electronic form. If you request copies, you will be charged a reasonable, cost-based fee for copying and mailing the requested information. In certain instances, these copies may be provide free-of-charge, such as when you are viewing your health information on your smartphone or computer or on an app.
- Correct or amend the PHI we maintain about you if you think it is incorrect or incomplete. You may request an amendment by submitting a written request. You must provide a reason for your request. If we deny your request for an amendment, we will provide you an explanation of why we denied it.
- Receive confidential communications from us at an address or contact method you specify, upon reasonable request. This means that you may, for example, designate that we contact you only via e-mail, or at work rather than home.
- Limit or restrict disclosures of certain information about you for treatment, payment or our healthcare operations except where we are required by law to disclose your information. We are not required to agree to your restriction request unless the disclosure you wish to prevent is to your health plan for payment or health care operations and pertains to services paid for out-of-pocket in full.
- Obtain a list (or accounting) of those with whom we have shared your information in the prior six years from the date you ask, except for disclosures about treatment, payment, and health care operations, and certain other disclosures.
- Get a copy a paper copy of this Notice (even if you have agreed to receive an electronic version) at any time or obtain an electronic copy available on our website at www.adelaideapothecary.pharmacy.
- Have someone to act on your behalf, such as a medical or healthcare power of attorney or legal guardian and allow such person to exercise your rights and make choices about your PHI.
You may exercise these rights at any time by contacting us using the contact information at the bottom of this Notice. Please note that certain exceptions or parameters may apply to these rights which we will further clarify with you when applicable.
Our Use and Disclosure of Your Information
We may use and share your information for certain purposes without requiring your authorization and without offering you an opportunity to object. For example, we may use or disclose your PHI for the following purposes:
- Treatment: To provide you with treatment and care, such as determining your eligibility or filling your prescriptions.
- Payment: For billing and payment activities associated with your prescription orders or other treatment services.
- Health Care Operations: To operate our pharmacy and run our business for day-to-day operations and functions, such as for quality improvement activities. We may also disclose your health information to another covered entity (health care provider, health plan or health care clearinghouse) to allow it to perform certain of its day-to-day functions, but only to the extent that we both have a relationship with you.
- Health Oversight Activities: For health oversight activities such as inspections, audits, surveys and licensing requirements by state and federal agencies.
- Public Health: To help with public health and safety issues such as preventing or controlling disease, injury or disability; reporting births, deaths and certain injuries or illnesses or suspected abuse or neglect as required by law; reporting reactions to medications or problems with or recalls of products; or to notify a person who may have been exposed to a disease or at risk of contracting or spreading a disease or condition.
- Required by Law: We will disclose your PHI when required by federal, state or local law.
- Avert a Serious Threat to Health or Safety: We may use or disclose your PHI when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person.
- Organ or Tissue Donation: If you are an organ or tissue donor, after your death, we may be required by law to provide PHI to organ procurement organizations, tissue and eye banks.
- Military and Veterans: We may release your PHI as required by military authorities, including information about foreign military personnel or the Department of Veterans Affairs for eligibility and other authorized activities.
- Correctional Institution: If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents PHI necessary for your health and the health and safety of others.
- Coroners, Medical Examiners and Funeral Directors: To assist a medical examiner or funeral director in carrying out their lawful duties.
- Workers’ Compensation: We may disclose PHI about your treatment as required to comply with laws and regulations related to workers’ compensation or similar programs for benefits for work-related illnesses or injuries.
- Law Enforcement and National Security: In response to law enforcement or other government requests, in accordance with applicable laws, such as: to identify or locate a fugitive, suspect, material witness or missing person; a death believed to be the result of criminal conduct or suspected criminal conduct that occurs on our premises; or in emergency circumstances to report a crime, to location of a crime or identity or description of the person who committed the crime; for counterintelligence and national security activities or protection of the President and other heads of state.
- Judicial and Administrative Proceedings: To respond to court orders, subpoenas, warrants, summons or similar legal actions or processes.
- De-Identified Material: To create de-identified materials that originally had identifying information about you, but which was deleted from the final materials, including for research and product or service development purposes.
- Victims of Abuse, Neglect, or Domestic Violence: To disclose information about victims of abuse, neglect or domestic violence as required by law.
- Disclosures to Parents or Legal Guardians: We may release a minor’s PHI to their parents or legal guardians consistent with applicable laws.
- Business Associates: To disclose information for services provided by us through contracts with HIPAA business associates. We may disclose PHI about you to our business associates so they can provided the services we have asked them to provide. Our business associates will be required by law and contract to appropriately safeguard your PHI.
We may also disclose your PHI for disaster relief purposes or to a family member, friend, or any other person who is involved in your care or payment for care, unless you object. In this case, you have the right and choice to tell us to share PHI with your family, friends, or others involved in your care. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest. However, except in emergency circumstances, we will inform you of our intended action prior to making any such disclosures and will, at that time, offer you the opportunity to object.
Other Uses and Disclosures
Other uses or disclosures of your PHI not covered by this Notice, including disclosure or sale of your PHI in exchange for payment or use or disclosure for marketing purposes, will only be made with your authorization. If you authorize us to use or disclose your information for certain purposes, you can revoke your authorization at any time using the contact information at the bottom of this Notice but such revocation will not apply to information already used or disclosed in reliance on the authorization.
Your state and other federal laws may have additional requirements that we must follow or that may be more restrictive than HIPAA on how we use and disclose your PHI. If there are more restrictive requirements, even for some of the purposes listed above, we may not disclose your health information without your written permission as required by such laws.
You also have the right to file a complaint if you feel we have violated your privacy rights and may do so by contacting us using the contact information at the bottom of this Notice. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
If you have any questions about this Notice, our privacy practices or your rights, please contact us at:
- Privacy Officer
- Adelaide Apothecary
- 160 Moore Dr., Suite 105, Lexington, KY 40503