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.
Effective Date: April 14, 2003 / Last Revised: July 30, 2013
FOLLOW THIS NOTICE
This notice describes the health information privacy practices followed by Parkside Pharmacy.
The practices described in this notice will be followed by all employees who have access to your health information.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your health,
health status, and the health care and services you receive at this Pharmacy. We are required by law to give you this notice.
It will tell you about the ways in which we may use and disclose health information about you and describes your rights and
our obligations regarding the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH
INFORMATION ABOUT YOU
We use and disclose health information about you for treatment, payment and healthcare
operations. For example:
For Treatment We may use or disclose your health information to
a physician or other healthcare provider providing treatment to you in the course of providing Pharmacy services.
For Payment We may use and disclose health information about you so that the services you receive at this Pharmacy
may be billed to and payment may be collected from you, an insurance company or a third party.
Care Operations We may use and disclose health information about you in order to run the Pharmacy and make sure that
you and our other patients receive quality care. For example, we may use your health information to evaluate the performance
of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what
additional services we should offer, how we can become more efficient.
Refill Reminders We may
contact you as a reminder that you have a Prescription refill . Please notify us if you do not wish to be contacted for refill
Required By Law We will disclose health information about you when required to do so
by federal, state or local law.
Family and Friends We may disclose health information about you
to your family members, friends or another person, to the extent necessary to help with your healthcare or with payment for
your healthcare, but only if you agree that we may do so.
Health Oversight Activities We may disclose
health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures
may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance
with civil rights laws.
National Security and Intelligence We may disclose to military authorities
the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal
officials health information required for lawful intelligence, counterintelligence, and other national security activities.
To Avert a Serious Threat to Health or Safety We may use and disclose health information 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.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION We will not use or disclose your health information for
any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain
your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to use or disclose
health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization,
we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot
take back any uses or disclosures already made with your permission.
USES AND DISCLOSURES THAT REQUIRE
YOUR AUTHORIZATION Without your authorization, we are expressly prohibited to use or disclose your protected
health information for marketing purposes. We may not sell your protected health information without your authorization.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information
we maintain about you.
Right to Inspect and Copy You have the right to inspect and copy
your health information, such as prescription and billing records, that we use to make decisions about your care. You must
submit a written request in order to inspect and/or copy your health information. If you request a copy of the information,
we may charge a fee for the costs of copying, mailing or other associated supplies. We may deny your request to inspect and/or
copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be
reviewed. If such a review is required by law, we will select a licensed health care professional to review your request and
our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome
of the review.
Right to an Electronic Copy of Electronic Health Records You have the right to request to be given to you or have
transmitted to another individual or entity, an electronic copy of your health records, if they are maintained in an electronic
format. We will make every effort to provide the electronic copy in the format you request however if it is not readily producible
by us we will provide it in either our standard format or in hard copy form (fees may apply).
Right to Amend If you believe
health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right
to request an amendment as long as the information is kept by this Pharmacy. To request an amendment, complete and submit
a Medical Record Amendment/Correction Form. We may deny your request for an amendment if it is not in writing or does not
include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: a)
we did not create, unless the person or entity that created the information is no longer available to make the amendment.
b) Is not part of the health information that we keep. c) You would not be permitted to inspect and copy. d) Is accurate and
Right to an Accounting of Disclosures You have the right to request an "accounting of disclosures." This
is a list of the disclosures we made of medical information about you for purposes other than treatment, payment and health
care operations. To obtain this list, you must submit your request in writing It must state a time period, which may not be
longer than six years and may not include dates before April 14, 2003. If you request this accounting more than once in a
12-month period we may charge you for the costs of providing the list.
Right to Request Restrictions You have the right to
request additional restrictions on the use or disclosure of your health information. You may restrict disclosure of your health
information to a health plan if you choose to pay out-of-pocket in full for the services at the time they are provided. We
are not required to agree to these additional restrictions, but if we do , we will abide by our agreement (except in an emergency).
To request restrictions, you must complete and submit the Request For Restriction On Use/Disclosure Of Medical Information
Right to Request Confidential Communications You have the right to request that we communicate
with you about your health information in a certain way or at a certain location. For example, you can ask that we only contact
you at work or by mail. To request confidential communications, you must complete and submit the Request For Restriction On
Use/Disclosure Of Medical Information And/Or Confidential Communication form.. we will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
Right to be Notified of a Breach We will notify
you if your unsecured health information is breached.
Right to a Paper Copy of This Notice You have the right to
a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive
it electronically, you are still entitled to a paper copy.
CHANGES TO THIS NOTICE
We reserve the right to change this
notice provided such changes are permitted by applicable law, and to make the revised or changed notice effective for health
information we already have about you as well as any information we receive in the future. We will post a copy of the current
notice in our Pharmacy, and on our Website You are entitled to a copy of the notice currently in effect.
QUESTIONS AND COMPLAINTS
you want more information about our privacy practices or have questions or concerns, please contact us. If you believe your
privacy rights have been violated, or you disagree with a decision we made about your health information in response to a
request, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a
complaint with us use the, contact information below. We will provide you with the address to file your complaint with the
U.S. Department of Health and Human Services upon request. You will not be penalized for filing a complaint.
Contact Officer: Alan Jay Telephone:
716-895-8811 Fax: 716-895-1244
Address: 975 Broadway, Buffalo, NY 14212