For Treatment. Information obtained by the Pharmacy will be used to dispense prescriptions to you. We may disclose PHI about you to pharmacists and other persons who are involved in dispensing your prescription.

For Payment. We may use and disclose PHI so that your pharmacy services may be billed to, and payment may be collected from you, an insurance company, or a third party. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.

For Health Care Operations. We may use and disclose PHI about you for pharmacy operations. Unless you provide us with alternative instructions, we may send refill reminders and other materials related to your health care to your home. These uses and disclosures are necessary to run the Pharmacy and make sure that you receive quality customer service.

Business Associates. There may be some services provided by us through contracts with business associates. When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payor for services rendered. To protect PHI about you, we require the business associate to appropriately safeguard the PHI.

Communication with individuals involved in your care or payment for your care. The Pharmacy, using their professional judgment, may disclose to a family member, other relative, close personal friend, or any person you identify, PHI relevant to that person’s involvement in your care or payment related to your care.

Worker’s compensation. The Pharmacy may disclose PHI about you as authorized by and as necessary to comply with laws related to worker’s compensation or similar programs established by law.

As required by law. The Pharmacy will disclose PHI about you when required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety. The Pharmacy may use and disclose PHI 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. Any disclosure, however, would only be to someone able to help prevent the threat.

Public Health Risks. As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability. This includes: to report reactions to medications or problems with products, to notify people of recalls of products they may be using, to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition, to notify the appropriate government authority if we believe a person has been the victim of abuse, neglect, or domestic violence (only disclosed if you agree and when required or authorized by law).

For Health Oversight Activities. We may disclose PHI about you to an oversight agency for activities authorized by law. The oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes. We may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI.

You have the right to request restriction of certain uses and disclosures of your PHI by sending a written request to the address listed below.* We are not required to agree to those restrictions.

You have the right to inspect and copy PHI about you as long as the Pharmacy maintains the health information. The PHI usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to the address listed below.* We may charge you a fee for the costs of copying, mailing, or supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.

You have the right to request the Pharmacy to amend your PHI that is incorrect or incomplete. You may request this amendment for as long as the Pharmacy maintains the PHI. To request an amendment, you must send a written request to the address listed below. * You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give you a rebuttal to your statement.

You have the right to receive an accounting of disclosures we have made of PHI about you after April 14, 2003 for most purposes other than: (1) treatment, payment, or health care operations, (2) to you or based upon your authorization, (3) for certain government functions, (4) to your friends or family members involved in your care. To request an accounting, you must submit a written request in writing to the address listed below.* Your request must specify the time period, but may not be longer than six (6) years.

You may request communications of your PHI by alternative means or at alternative locations. For example, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communications of your PHI, you must submit a request in writing to the address listed below.* Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.
*= If you would like to exercise one or more of these rights, submit a written request to Peakside Pharmacy Care Center, Attn: Privacy Officer, 4063 Quarles Court, Harrisonburg, VA 22801.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have any questions or would like additional information about the Pharmacy’s privacy practices, you may contact the Privacy Officer at Peakside Pharmacy Care Center, 4063 Quarles Court, Harrisonburg, VA 22801 or phone (540) 432-1575 or FAX (540) 432-1361. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer at the above address or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.