Notice of Privacy Practices

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Wayne Pharmacy, Inc. Notice of Privacy Practices

(Also doing business as "Johnston Medical and Surgical Supply" and "Duplin Medical Supply")

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.

Introduction

All of us at Wayne Pharmacy, Inc.value your relationship with us, and we know that respect for your privacy is the foundation of that relationship. We are committed to protecting the privacy of your Protected Health Information (PHI)that is in our possession.

Your PHI will only be used and disclosed as described in this Notice. Should a need for use and disclosure of your PHI occur that is not described in this Notice, we will obtain your written authorization before the use and disclosure. At some future time, it may be necessary for us to revise this Notice. If such becomes necessary, we will post the revised Notice in the pharmacy and, if you request, provide a written Notice to you.

Your Rights With Respect To Your PHI

1. You have the right to receive this written Notice of Privacy Practices describing how we will protect your PHI and your rights related to PHI. You are entitled to request this written Notice at any time.

2. You have the right to request a limitation on our use and disclosure of your PHI. But please be aware that we may not be able to agree to your requested limitation if it results in our not being able to provide health care products and services to you or if we are required to use and disclose the PHI under federal or state law. All requests for limitation on the use and disclosure of your PHI must be submitted to our Privacy Officer in writing using a form that we will provide to you.

3. You have the right to review or receive photocopies of our records that contain your PHI, to the extent that these records are part of a designated record set as defined by HIPAA. The most common such records are your prescriptions on file with us, our patient profile for you, and our billing records for health care products and services that have been provided to you. We will be pleased to allow you to review such records at no charge during normal business hours. However, we may charge you a reasonable, cost-based fee for photocopies of the records, together with any expenses for mailing, special courier, faxing, and supplies necessary to fulfilling your request for records. All requests to review or receive photocopies of our records that contain your PHI must be submitted to our Privacy Officer in writing using a form that we will provide to you.

4. You have the right to request changes in the content of your PHI contained in our records where you believe the content is incomplete, inaccurate, or for some other reason needs to be changed. All requests for changes to your PHI in our records must be submitted to our Privacy Officer in writing, using a form that we will provide to you.

5. You have the right to request that we communicate with you about your PHI in a confidential manner and only to locations (such as a post office box) or by means (such as personal cellular telephone) specified by you. All requests for confidential communications must be submitted to our Privacy Officer in writing, using a form that we will provide to you.

6. You have the right to obtain an accounting of some of our disclosures of your PHI made after April 14, 2003. Disclosures for purposes of treatment, obtaining payment, and carrying out health care operations and disclosures made directly to you or your caregivers are not required by HIPAA to be included in the accounting. You may obtain from us, without charge, one accounting during a 12-month period. However, if you request additional accountings during the same 12-month period, we may charge you a reasonable, cost-based fee for the accounting All requests for an accounting of our disclosures of your PHI must be submitted to our Privacy Officer in writing, using a form that we will provide to you.

7. You have the right to file a complaint if you believe that we have violated your rights as described above, and to not fear retaliation by us against you for exercising your right. You can file the complaint with us directly, or with the United States Department of Health and Human Services (HHS). Please be assured that we will work with you to resolve any complaint, including providing you with the address for filing a complaint with HHS.

Contact: Wayne Pharmacy, Inc., 2302 Wayne Memorial Drive, Goldsboro, NC 27534, Attention: Privacy Officer or Phone 919-735-6936

Ways That We May Use and Disclose Your PHI

1. Treatment. We will maintain records that contain your PHI, and we will use and disclose your PHI as necessary to provide health care products and services to carry out and support your treatment. As a pharmacy, medical equipment and home infusion company, we may use and disclose your PHI as necessary to maintain a patient profile on you, which may include information about you; your medical condition, medications, and prescription devices that you use; any allergies that you may have; and other information, such as any health insurance that you may have. We may use and disclose your PHI in dispensing prescription medicines and medical equipment and related products and services, including counseling you and your caregivers about proper use of your medications or equipment. We may discuss PHI with your other health care professionals, such as your physician or home care nurse, and may use and disclose your PHI. Finally, we may use and disclose your PHI to you and your caregivers in our discussions with you and your caregivers about your treatment. If there are family members involved in your care, ordering or picking up your medicines, equipment or supplies or making payments for your healthcare, they may also receive your PHI as we believe necessary and appropriate for your health care. We may use and disclose PHI if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them. We will abide by applicable state and federal laws pertaining to use and disclosure of medical records of a minor child (see payment section regarding charge accounts). We will use and disclose PHI as necessary to provide home delivery of products or services.

2. Payment. We will use and disclose PHI for payment activities. These activities include primarily billing you directly or someone who pays for your health care, such as a family member or health insurance company, for health care products and services that we provide to you. Activities related to billing may include claims management, collections, and related health care data processing. For reimbursement purposes, your PHI may be disclosed to one or several intermediaries, including but not limited to insurers, pharmacy benefits managers, claims administrators and computer switching companies. Depending on who pays for the health care products and services that we provide you, other activities may include determination of eligibility or coverage; medical necessity; justification of charges; utilization review activities, including pre-authorization of services; reviews of services; and disclosure to consumer reporting agencies of PHI as necessary for collection of payment. In relation to this, public and private health care insurance programs that may provide or pay for your health care can conduct audits, inspections, and investigations of us in relation to our activities and your activities. We may be required to disclose your PHI to these programs for purposes of audits, inspections, and investigations.

PLEASE NOTE : If you charge your medicine to a family charge account, PHI will be disclosed on the statement mailed to the responsible party of that account!

3. Health care operations. Healthcare operations are those activities necessary and related to our providing of health care products and services to you. These activities include, but may not be limited to conducting quality assessment and improvement activities, case management and care coordination, and contacting of health care providers and patients with information about treatment alternatives and related functions that do not include treatment, legal services, and auditing functions; our pharmacy management and general administrative activities, including, but not limited to, activities relating to implementation of and compliance with the requirements of HIPAA.

We will use and disclose your PHI to carry out the above activities as necessary or required, and especially to monitor and improve the quality of the health care products and services that are provided to you by us and other health care professionals.

4. Business associates. The nature of the health care system is such that we may not be able to provide health care products and services to you without the involvement of other businesses or persons. Depending on what these other businesses or persons do for us, they may become "business associates" as defined by HIPAA. In many situations, it will be necessary for us to provide your PHI to these business associates so that they can carry out the activities that we need to have performed in order to provide you health care products and services. Examples might include the computer vendors we use to process and transmit prescriptions or medical equipment claims, health insurance companies, home health nursing or hospice agencies, telephone answering services. Business associates must protect the privacy of your PHI.

5. Disclosures of your PHI involving treatment, payment, and health care operations. In addition to communicating with these businesses and individuals, we may also communicate with you directly, as well as others who assist you with your health care, commonly referred to as caregivers. For group home, nursing home, rest home or assisted living facility patients, or home health care agencies, representatives of agencies or facilities will be considered caregivers and we will disclose to these representatives PHI necessary for your treatment, payment or general healthcare operations.We may disclose your PHI to family members involved in your care, ordering or picking up your medicine, equipment or supplies or making payment for your healthcare. We will disclose your PHI to these caregivers, or appropriate others, as we believe necessary and appropriate for your health care. We may provide to you or your family tax or insurance forms if requested by you or on your behalf.

6. Communications with you concerning your health and treatment. For example, if our records show that a refill of your medication is due, we may contact you to remind you to obtain the refill. In the event of a medication recall, we may contact you, if you are taking the medication subject to the recall or we may contact you for patient counseling as we find necessary and appropriate for your health care.

7. Federal and state government agencies. We may disclose your PHI to federal and state government agencies for a variety of purposes, applicable to health care, for example, to the DEA or FDA. Where some private businesses, such as manufacturers are legally required to conduct surveillance for product safety and we may disclose or use your PHI for such surveillance as may be necessary.

8. Federal and state government health care insurance programs. If you apply for and receive benefits from federal and state health care programs, such as Medicare or Medicaid, your PHI may be disclosed to the agency granting these benefits. If you are injured in such a way that a workers' compensation plan covers your health care, it may be necessary to disclose your PHI to the workers' compensation plan as required by law.

9. Matters of public health and safety. If your physical or mental health condition and illness is of a nature that federal or state law requires that it be reported, then we will disclose your PHI to the appropriate government agency in order to comply with these laws. We may also disclose your PHI to government agencies in other situations where we are required to submit reports, such as suspected domestic, child or elder abuse, or neglect.

10. Law enforcement activities or legal disputes. At any time we are required by federal or state laws, or by court order, subpoena or other legal mandate, to use or disclose your PHI, we will do so as necessary. We will disclose your PHI when required to comply with a court order, subpoena, discovery proceeding, such as a deposition, or other legal mandate served upon us.

11. Disclosures for the benefit of you and others. We may use and disclose your PHI for your benefit and to prevent or reduce the risk of harm to you. For example, if you are in a car accident and are unconscious in a hospital emergency room and the emergency room medical staff calls us with a request for your PHI, we may disclose it for the purpose of assisting in your prompt medical treatment. We may disclose your PHI where necessary to protect the health and safety of others. Finally, we may use or disclose your PHI as otherwise permitted by HIPPA or required by law.

12. Disclosures for national security and intelligence. We are legally required to disclose your PHI to authorized government officials where necessary for national security activities and intelligence and counterintelligence activities.

13. Disclosures if you are in the military or a veteran. We may disclose your PHI, if you are a member of any branch of the armed services, whether on active or reserve status as required by the U.S. Military. If you are a veteran, we may release your PHI to authorized government officials, particularly if you are receiving health care products and services from the Veterans Services.

14. Disclosures of a miscellaneous nature. We may be required to disclose your PHI if you are placed into the custody of a federal or state correctional system. We may disclose your PHI to organizations that manage organ transplantation programs.

Uses and Disclosures Not Contained in this Notice

If a use and disclosure of your PHI is not contained in this Notice, then we will obtain your written authorization before the use and disclosure. You may have the right to refuse to authorize the use and disclosure, or if you grant the authorization, to revoke the authorization at any time. If such authorization is requested, we will provide you with a form that describes the proposed use and disclosure and your rights related to the authorization.

Conclusion

Upon giving you this Notice, you will be asked to sign a document acknowledging that you received this Notice. We appreciate your cooperation in reviewing this Notice and in giving us your written acknowledgement.

IF YOU HAVE ANY QUESTIONS ABOUT THE WAYS IN WHICH WE MAY USE OR DISCLOSE YOUR PHI, PLEASE CONTACT:  WAYNE PHARMACY, INC., 2302 WAYNE MEMORIAL DRIVE, GOLDSBORO, NC 27534 ATTN: PRIVACY OFFICER

Or you may contact the privacy officer by phone at : 919-736-6936 or 1-800-443-9261

Effective date: 04/14/03
Hours
M-F8:30 a.m.8:00 p.m.
Sat8:30 a.m.5:00 p.m.
Sun1:00 p.m.5:00 p.m.
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