This notice describes how your medical information may be used and disclosed and how you can access this information.

Valley Independent Pharmacies-Corporate Office Ÿ 3558 Jefferson St N Ste 1, Lewisburg, WV 24901    

Phone: 304-645-5547

Introduction: Each Valley Independent Pharmacy network member (Greenbrier Medical Arts Pharmacy Inc., Union Pharmacy, and Western Greenbrier Pharmacy, Inc.) understands that respect for your privacy is the foundation of our relationship and we are committed to protecting your protected health information (PHI). We will only use or disclose your PHI as necessary to provide you with healthcare products and services or as required by state or federal law. PHI is any information that we possess, use and disclose that identifies you or relates to your past, current or future physical/mental health condition or illness and the healthcare products or services that have been provided to you. Protecting your privacy is our priority and your PHI will only be used as described in this Notice. Our confidentiality and privacy practices will be implemented in a professional manner and according to law and regulation. Should a need arise for use or disclosure of your PHI that is not described in this notice, we will obtain written authorization from you before releasing this information. We reserve the right to change this notice at any time.

 

Your Rights with Respect to Your PHI: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides you with the following rights relative to your PHI. You have the right to:

• Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of the pharmacy’s uses and disclosures of your PHI. This includes the right to restrict disclosures to insurances for those products and services you pay out-of-pocket for. All requests for limits on the use and disclosure of your PHI must be submitted to the pharmacy Privacy Officer in writing using a form that we will provide to you. The pharmacy is not required to accommodate a request.
• Have your PHI communicated to you by alternate means or locations: You have the right to request that the pharmacy communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require the pharmacy to have an accurate address and home phone number in case of emergencies. The pharmacy will consider all reasonable requests. All requests for confidential communication must be submitted in writing to the Privacy Officer and mailed to the address above.
• To inspect and/or obtain a copy of your PHI: You have the right to request access and/or obtain a copy of your PHI that is contained in the pharmacy for the duration the pharmacy maintains PHI about you. There may be a reasonable cost-based charge for photocopying, mailing, faxing or extensive personnel time required to fulfill your request. You will be notified in advance of incurring such charges, if any. If we are unable to provide your records to you, we will provide you with a written explanation.
• To amend your PHI: You have the right to request an amendment of the PHI the pharmacy maintains about you, if you feel that the PHI the pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services (“HHS”), or their appropriate designee, to review such a denial.
• To receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by the pharmacy. This is a list of certain disclosures we made of medical and billing information about you, except for those disclosures to carry out treatment, payment, or health care operations, disclosures made to you, disclosures you have authorized, or certain other disclosures. To request an accounting of disclosures, you must submit your request in writing to the pharmacy Privacy Officer at the address above. Your request must state a time period, which may not be longer than six (6) years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. We may charge you for the costs of providing additional lists.
• To receive additional copies of the pharmacy’s Notice of Privacy Practices: You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically.
• Notification of Breaches: You will be notified of any breaches that have compromised the privacy of your PHI.

 

Ways That We May Use and Disclose Your PHI: The following is an accounting of the ways that the pharmacy is permitted, by law, to use and disclose your PHI:

• Uses and disclosures of PHI for Treatment: The pharmacy will use the PHI that is received from you to fill your prescription and coordinate or manage your health care.
• Uses and disclosures of PHI for Payment: The pharmacy will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.
• Uses and disclosures of PHI for Health Care Operations: The pharmacy may use the minimum necessary amount of your PHI to conduct quality assessments, improvement activities, and evaluate the pharmacy workforce.

 

The following is an accounting of additional ways in which the pharmacy is permitted or required to use or disclose PHI about you without your written authorization.

 

As Required by Law. The pharmacy is required to use or disclose PHI about you as required and as limited by law.

 

Public Health Activities. The pharmacy may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability. This includes the FDA so that it may monitor any adverse effects of drugs, foods, nutritional supplements and other products as required by law.

 

About Victims of Abuse, Neglect or Domestic Violence. The pharmacy may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence.

 

Individuals Involved in Your Care or Payment for Your Care. Unless you tell us otherwise, we may release medical information about you to a friend or family member who is directly involved in your medical care, and we may give information to someone who helps pay for your care unless otherwise directed by you in writing.

 

Business Associates. The pharmacy may disclose PHI about you to the pharmacy’s business associates for services that they may provide to or for the Pharmacy to assist the Pharmacy to provide quality health care. To ensure the privacy of your PHI, we require all business associates to apply appropriate safeguards to any PHI they receive or create.

 

To Avert a Serious Threat to Health or Safety. We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or other person. Any disclosure would only be necessary as required by public health agencies.

 

Workers’ Compensation. We may release medical information about you as necessary to comply with laws related to workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.

 

Cadaveric Organ, Eye or Tissue Donation Purposes. The pharmacy may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.

 

Research Purposes. The pharmacy may use and disclose PHI about you for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board. Otherwise, the pharmacy will request a signed authorization by the individual for all other research purposes.

 

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections as necessary for licensure, compliance with civil laws, or other activities the health oversight agency is authorized by law to conduct.

 

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court order. We may also disclose PHI 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 information requested.

 

Law Enforcement. We may release medical information if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, etc. or in emergency circumstances to report a crime or help identify the suspect.

 

Specialized Government Functions. The pharmacy may use or disclose PHI about you for specialized government functions including; military and veteran’s activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations.

 

Disaster Relief Purposes. The pharmacy may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts and for family and personal representative notification.

 

Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death.

Other Uses and Disclosures. The pharmacy may contact you for the following purposes:

• Information about treatment alternatives: The pharmacy may contact you to notify you of alternative treatments and/or products.
• Health related benefits or services: The pharmacy may use your PHI to notify you of benefits and services the pharmacy provides.
• Fundraising: If the pharmacy participates in a fundraising activity, the pharmacy may use demographic PHI to send you a fundraising packet, or the pharmacy may disclose demographic PHI about you to its business associate or an institutionally related foundation to send you a fundraising packet. No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization. You will be provided with an opportunity to opt-out of all future fundraising activities.

 

Other uses of medical information: Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you authorize us to use or disclose your PHI you may revoke that authorization, in writing, at any time by contacting the pharmacy Privacy Officer. You understand that we are unable to take back any disclosures we have already made and that we are required by state law to retain our records of the care that we provide to you.

 

Revisions to the notice of privacy practices. The pharmacy reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The pharmacy will also post the revised version of the Notice in the pharmacy.

 

Complaints. If you believe your privacy rights have been violated, you may file a complaint with the pharmacy or with the Secretary of the Department of Health and Human Services, or his designee. To file a complaint with the pharmacy, contact the pharmacy Privacy Officer at 3558 Jefferson St N Ste 1, Lewisburg, WV 24901 or by phone at 304-645-5547. To file a complaint with the Secretary, please go to http://www.hhs.gov/ocr/office/about/rgn-hqaddresses.html or contact by phone at 1-877-696-6775. The pharmacy will not take any adverse action against you as a result of your filing of a complaint.

 

Contact Information. If you have any questions on the pharmacy’s privacy practices or for clarification on anything contained within the Notice, please contact the pharmacy Privacy Officer at 304-645-5547.