HIPAA 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
When this Notice of Privacy Practices (“Notice”) refers to“we” or “us,” it is referring to BIOPHORIA LLC and all the pharmacists who provide health care services and the employees of our pharmacy. We are required by law to maintain the privacy of your protected health information (“PHI”), to follow the terms of the Notice currently in effect, to give you this Notice setting forth our legal duties and privacy practices concerning your PHI and to notify affected individuals following a breach of unsecured PHI. This Notice describes how we may use and disclose your PHI. Additionally, this Notice explains the rights you have with respect to your PHI, and certain obligations we must abide by in accordance with the law. We reserve the right to amend thisNotice. If we make any material revisions to this Notice, we will post a copy of the revised Notice in the pharmacy, on our website and will offer you a copy of the revised Notice.
I. USE AND DISCLOSURE OF YOUR PHI
We will use and disclose your PHI for treatment, payment and health care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization. The following lists examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will only be made with your explicit written authorization, which you may revoke at any time by providing us with written notice of your revocation.
A. Treatment – We may use and disclose your PHI in order to provide you with prescription and supply services. We may disclose your PHIto other pharmacists, pharmacy technicians and health care providers that are involved in your care. You will receive an individual notice and have the opportunity to opt out of any subsidized treatment communications.
B. Payment – We will use and disclose your PHI in order to obtain payment for the health care services we provide to you. We may also need to disclose yourPHI to receive prior approval from your health plan or to determine if your health plan will cover a certain prescription or service.
C. Health Care Operations – We may use and disclose your PHI in connection with the management of our pharmacy. For example, this may include: quality assessment and improvement, internal compliance audits, and performance evaluations. Additionally, we may use your PHI for our business management and general administrative activities.
D. Prescription Refill Reminders, Treatment Alternatives or Health-RelatedBenefits – We may use and disclose your PHI to contact you to remind you aboutprescription refills, to tell you about treatment options or alternatives, orto inform you about health-related benefits or services that may be of interestto you.
E. Family Members, Relatives or Close Friends – Unless you object to suchdisclosure, we may disclose your PHI to your family members, relatives or closepersonal friends, or any other persons identified by you as being involved inthe treatment or payment for your medical care. If you are not present to agreeor object to our disclosure of your PHI to a family member, relative or friend,we may exercise our professional judgment to determine whether the disclosureis in your best interest. If we decide to disclose your PHI, we will onlydisclose the PHI that is relevant to your treatment or payment.
F. Other Permitted and Required Uses and Disclosures – We may use your PHIwithout obtaining your authorization and without offering you the opportunityto agree or object as follows:
• as required by law, provided however, that theuse or disclosure will be made in compliance with applicable law;
• to a public health authority that is authorizedby law to collect or receive such information, or to a foreign governmentagency that is acting in collaboration with a public health authority and thesehealth activities generally include preventing or controlling disease,reporting deaths, reporting adverse effects of medications or problems withproducts, notification of communicable disease, and reporting abuse or neglectunder certain circumstances;
• to a health oversight agency for oversightactivities authorized by law, including audits and inspections, and civil,administrative or criminal investigations, proceedings or actions;
• for judicial or administrative proceedingspurposes in response to a subpoena, court order, discovery request, etc. butonly if efforts have been made to inform you about the request or to obtain anorder protecting the information requested;
• to law enforcement to report certain injuries,comply with court orders or warrants or similar process, to identify a suspect,fugitive, missing person or victim or to report a crime;
• to a coroner or medical examiner to performduties authorized by law such as identification of a deceased person ordetermining the cause of death;
• to funeral directors, consistent with applicablelaw, as necessary to carry out their duties;
• to organ procurement organizations or similarentities for the purpose of facilitating organ, eye or tissue donation andtransplantation;
• for research purposes provided that certainapprovals take place and assurances are given;
• to avert a serious threat to health or safety,so long as the disclosure is only to a person who is reasonably able to preventor lessen such threat;
• for military and veterans activities (includingforeign military personnel) to assure the proper execution of a militarymission and to determine eligibility for benefits;
• for national security and intelligenceactivities for the purpose of conducting lawful intelligence,counter-intelligence and other national security activities;
• for protection of the President and otherauthorized persons or foreign heads of state or to conduct authorizedinvestigations;
• to a correctional institution or law enforcementcustodian if you are an inmate or under custody; and
• to the extent necessary to comply with lawsrelating to workers’ compensation and work-related injuries.
II. YOUR RIGHTS AS OUR PATIENT
A. You have the right to request restrictions orlimitations on how we use and/or disclose your PHI, however, we do not have toagree to your requested restriction or limitation (except for transactions youpaid for in full out-of-pocket). Your written request must specify: (1) if youwould like to restrict or limit our use and/or disclosure; (2) what informationyou want restricted or limited; and (3) to whom the restriction or limitationapplies (e.g., spouse). If we agree to your request, it will not prevent usfrom disclosing your PHI as follows: (1) to you if you request access or anaccounting of disclosures; (2) for purposes required or permitted by law; or(3) in case of an emergency.
B. You have the right to receive confidentialcommunications concerning your PHI by alternative means or via alternativelocations. For example, you may want to receive communications related to yourprescriptions at a different address other than your home address. If you wishto receive confidential communications via alternative means or locations,please submit your request in writing to the Privacy Officer and set forth thealternative means by which you wish to receive communications or the alternativelocation at which you wish to receive such communications. We will accommodateall reasonable requests.
C. You have the right to access, inspect and obtain a copyof your PHI, including any electronic PHI; provided, however, you are notentitled to access certain PHI exempted under HIPAA. To the extent we maintainelectronic PHI, upon request we will provide you with a copy of your PHI in theformat requested. If we do not have your PHI in our possession, we will provideyou with the appropriate contact information when your request is received. Ifyou request a copy of your PHI, you will receive a response to your request ina timely fashion but may be charged a reasonable, cost-based fee to cover copycosts and postage. In some limited circumstances, we may deny your request foraccess to PHI in which case you may request for the denial to be reviewed. If accessis ultimately denied, you are entitled to a written explanation with thereason(s) for the denial.
D. You have the right to receive an accounting ofdisclosures of your PHI made by us, including disclosures to or by our businessassociate(s), for a period of six (6) years prior to the date on which yourequest an accounting of disclosures, or such lesser period as you indicate.You will receive one request annually free of charge and, thereafter, we maycharge you a reasonable, cost-based fee for each subsequent request for anaccounting of disclosures within the same twelve-month period. We will notify youof the cost for an accounting of disclosures and you may choose to withdraw ormodify your request before we charge you.
E. If you believe we have PHI about you that is incorrector incomplete, you may make a written request to us stating the reasons tosupport any requested amendment. You have the right to request an amendment toyour PHI for so long as we maintain your PHI. If we do not have your PHI in ourpossession, we will provide you with the appropriate contact information whenwe receive your request. We will respond to your request for an amendment afterwe receive your request. However, we may deny your request for amendment if,for example, we determine that the PHI you requested was not created by us oris already accurate and complete. You may respond to our denial by filing awritten statement of disagreement, but we have the right to rebut yourdisagreement. If this occurs, you have the right to request that your originalrequest, our denial, your statement of disagreement, and our rebuttal beincluded in future disclosures of your PHI.
F. You have the right at any time to obtain a paper copyof this Notice, even if you receive this Notice electronically. If you havereceived an electronic copy of this Notice but wish to obtain a paper copy ofthis Notice, please send your request in writing to the Privacy Officer at theaddress listed below.
G. You have the right to opt-out of fundraising and yourPHI will not be used for fundraising purposes or sold without your priorauthorization.
III. Additional Information/Questions or Complaints
A. If you need any additional information about thisNotice or wish to exercise any of your rights set forth in this Notice, pleasecontact the Privacy Officer at the following address:
BioPhoria LLC.
1650 Garnet Ave #1144
San Diego, CA 92109
If you believe your privacy rights have been violated, youmay file a complaint without retaliation with the Privacy Officer of thepharmacy or with: Secretary of the Department of Health and Human Services 200Independence Avenue SW Washington D.C. 20201
