February 22, 2012
Your Privacy
Rider Drug, Inc.
NOTICE OF PRIVACY PRACTICES
Effective Date: September 1, 2003
- Your Health Information Rights
- How Rider Drug, Inc. May Use and Disclose Your Health Information
- For More Information or to Report a Problem
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.
Rider Drug, Inc. is required by law to maintain the privacy of your Protected Health Information (“PHI”) and to provide you with a notice of our legal duties and privacy practices with respect to your health information. PHI is information about you, including basic demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes your rights with respect to your health information and how Rider Drug, Inc. may use and disclose health information about you to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. A paper copy of this notice may be obtained upon request.
Rider Drug, Inc. is required to follow the terms of this Notice. We will not use or disclose your health information without your written authorization, except as described in this Notice. If you do authorize Rider Drug, Inc. to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. We reserve the right to change our practices and the Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide a revised Notice to you.
Your Health Information Rights
- You have the right to request restrictions on our use
or disclosure of your health information. Rider Drug, Inc.
is not required to agree to those restrictions. If we do
agree to any restriction, we will put the agreement in writing
and follow it, except in emergency situations. We cannot
agree to limit the uses or disclosures of information that
are required by law.
- You have the right to inspect and copy your health information
as long as Rider Drug, Inc. maintains the health information.
Your health information usually will include prescription
and billing records. To inspect or copy your health information,
you must submit a written request to Rider Drug, Inc. We
may charge you a fee for the costs of copying, mailing,
or other supplies that are necessary to grant your request.
We may deny your request to inspect and copy in certain
limited circumstances. If you are denied access to your
health information, you may request that the denial be reviewed.
- You have the right to request that Rider Drug, Inc. amend
your health information that is incorrect or incomplete.
You may request an amendment for as long as we maintain
the PHI. In addition, 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.
- You have a right to receive an accounting of disclosures
of your health information we have made after September
1, 2003 for most purposes other than treatment, payment,
or health care operations. The accounting will exclude disclosures
we have made directly to you, disclosures to friends or
family members involved in your care, and disclosures for
notification purposes. The right to receive an accounting
is subject to certain other exceptions, restrictions, and
limitations. Your request must specify the time period,
but may not be longer than six years. The first accounting
you request within a 12 month period will be provided free
of charge, but you may be charged for the cost of providing
additional accountings.
- You may request communications of your health information by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests.
How Rider Drug, Inc. May Use and Disclose Your Health Information
For treatment: Example: Information obtained by the pharmacy will be used to dispense prescription medications to you. We may disclose health information about you to pharmacists and other persons who are involved in dispensing your prescription.
For payment: Example: We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment responsibility. We will bill you or a third-party payer for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.
Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, your health information relevant to that person’s involvement in your care or payment related to your care.
As required by law: We will disclose health information about you when required to do so by federal, state or local law.
For health care operations: We may use and disclose health information about you for pharmacy operations. We may send materials related to your health care to your home.
Health oversight activities: We may disclose health information to a health oversight agency for activities authorized by law. These 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.
Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information 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 information.
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.
Public health risks: We may disclose health information about you for public health activities. These activities include the following: (1) to prevent or control disease, injury or disability; (2) to report reactions to medications or problems with products; (3) to notify people of recalls of products they may be using; (4) 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; (5) to notify the appropriate government authority if we believe a person has been the victim of abuse, neglect or domestic violence (we will only make this disclosure if you agree and when required or authorized by law).
For specific government functions: We may disclose health information for the following specific government functions: (1) health information of military personnel, as required by military command authorities; (2) health information of inmates, to a correctional institution or law enforcement official; (3) in response to a request from law enforcement, if certain conditions are satisfied; and (4) for national security reasons.
For More Information or to Report a Problem
If you have questions or would like additional information about Rider Drug, Inc. privacy practices, you may contact our Privacy Officer, Teresa Harris, at Rider Drug, Inc., 1207 S. Baltimore, Kirksville, MO 63501; phone (800) 624-1473 or (660)665-4666; fax (660) 665-2257. If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.