Your Privacy
Rider Drug, Inc.
NOTICE OF PRIVACY PRACTICES
Effective Date: September 1, 2003
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.
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