Notice of Privacy Practices

SECTION A:  Uses and Disclosures of Protected Health Information

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1.                      Under applicable law, we are required to protect the privacy of your individual health information (information we refer to in this notice as “Protected Health Information”).  We are also required to provide you with this Notice regarding our policies and procedures regarding your Protected Health Information and to abide by the terms of this notice, as it may be updated from time to time.

We are permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and health care operations purposes.  We may obtain information to dispense prescriptions and for the documentation of pertinent information in your records that may assist us in managing your medication therapy of your overall health.  For treatment purposes, such use and disclosure will take place in providing or coordinating for managing health care and its related services by one or more of your providers, such as when your pharmacist consults with your physician or a specialist regarding your medications, treatment, or condition.

For payment purposes, such use and disclosure will take place to obtain or provide reimbursement for providing pharmaceutical care services, such as when your case is reviewed to ensure the appropriate care was rendered.  For reimbursement purposes, your Protected Health Information may be disclosed to one or several intermediaries employed by your plan sponsor including, but not limited to, insurers, pharmacy benefits managers, claims administrators and computer switching companies.

For health care operations purposes, such use and disclosure will take place in several ways, including for quality assessment and improvement; provider review and training; underwriting activities, reviews, and compliance activities; and planning, development, management, and administration.  Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided.

We store some of your Protected Health Information in computer files.  We backup our electronic records daily, periodically store backups offsite, and employ other precautions to safeguard the integrity of your Protected Health Information.  Despite these precautions, it is possible but unlikely that a computer crash or other technological failure could cause the loss of data.  In addition, reasonable safeguards are employed to protect your Protected Health Information stored on electronic media.

In addition, we may contact you to provide refill reminders, health screenings, wellness events, inoculations, vaccinations or information about treatment alternatives or other health-related benefits and services that may be of interest to you.  In addition, we may disclose your health information to your plan sponsor.

We may use and disclose your Protected Health Information without your authorization when the pharmacy needs to contact a physician or a physician’s staff and is permitted or required to do so without individual written authorization.  We may use and disclose your Protected Health Information if we are contacted by another pharmacy who states they have your request and consent to transfer records to them.

From time to time, we may employ the services of business associates who may assist us in one or more tasks and who may use, change, or create Protected Health Information.  Business associates are required to comply with all the privacy regulations on your behalf.

We may disclose Protected Health Information about you without your authorization to comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, health oversight activities, and as required by law.

2.                     You may ask us to restrict uses and disclosures of your Protected Health Information to carry out treatment, payment, or health care options, or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care.  However, we are not required to agree to your request.

3.                     You have the right to request the following with respect to your Protected Health Information:  (I)  inspection and copying;  (II)  amendment or corrections;  (III)  an accounting of the disclosures of this information by us (we are not required to account to you for disclosures made for treatment, payment, operations, disclosures to your care givers, for notifications or as otherwise excluded by law);  and (IV)  the right to receive a paper copy of this notice upon request.  We may require you to pay for this request to cover our costs of copying, labor, and postage.

                        In addition, you may request, and we must accommodate, if reasonable, to receive communications of Protected Health Information by alternative means or at alternative locations.  To make this request, please contact, in writing, using the address in Section B

4.                     We may use your name to reference your prescriptions and pharmaceutical care services.  You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this Notice and the disclosure of Protected Health Information as outlined herein.  This information may be disclosed by us to other persons who ask for you or your prescriptions by name.  You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative orally or in writing of your restriction prohibition.  We are not required to honor those requests.  We can provide treatment services to you even if you object to sign the acknowledgement of the receipt of this Notice or if we decide not to honor a request regarding the information in this document.  In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preference, and what we determine to be in your best interest.  We will inform you of any such uses or disclosures if uses and disclosures would require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable. 

5.                     We may disclose to one of your family members, to a relative, to a close friend or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care.  In addition, we may use or disclose the Protected Health Information to notify, identify or locate a member of your family, your personal representative, another person responsible for care, certain disaster relief agencies of your location, general location, or death.  If you are incapacitated, there is an emergency or you object to this use or disclosure, we will do in our judgment what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your health care.  We will also use our judgment and experience regarding your best interest in allowing people to pick up filled prescriptions or other similar forms of Protected Health Information.

6.                     We reserve the right to change the terms of this Notice and to make new Notice provisions effective for all Protected Health Information we maintain.  You may receive a copy of this Notice by contacting us as outlined in Section B or upon the receipt of pharmacy care services.

7.                     If you believe that your privacy rights have been violated, you may complain to us at the location described in Section B or to the U.S. Department of Health & Human Services - 200 Independence Avenue, S.W. - Washington, D.C. 20201.  You will not be retaliated against for filing a complaint.

8.                    Hieber’s Pharmacy constantly strives to improve the quality of compounded preparations and takes the complaints or grievances of customers seriously.  Please contact us (see Section B) if you have any concerns about your prescription service so that the matter may be reviewed and resolved promptly.

 

 

Section B:  Contacting Us

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You may contact us for further information:

Hieber’s Pharmacy

Rosemary Mihalko, Sole Member

Mihalko Medical, LLC

3500 Fifth Avenue

Pittsburgh, PA  15213

Phone:  412-681-6400     •     Fax:  412-681-8774

Email:  info@hiebers.com

www.hiebers.com