THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ THIS NOTICE CAREFULLY.
EFFECTIVE April 14, 2003
Our Commitment to Your Privacy
SULLIVAN'S PHARMACY AND MEDICAL SUPPLY is dedicated to
maintaining the privacy of your identifiable health information. In
conducting our business, we will create records regarding you and the
treatment and services we provide you. We are required by law to
maintain the confidentiality of health information that identifies you.
We also are required by law to provide you with this notice of our legal
duties and privacy practices concerning your identifiable health
information. By law, we must follow the terms of the Notice of Privacy
Practices that we have in effect at the time.
To summarize, this notice provides you with the following information:
- How we may use and disclose your identifiable health information;
- Your privacy rights in your identifiable health information;
- Our obligations concerning the use and disclosure of your identifiable health information.
The terms of this notice apply to all records containing your identifiable health information that are created or retained by our organization. We reserve the right to revise or amend our Notice of Privacy Practice. Any revision or amendment to this notice will be effective for all of your records our organization has created or maintained in the past, and for any of your records we may create in the future.
If you have any questions about this notice, please contact SULLIVAN'S PHARMACY AND MEDICAL SUPPLY.
We may use and disclose your information in the following ways:
- Treatment. We may use your identifiable information to provide supplies and services to you. For example, we ask you to provide us with such information as body weight, height , etc. Many of the people who work for us may use or disclose your identifiable health information in order to provide supplies and services to you or to assist others in your treatment. Additionally, we may disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children or parents.
- Payment. We may use and disclose your identifiable health information in order to bill and collect payment for the services and supplies you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for your supplies and/or services. We may also use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and supplies.
- Health Care Operations. We may use and disclose your identifiable health information to operate our business. As examples of the ways in which we may use and disclose your health information for our operations, we may use your health information to evaluate the quality of care you receive from us, or to conduct cost-management and business planning activities for our business.
- Appointment Reminders. We may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.
- Health-Related Benefits and Services. We may use your identifiable health information to inform you of health-related benefits or services that may be of interest to you.
- Release of Information to Family / Friends. We may release your identifiable health information to a friend or family member that is helping you pay for your health care, or who assists in taking care of you.
- Disclosures Required By Law. We will use and disclose your identifiable health information when we are required to do so by federal, state or local laws.
Use and Disclosure of Your Identifiable Health Information in Certain Special Circumstances
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
Public Health Risk. We may disclose your
identifiable health information to public health authorities that are
authorized by law to collect information for the purpose of:
- Maintaining vital records, such as births and deaths;
- Reporting child abuse or neglect;
- Preventing or controlling disease, injury or disability;
- Notifying a person regarding a potential exposure to a communicable disease;
- Notifying a person regarding a potential risk for spreading or contracting a disease or condition;
- Reporting reactions to drugs or problems with products or devices;
- Notifying individuals if a product or device they may be using has been recalled;
- Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
- Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
- Lawsuits and Similar Proceedings. We may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health in response to a discovery request, subpoena, or other lawful process by another party involved in a dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
Law Enforcement. We may release identifiable health information if asked to do so by a law enforcement official:
- Regarding a crime victim in certain situations, if we are unable to obtain the person?s agreement;
- Concerning a death we believe might have resulted from criminal conduct;
- Regarding criminal conduct in our offices;
- In response to a warrant, summons, court order, subpoena, or similar legal process;
- To identify/locate a suspect, material witness, fugitive or missing person;
- In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).
- Serious Threats to Health or Safety. We may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
- Military. We may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command facilities.
- National Security. We may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
- Inmates. We may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
- Workers' Compensation. We may release your identifiable health information for workers' compensation and similar programs.
- Coroners, Medical Examiners and Funeral Directors. We may disclose health information to a coroner or medical examiner. We may also disclose medical information to funeral directors consistent with applicable law to carry out their duties.
- Organ Procurement Organizations. Consistent with applicable law, we may disclose health information to organ procurement organizations or entities engaged in the procurement, banking, or the transportation of organs for the purpose of tissue donation and transplant.
- Research. We may disclose information to researchers when their research has been approved by an Institutional Review Board or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your healthcare information.
Your Rights Regarding Your Identifiable Health Information
- Confidential Communications. You have the right to request that we communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to us, specifying the requested method of contact or location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.
- Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment or health care operations. Additionally, you have the right to request we limit our disclosure of your identifiable health care information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your identifiable health information, you must make your request in writing to us. Your request must describe in clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our use, disclosure or both; and (c) to whom you want the limits to apply.
- Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to us in order to inspect and/or obtain a copy of your identifiable health information. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by us.
- Amendment. You may ask us to amend your health information if you believe it to be incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be made in and submitted to us in writing. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and correct; (b) not part of the identifiable health information kept by or for us; (c) not part of the identifiable health information which you would be permitted to inspect and copy; (d) not created by us, unless the individual or entity that created the information is not available to amend the information.
- Accounting of Disclosures. All of our patients have the right to request an accounting of disclosures. An accounting of disclosures is a list of certain disclosures we have made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to our office. All requests for an accounting of disclosures must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. We will notify you of the cost involved with additional requests, and you may withdraw your request before you incur any costs.
- Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact our office.
- Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us or with the Office of Civil Rights. All complaints must be in writing. You will not be penalized for filing a complaint.
- Right to Provide an Authorization for Other Uses and Disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note, we are required to retain records of your care.
SULLIVAN'S PHARMACY AND MEDICAL SUPPLY
NOTICE OF PRIVACY PRACTICES
This notice describes how your PHI (protected health information) may be used and disclosed and how you can get access to this information. Please review this carefully.
OUR PLEDGE REGARDING YOUR PRIVATE HEALTH INFORMATION
We at Sullivan's Pharmacy and Medical Supply, Inc. are concerned about the privacy of your protected health information, which must be collected in order to give optimal services. The type of information in which we collect and the types of information we may disclose to others are described below.
Documenting and collecting protected health information is required in order to provide the services which our customers need. It is our pledge to keep your protected health information secure and confidential and use this information only as a means to provide necessary services. We agree to abide by your wishes as required by state and federal laws in the use and release of your protected health information.
Sullivan's Pharmacy and Medical Supply is required by law to maintain the privacy of protected health information. Sullivan's Pharmacy and Medical Supply reserves the right to change the privacy practice and the terms of the notice as allowed by law. Sullivan's Pharmacy and Medical Supply agrees to abide by the notice that is currently in effect.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
- Sullivan's Pharmacy and Medical Supply will safeguard and maintain confidentiality of protected health information you share with us about you or your child/ward.
- Sullivan's Pharmacy and Medical Supply will only collect and use protected health information required to provide the needed services.
- Sullivan's Pharmacy and Medical Supply will only allow authorized staff to have access to your protected health information. This staff will be trained in the proper handling of protected health information.
- Sullivan's Pharmacy and Medical Supply will not disclose your
protected health information to any external organization without the
written consent of the parent or guardian except as permitted by law.
- Treatment We may disclose your protected health information for providing, coordinating and/or managing your healthcare related services. For example: If your primary care physician writes a prescription and you are covered by insurance, we can provide the needed health care information required to the insurance company. We may also disclose protected health information to Sullivan's Pharmacy and Medical Supply staff and others outside the facility that are involved with your care and treatment, such as family members, physicians or others we use to provide services that are part of your care.
- Payment We may disclose your protected health information to obtain payment for services that are provided to you. This may include certain activities that your health insurance plan may undertake before it approves or pays for health services recommended for you. Such as making a determination for eligibility or coverage from your health insurance provider or for utilization review. For example, we may need to share your protected health information by submitting an electronic request for payment with a third party billing service.
- Healthcare Operations We may disclose your protected health information to support the business activities of Sullivan's Pharmacy and Medical Supply, which may include but are not limited to: licensing, review of compliance activity, and quality improvement. For example, we may have to share your protected health information with state auditor who is reviewing Sullivan's Pharmacy and Medical Supply for regulation compliance.
USES AND DISCLOSURE OF PROTECTED HEALTH INFORMATION THAT REQUIRES YOUR AUTHORIZATION
- Sullivan's Pharmacy and Medical Supply will not disclose your protected health information without your written consent unless otherwise permitted or required by law. We recognize that you have the right to revoke written authorization to disclose protected health information at anytime except to the extent that action has already been taken or if the authorization was obtained as a condition of obtaining insurance coverage.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION
- You have the right to request restrictions on certain uses and disclosures of protected health information. However, Sullivan's Pharmacy and Medical Supply in some circumstances is not required to agree to the requested restriction.
- You have the right to receive confidential communications by alternative means if applicable.
- You have the right to inspect and copy your protected health information.
- You have the right to amend protected health information.
- You have the right to receive an accounting of disclosure of protected health information.
- You have the right to obtain a paper copy of the notice from Sullivan's Pharmacy and Medical Supply upon request.
Sullivan's Pharmacy and Medical Supply recognizes that you have the right to make a complaint to Sullivan's Pharmacy and Medical Supply if you believe your privacy rights have been violated. You are protected by law against retaliation for filing a complaint. For more information about the complaint process, contact Sullivan's Pharmacy and Medical Supply at 617-323-6544.
HOW TO REVIEW AND CORRECT YOUR PROTECTED HEALTH INFORMATION
Requests made in writing will be honored except documents as protected by law, i.e. documents related to claims, lawsuits, etc.
- Requests to review your record at Sullivan's Pharmacy and Medical Supply should be made in writing and received by Sullivan's Pharmacy and Medical Supply. If you believe any of the information in your record is incorrect, please notify Sullivan's Pharmacy and Medical Supply in writing and we will investigate. If errors are found, they will be corrected. If Sullivan's Pharmacy and Medical Supply determines the information is correct, you may file a statement with us that disputes the information in client files. We will send this statement to anyone who received or will receive the original information.
Privacy Statement regarding online refills.
Your refill and product order is sent to the Pharmacy by FAX transmission. Information submitted via the 'send refill' button is encrypted. No computer system is completely secure. It is possible that someone with the proper equipment, software and motivation can intercept your information. There is no acceptable way of completely securing any web or fax transmission at this time and therefore, the Pharmacy and the Web site administrators make no promises or representations whatsoever to the security of the website. The decision to use this site is your choice. Regarding your e-mail address: Your e-mail address will not be distributed to anyone. The Pharmacy may occasionally use it to send you an email to inform you of special promotions or health related alerts and other matters.
WARRANTIES AND GUARANTEES
The Pharmacy makes NO warranties as to the effectiveness of the prescription drugs your doctor orders for you. The Pharmacist warrants that your prescription order will be filled promptly and accurately.
You acknowledge that the site contains information, data, software, photographs, graphics, videos, text, images, typefaces, sounds, and other material (collectively "Content") that are protected by copyrights, trademarks, or other proprietary rights, and that these rights are valid and protected in all forms, media and technologies existing now or hereinafter developed. All Content is copyrighted as a collective work under the U.S. copyright laws, and we own a copyright in the selection, coordination, arrangement, and enhancement of such Content. You may not modify, remove, delete, augment, add to, publish, transmit, participate in the transfer or sale of, create derivative works from, or in any way exploit any of the Content, in whole or in part. If no specific restrictions are displayed, you may make copies of select portions of the Content, provided that the copies are made only for your personal, information and non-commercial use and that you do not alter or modify the Content in any way, and maintain any notices contained in the Content, such as all copyright notices, trademark legends, or other proprietary rights notices. Except as provided in the preceding sentence or as permitted by the fair use privilege under the U.S. copyright laws (see e.g. 17 U.S.C. Section 107), you may not upload, post, reproduce, or distribute in any way Content protected by copyright, or other proprietary right, without obtaining permission of the owner of the copyright or other proprietary right. In addition to the foregoing, use of any software Content shall be governed by the software license agreement accompanying such software, if any. All material on this site is copyrighted to Sullivan's Pharmacy, Roslindale MA 02131
All information contained on the Site, including information relating to medical and health conditions, products and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals or any information contained on or in any product packaging or labels. YOU SHOULD NOT USE THE INFORMATION CONTAINED ON THE SITE FOR DIAGNOSING A HEALTH PROBLEM OR PRESCRIBING A MEDICATION. YOU SHOULD CAREFULLY READ ALL INFORMATION PROVIDED BY THE MANUFACTURERS OF THE PRODUCTS ON OR IN THE PRODUCT PACKAGING AND LABELS BEFORE USING ANY PRODUCT PURCHASED ON THE SITE. YOU SHOULD ALWAYS CONSULT YOUR OWN PHYSICIAN AND MEDICAL ADVISORS. INFORMATION AND STATEMENTS REGARDING DIETARY SUPPLEMENTS HAVE NOT BEEN EVALUATED BY THE FOOD AND DRUG ADMINISTRATION AND ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE.
Further, we explicitly disclaim any responsibility for the accuracy, content, or availability of information found on sites that link to or from the Site from third parties not associated with us. We encourage discretion when browsing the Internet using our or anyone else's service. Because some sites employ automated search results or otherwise link you to sites containing information that may be deemed inappropriate or offensive, we cannot be held responsible for the accuracy, copyright compliance, legality, or decency of material contained in third-party sites, and you hereby irrevocably waive any claim against us with respect to such sites.
LIMITATION OF LIABILITY
UNDER NO CIRCUMSTANCES SHALL WE OR ANY OTHER PARTY INVOLVED IN CREATING, PRODUCING, OR DISTRIBUTING THE SITE BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES FOR LOSS OF PROFITS, GOOD WILL, USE, DATA OR OTHER INTANGIBLE LOSSES (EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES) THAT RESULT FROM (i) THE USE OF OR INABILITY TO USE THE SITE, (ii) THE COST OF PROCUREMENT OF SUBSTITUTE GOODS AND SERVICES RESULTING FROM ANY GOODS, DATA, INFORMATION OR SERVICES PURCHASED OR OBTAINED OR MESSAGES RECEIVED OR TRANSACTIONS ENTERED INTO THROUGH OR FROM THE SERVICE; (iii) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; (iv) STATEMENTS OR CONDUCT OF ANY THIRD PARTY ON THE SITE; OR (v) ANY OTHER MATTER RELATING TO THE SERVICE. YOU HEREBY ACKNOWLEDGE THAT THIS PARAGRAPH SHALL APPLY TO ALL CONTENT, MERCHANDISE, AND SERVICES AVAILABLE THROUGH THE SITE. BECAUSE SOME STATES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, IN SUCH STATES LIABILITY IS LIMITED TO THE FULLEST EXTENT PERMITTED BY LAW.