VILLAGE COMPOUNDING
PHARMACY'S NOTICE OF PRIVACY PRACTICES
I. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH
INFORMATION (PHI).
We are legally required to protect the privacy of your
health information. We call this information protected
health information, or PHI for short, and it includes
information that can be used to identify you that we’ve
created or received about your past, present, or future
health condition, the provision of health care for you, or
the payment of this health care. We must provide you with
this notice about our privacy practices that explains how,
when, and why we use and disclose your PHI. With some
exceptions, we may not use or disclose any more of your PHI
that is necessary to accomplish the purpose of the use or
disclosure. We are legally required to follow the privacy
practices that are described in this notice.
However, we reserve the right to change the terms of this
notice and our privacy policies at any time. Any changes
will apply to the PHI we already have. Before we make an
important change to our policies, we will promptly change
this notice and post a new notice in our checkout area. You
can also request a copy of this notice from any Village
Compounding Pharmacy employee, at any time and can view a
copy of the notice on our Web site at
www.villagecompounding.com.
II. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION.
We use and disclose health information for many different
reasons. For some of these uses or disclosures, we need your
specific authorization. Below, we describe the different
categories of our uses and give you some examples of each
category.
A. Uses and Disclosures Relating to Medication Treatment,
Payment, Or Pharmacy Operations.
We may use and disclose your PHI for the following reasons:
1. For medication treatment. We may disclose your PHI to
physicians, nurses, medical students, and other health care
personnel, who provide you with health care services or are
involved in your care. For example, if you’ve been
prescribed a medication for a knee injury, we may disclose
your PHI to the physical rehabilitation department in order
to coordinate your care.
2. To obtain payment for medication or services provided to
you. We may use and disclose your PHI in order to bill and
collect payment for the medication or services provided to
you. For example, we may provide portions of your PHI to our
accounting department in order for payment to be achieved
for the medication or services we have provided to you. We
may also provide your PHI to our business associates, such
as billing companies, claims processing companies, and
others that process our medication or services claims.
3. For pharmacy operations. We may disclose your PHI in
order to operate this pharmacy. For example, we may use your
PHI in order to evaluate the performance of the employee who
provided the services to you. We may also provide your PHI
to our accountants, attorneys, consultants, and others n
order to make sure we’re complying with the laws that affect
us.
B. Certain Uses and Disclosures Do Not Require Your
Authorization. We may use and disclose your PHI without your
authorization for the following reasons:
1. When a disclosure is required by federal, state, or local
law, judicial or administrative proceedings, or law
enforcement. For example, we make disclosures when a law
requires that we report information to government agencies
and law enforcement personnel when ordered in a judicial or
administrative proceeding.
2. For pharmacy oversight activities. For example, we will
provide information to assist the government when it
conducts an investigation or inspection of a pharmacy or
organization.
3. For research purpose. In certain circumstances, we may
provide PHI in order to conduct medical research.
4. To avoid harm. In order to avoid a serious threat to the
health or safety of a person or the public, we may provide
PHI to law enforcement personnel or persons able to prevent
or lessen such harm.
5. For specific government functions. We may disclose PHI of
military personnel and veterans in certain situations. And
we may disclose PHI for national security purposes, such as
protecting the president of the United States or conducting
intelligence operations.
6. For worker’s compensation purposes. We may provide PHI in
order to comply with worker’s compensation laws.
7. Appointment reminders and health-related benefits or
services. We may use PHI to provide appointment reminders or
give you information about treatment alternatives or other
health care services or benefits we offer.
C. Uses and Disclosures Require You to Have the Opportunity
to Object.
1. Disclosures to family, friends, and others. We may
provide your PHI to a family member, friend, or other person
that you indicate is involved in your care or the payment
for your health care services, unless you object in whole or
in part. The opportunity to consent may be obtained
retroactively in emergency situations.
D. All Other Uses and Disclosures Require Your Written
Authorization. In any other situation not described in
Sections IIA, B, and C, above, we will ask for your written
authorization before using or disclosing any of your PHI. If
you choose to sign an authorization to disclose your PHI,
you can later revoke that authorization in writing to stop
any future uses and disclosures (to the extent that we
haven’t taken any action relying on the authorization).
III. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following rights with respect to your PHI:
A. The Right to Request Limits on Uses and Disclosures of
Your PHI. You have the right to ask that we limit how we use
and disclose your PHI. We will consider your request but are
not legally required to accept it. If we accept your
requests, we will put any limits in writing and abide by
them except in emergency situations. You may not limit the
uses and disclosures we are legally required or allow to
make.
B. The Right to Choose How We Send PHI to You. You have the
right to ask that we send information to you to an alternate
address (for example, sending information to your work
address rather that your home address) or by alternate means
(for example, e-mail instead of regular mail). We must agree
to your request so long as we can easily provide it in the
format you request.
C. The Right to See and Get Copies of Your PHI. In most
cases, you have the right to look at or get copies of your
PHI that we have, but you must make the request in writing.
If we don’t have your PHI but we know who does, we will tell
you how to get it. We will respond to you within 30 days
after receiving your written request. In certain situations,
we may deny your request. If we do, we will tell you in
writing our reasons for the denial and explain your rights
to have the denial reviewed. Instead of providing the PHI
you requested, we may provide you with a summary or
explanation of the PHI as long as you agree to that.
D. The Right to Get a List of the Disclosures We Have Made.
You have the right to get a list of instances in which we
have disclosed your PHI. The list will not include uses or
disclosures that you have already consented to, such as
those made for treatment, payment, or services, directly to
you, to your family, or others. The list also won’t include
uses and disclosures made for national security purposes, to
corrections or law enforcement personnel, or before April
15, 2003.
We will respond within 60 days of receiving your request.
The list we will give you will include disclosures made in
the last three years unless you request a shorter time. The
list will include the date of the disclosure, to whom PHI
was disclosed (including their address, if known), a
description of the information disclosed, and the reason for
the disclosure. We will provide the list to you at no
charge.
E. The Right to Correct or Update Your PHI. If you believe
that there is a mistake in your PHI or that a piece of
information is missing, you have the right to request that
we correct the existing information or add the missing
information. You must provide the request and your reason
for the request in writing. We will respond whiting 60 days
of receiving your request. We may deny your request in
writing if the PHI is (i) correct and complete, (ii) not
created by us, (iii) not allowed to be disclosed, or (iv)
not part of our records. Our written denial will state the
reasons for the denial and explain you right to file a
written statement of disagreement with the denial. If you
don’t file one, you have the right to request that your
request and our denial be attached to all future disclosures
of your PHI. If we approve your request, we will make the
change to your PHI, tell you that we have done it, and tell
others that need to know about the change to your PHI.
F. The Right to Get This Notice by E-mail. You have the
right to get a copy of this notice by e-mail. Even if you
have agreed to receive notice via e-mail, you also have the
right to request a paper copy of this notice.
IV. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you think that we may have violated your privacy rights,
or you disagree with a decision we made about access to your
PHI, you may file a complaint with the person listed in
Section V below. You also may send a written complaint to
the Texas State Board of Pharmacy (William P. Hobby Building
333 Guadalupe Street, Box 21, Suite 3-600 Austin, Texas
78701-3942). We will take no retaliatory action against you
if you file a complaint about our privacy practices.
V. PERSONS TO CONTACT FOR INFORMATION ABOUT THIS NOTICE
OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you have any questions about this notice or any
complaints about our privacy practices, or would like to
know how to file a complaint with the Secretary of the
Department of Health and Human Services, please contact
Village Compounding Pharmacy’s Pharmacy Manager at 975
Corbindale Road, Suite 100 Houston, TX 77024: phone (713)
464 5069 or (800) 783-5068; fax (713) 464-5099: email
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