Notice of Privacy
Practices
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.
K.O. Pharmacy
Services, L.L.C. is required by law to maintain the privacy of
Protected Health Information ("PHI") and to provide you with notice
of our legal duties and privacy practices with respect to PHI. PHI
is 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 how we may use and disclose PHI to carry out treatment,
payment or health care operations and for other specified purposes
that are permitted or required by law. The Notice also describes
your rights with respect to your PHI. We are required to provide
this notice to you by the Health Insurance Portability and
Accountability Act ("HIPAA").
K.O. Pharmacy
Services, L.L.C. is required to follow the terms of this Notice. We
will not use or disclose your PHI without your written
authorization, except as described or otherwise permitted by this
Notice. We reserve the right to change our practices and this Notice
and to make the new Notice effective for all PHI we maintain. Upon
request, we will provide any revised Notice to you.
Examples of How We
Use and Disclose Protected Health Information About You.
The following
categories describe different ways that we use and disclose your
protected health information. We have provided you with examples in
certain categories; however, not every use or disclosure in a
category will be listed.
Treatment. We may use
your health information to provide and coordinate the treatment,
medications and services you receive. For example, we may contact
you regarding compliance programs such as drug recommendations,
therapeutic substitution, refill reminders, other product
recommendations, counseling and drug utilization review (DUR),
product recalls or disease state management.
Payment. We may use
your health information for various payment-related functions.
Example: We may contact your insurer, pharmacy benefit manager or
other health care payor to determine whether it will pay for your
medication and the amount of your co-payment. We will bill you or a
third-party payor for the cost of medications dispensed to you. The
information on or accompanying the bill may include information that
identifies you, as well as the medications you are taking.
Health Care
Operations. We may use your health information for certain
operational, administrative and quality assurance activities.
Example: We may use information in your health record to monitor the
performance of the pharmacists providing treatment to you. This
information will be used in an effort to continually improve the
quality and effectiveness of the health care and service we provide.
We may disclose health information to business associates if they
need to receive this information to provide a service to us and will
agree to abide by specific HIPAA rules relating to the protection of
health information.
We may also use your
health information to provide you with information about benefits
available to you, and, in limited situations, about health-related
products or services that may be of interest to you. If you register
your email address on K.O. Pharmacy Services, L.L.C. com, you may
elect to receive this information via email.
We are permitted to
use or disclose your PHI for the following purposes. However, K.O.
Pharmacy Services, L.L.C. may never have reason to make some of
these disclosures.
To Communicate with
Individuals Involved in Your Care or Payment for Your Care. We may
disclose to a family member, other relative, close personal friend
or any other person you identify, PHI directly relevant to that
person's involvement in your care or payment related to your care.
United States Food
and Drug Administration (FDA). We may disclose to the FDA, or
persons under the jurisdiction of the FDA, PHI relative to adverse
events with respect to drugs, foods, supplements, products and
product defects, or post-marketing surveillance information to
enable product recalls, repairs, or replacement.
Worker's
Compensation. We may disclose your PHI to the extent authorized by
and to the extent necessary to comply with laws relating to worker's
compensation or other similar programs established by law.
Public Health. As
required by law, we may disclose your PHI to public health or legal
authorities charged with preventing or controlling disease, injury,
or disability.
Law Enforcement. We
may disclose your PHI for law enforcement purposes as required by
law or in response to a subpoena or court order.
As Required by Law.
We will disclose your PHI when required to do so by federal, state,
or local law.
Health Oversight
Activities. We may disclose your PHI to an oversight agency for
activities authorized by law. These oversight activities include
audits, investigations, inspections, and credentialing, as necessary
for 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 your PHI 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 instituted by someone else involved in the dispute, but only
if efforts have been made, either by the requesting party or us, to
tell you about the request or to obtain an order protecting the
information requested.
Research. We may
disclose your PHI 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 information.
Coroners, Medical
Examiners, and Funeral Directors. We may release your PHI to a
coroner or medical examiner. This may be necessary, for example, to
identify a deceased person or determine the cause of death. We may
also disclose PHI to funeral directors consistent with applicable
law to enable them to carry out their duties.
Organ or Tissue
Procurement Organizations. Consistent with applicable law, we may
disclose your PHI to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of
organs for the purpose of tissue donation and transplant.
Notification. We may
use or disclose your PHI to notify or assist in notifying a family
member, personal representative, or another person responsible for
your care, regarding your location and general condition.
Fundraising. We may
contact you as part of a fundraising effort.
Correctional
Institution. If you are or become an inmate of a correctional
institution, we may disclose to the institution or its agents PHI
necessary for your health and the health and safety of other
individuals.
To Avert a Serious
Threat to Health or Safety. We may use and disclose your PHI when
necessary to prevent a serious threat to your health and safety or
the health and safety of the public or another person.
Military and
Veterans. If you are a member of the armed forces, we may release
PHI about you as required by military command authorities. We may
also release PHI about foreign military personnel to the appropriate
foreign military authority.
National Security,
Intelligence Activities, and Protective Services for the President
and Others. We may release PHI about you to federal officials for
intelligence, counterintelligence, protection to the President, and
other national security activities authorized by law.
Victims of Abuse or
Neglect. We may disclose PHI about you to a government authority if
we reasonably believe you are a victim of abuse or neglect. We will
only disclose this type of information to the extent required by
law, if you agree to the disclosure, or if the disclosure is allowed
by law and we believe it is necessary to prevent serious harm to you
or someone else.
Other Uses and
Disclosures of PHI
We will obtain your
written authorization before using or disclosing your PHI for
purposes other than those provided for above (or as otherwise
permitted or required by law). You may revoke an authorization in
writing at any time. Upon receipt of the written revocation, we will
stop using or disclosing your PHI, except to the extent that we have
already taken action in reliance on the authorization.
Your Health
Information Rights:
Obtain a paper copy
of the Notice upon request. You may request a copy of our current
Notice at any time. Even if you have agreed to receive the Notice
electronically, you are still entitled to a paper copy. You may
obtain a paper copy from a pharmacy, mail service location or the
Privacy Office.
Request a restriction
on certain uses and disclosures of PHI. You have the right to
request additional restrictions on our use or disclosure of your PHI
by sending a written request to the Privacy Office. We are not
required to agree to those restrictions. We cannot agree to
restrictions on uses or disclosures that are legally required, or
which are necessary to administer our business.
Inspect and obtain a
copy of PHI. In most cases, you have the right to access and copy
the PHI that we maintain about you. To inspect or copy your PHI, you
must send a written request to the Privacy Office. We may charge you
a fee for the costs of copying, mailing and supplies that are
necessary to fulfill your request. We may deny your request to
inspect and copy in certain limited circumstances.
Request an amendment
of PHI. If you feel that PHI we maintain about you is incomplete or
incorrect, you may request that we amend it. To request an
amendment, you must send a written request to the Privacy Office.
You must include a reason that supports your request. In certain
cases, we may deny your request for amendment.
Receive an accounting
of disclosures of PHI. You have the right to receive an accounting
of the disclosures we have made of your PHI after April 14, 2003 for
most purposes other than treatment, payment, or health care
operations. The right to receive an accounting is subject to certain
exceptions, restrictions, and limitations. To request an accounting,
you must submit a request in writing to the Privacy Office. Your
request must specify the time period. The time period may not be
longer than six years and may not include dates before April 14,
2003.
Request
communications of PHI by alternative means or at alternative
locations. For instance, you may request that we contact you at a
different residence or post office box. To request confidential
communication of your PHI, you must submit a request in writing to
the Privacy Office. Your request must tell us how or where you would
like to be contacted. We will accommodate all reasonable requests.
Where to obtain forms
for submitting written requests. You may obtain forms for submitting
written requests from any K.O. Pharmacy Services, L.L.C. store or
mail service location or by contacting the Privacy Officer at 623
North New Ballas Rd., St. Louis, MO 63141 or by telephone at (314)
991-5200.
Incidental
Disclosures:
K.O. Pharmacy
Services, L.L.C. will make reasonable efforts to avoid incidental
disclosures of protected health information. An example of an
incidental disclosure is conversations that may be overheard between
the pharmacy staff and the patient at the office location. To reduce
the likelihood of this happening, we recommend that you go inside
the store to the pharmacy for any consultations.
Minors.
If you are a minor
who has lawfully provided consent for treatment and you wish for K.O.
Pharmacy Services, L.L.C. to treat you as an adult for purposes of
access to and disclosure of records related to such treatment,
please notify a pharmacist or the Privacy Office.
For More
Information or To Report a Problem:
If you have questions
or would like additional information about K.O. Pharmacy Services,
L.L.C.' privacy practices, you may contact our Privacy Officer at
623 North New Ballas Rd., St. Louis, MO 63141 or by telephone at
(314) 991-5200. If you believe your privacy rights have been
violated, you can file a complaint with the Privacy Officer or with
the Secretary of Health and Human Services. There will be no
retaliation for filing a complaint.
Effective Date
This Notice is
effective as of April 13, 2003.