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.
Acres Pharmacy (“we,” “us,” or “our”) is committed to protecting your health information in accordance with federal and state law. This Notice explains your rights regarding your protected health information (PHI) and how we may use or disclose that information.
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Your Rights
You have the following rights regarding your PHI:
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Right to Inspect and Copy:
- You may request to inspect or obtain a copy of your PHI contained in a designated record set.
- Requests must be submitted in writing.
- We may charge a reasonable fee for copies.
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Right to Request an Amendment:
- If you believe information in your PHI is incorrect or incomplete, you may request an amendment.
- Requests must be in writing and include a reason for the change.
- We may deny your request under certain circumstances.
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Right to an Accounting of Disclosures:
- You may request a list of disclosures of your PHI made by us in the past six years (except for disclosures made for treatment, payment, or healthcare operations, or those required by law).
- Requests must be in writing.
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Right to Request Restrictions:
- You may request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations.
- We are not required to agree to the restriction, except when required by law.
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Right to Request Confidential Communications:
- You may request that we communicate your PHI by alternative means or locations (e.g., mail or phone).
- Requests must be in writing.
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Right to Receive a Paper Copy of This Notice:
- You may request a paper copy of this Notice at any time, even if you have received it electronically.
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Right to Receive Notice of a Breach:
- You will be notified if there is a breach of your unsecured PHI.
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How We May Use and Disclose Your Health Information
We may use or disclose your PHI without your authorization for the following purposes:
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Treatment:
- To provide, coordinate, or manage your healthcare, including consultations with other healthcare providers and medication delivery.
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Payment:
- To bill and receive payment for pharmacy services.
- Examples include insurance claims and eligibility verification.
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Healthcare Operations:
- For quality improvement, compliance, audits, licensing, training, and administrative purposes.
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Required by Law:
- When disclosure is required by federal, state, or local law.
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Public Health and Safety:
- To prevent or control disease, injury, or disability.
- To report adverse events, product defects, or problems with medications.
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Law Enforcement:
- For law enforcement purposes or as required by court orders.
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Research:
- Under strict regulations, PHI may be used for medical research.
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Organ and Tissue Donation:
- If you are an organ or tissue donor, information may be shared with donation organizations.
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Military, National Security, and Protective Services:
- For members of the armed forces, national security, or law enforcement protective services.
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Workers’ Compensation:
- As required to comply with workers’ compensation laws.
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Uses and Disclosures Requiring Your Written Authorization
We must obtain your written authorization for uses and disclosures not described above. This includes:
- Most uses of psychotherapy notes (if applicable).
- Marketing purposes (unless directly related to your care).
- Sale of PHI.
You may revoke an authorization at any time in writing, except to the extent we have already relied on it.
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Our Responsibilities
- We are required by law to maintain the privacy of your PHI.
- We must provide you with this Notice of our legal duties and privacy practices.
- We must abide by the terms of this Notice currently in effect.
- We will notify you promptly if a breach of your unsecured PHI occurs.
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Filing a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:
Or with the U.S. Department of Health and Human Services:
www.hhs.gov/hipaa/filing-a-complaint
No retaliation will be taken against you for filing a complaint.
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Contact Information
For questions about this Notice or your privacy rights, please contact:
- Acres Pharmacy
- 1446 Lee Blvd., Lehigh Acres, FL 33936
- Phone: 239-674-9737
- Email: acrespharmacy@gmail.com
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Effective Date and Changes to This Notice
- This Notice is effective as of the date listed above.
- We reserve the right to change this Notice at any time.
- Any updated Notice will be posted on our website and available upon request.
