Westside Pharmacy, Inc.
4440-1 West Main St, PO Box 8612, Dothan, AL 36304
334-699-6337 ▪ Fax# 334-699-6338 
www.westsiderx.com

NOTICE OF PRIVACY PRACTICES as Required by the Privacy Regulations

Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996(HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION PLEASE REVIEW THIS NOTICE CAREFULLY. 

This notice provides you with the following important information: 

A. Our obligations concerning the use and disclosure of your Protected Health Information (PHI)  

B. How we may use and disclose your Protected Health Information (PHI) 

C. Your privacy right with regard to your Protected Health Information (PHI) 

A. OUR COMMITMENT TO YOUR PRIVACY AND OUR OBLIGATIONS 

All of us at Westside Pharmacy, Inc. value your relationship with us, and we know that respect for your privacy is the foundation of that relationship. We are committed to protecting the privacy of your protected health information (PHI) that is in our possession and only using and disclosing your PHI as necessary to providing you with health care products and services. PHI is any information that we possess, use, and disclose that identifies you and relates to your past, current, or future physical and mental health condition or illness and the health care products and services that have been provided to you. In conducting our business, we will create records regarding you, and the treatments, services and goods we provide to you.  

By law we are required to: 

1. Maintain the confidentiality of health information that identifies you (Protected Health Information –PHI) 

2. Provide you with this notice of our legal duties and privacy practices concerning your identifiable healthy information (Protected Health Information –PHI) 

3. Follow the terms of the Notice of Privacy Practices that we have in effect at the time. 

4. Notify you of the following: That the terms of this notice apply to all records containing your identifiable health information (Protected Health Information – PHI) that are created or retained by our business. That we reserve the right to revise or amend our notice of privacy practices That any revision or amendment to this notice will be effective for all of your records our practice has created or maintained in the past, and for any of your records we may create or maintain in the future That our business will post a copy of our most current notice in our business in a prominent location. That you may make a verbal or written request to receive a copy of our most current notice. You may make a request during any visit to our business, or make a written request. See Appendix A to make a written request. 

B. HOW WE MAY USE and/or DISCLOSE YOUR PROTECTED HEALTH    INFORMATION REFERRED TO AS PHI FOR THE REMAINDER OF THIS NOTICE 

We May use and/or disclose your PHI for the purpose of treatment, payment, health care operations, and other purposed that do not require the individuals written authorization. We will not use or disclose your PHI without your authorization, EXCEPT AS DESCRIBED IN THIS NOTICE. 

1. TREATMENT. Our business may use your PHI as part of the services that we provide for treatment. For example, information about you may be obtained and/or disclosed for the purpose of dispensing medications, equipment, supplies or other products, items or services to be used in your treatment. Information about you may be used and/or disclosed to assist others. For example, information about you may be used and/or disclosed to assist your physicians, healthcare facilities such as hospitals, nursing homes, assisted living homes, domiciliaries, and hospices, therapists, and others involved in your care and treatment such as your spouse, children, parents, caregivers and others so designated. 

2. PAYMENT. Our business may use and/or disclose your PHI in order to bill and collect payment for the medications, items and other services you may receive from us. For example, we may contact your health insurer, pharmacy benefit manager (PBM) claims administrator, computer/internet switching company, or public, private, or government agency to certify that you are eligible for benefits (and for what range of benefits), and we may 
provide your insurer, or responsible party with details to determine if your insurer or responsible party will cover, or pay for, your treatment. We may also use your PHI to bill you directly for services and items. Your PHI may be used to collect payment through collection agencies or legal proceedings. 

3. HEALTH CARE OPERATIONS. Our business may use and disclose your PHI to operate our business. Examples of ways in which we may use and disclose your information may include but not be limited to evaluation the quality of care you receive from us, training employees on policies and procedures for providing services, 
conduction cost-management and business planning activities for our business. Such uses and disclosures will be for the purpose of improving the quality and effectiveness of the healthcare services we provide. 

4. OTHER LIKELY USES NOT REQUIRING AUTHORIZATION BUSINESS ASSOCIATES – There are some services provided to us by business associates through contracts. Examples may include but not be limited to telephone answering services, computer hardware software vendors, sub-contracted delivery services, business 
consultants, accreditation and certification services, shredding services, internet services, accountants, attorneys, data aggregation, benefits management, claims processing and collection agencies. In such cases the business associate is required by the contract to appropriately safeguard your information. It is also restricted to only use or disclose your PHI to fulfill the terms of the contract. 

COMMUNICATION - Health professionals, using their best judgment, may disclose to your family members, other relatives, close personal friends, or any other person(s) so identified, your PHI that is relevant to that person’s involvement in your care or payment for your care. 

CORRECTIONAL INSTITUTIONS - We may disclose to a correctional institution or agents thereof who has lawful custody, PHI necessary for your health and the health and safety of other individuals. 

FOOD AND DRUG ADMINSTRATION (FDA) – We may disclose to the FDA PHI relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements. 

HEALTH RELATED BENEFITS AND SERVICES – We may contact you to provide refill reminders or information about treatment or treatment alternatives or other health-related benefits and services that may be of interest or value to you. Examples of such contacts may include but not be limited to offering flu immunizations, or notification of newly covered services and products as may be related to your treatment, and health fairs and clinics in which we may participate. We may contact you to inform you that our business participates in a particular health care plan. 

LAW ENFORCEMENT - We may disclose PHI for law enforcement ppurposes as required by law or in response to a valid subpoena. 

MILITARY AND VETERANS – We may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to appropriate military authority. 

NOTIFICATION – We may use or disclose PHI to notify or assist in notifying a family member, personal 
representative, or another person responsible for your care and treatment, you location and general condition 

PUBLIC HEALTH - As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, disability, drug abuse or misuse. 

DATA STORAGE – We store some of your PHI in electronic computer files. We backup our electronic records daily/periodically store backups offsite and employ other precautions to safeguard the integrity of you PHI. In spite of 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 PHI stored on electronic media. 

IN-STORE CHARGE ACCOUNTS - If you charge prescriptions, prescription services, or other goods or services provided by us to your charge account, your parents charge account, your spouses charge account, your employers charge account, or any other entity’s charge account, then you understand that your PHI (Minimum necessary for billing) will be disclosed to the holder of that account and the person or persons responsible for payment of that account. For example dependents, children, friends, employees, or associates, charging prescriptions, prescription services, items or goods to parents, legal guardian, or other responsible person, business entity, public, private or government entity or agency. 

ASSISTED LIVING FACILITY, NURSING HOME, OR DOMICILIARY - Our business may use and disclose your PHI to operate our business and provide treatment, billing, and collection of bills from you or other responsible party. This will be in the normal course our business providing prescriptions, prescription services, other goods, items, and services (to include delivery) for your treatment and wellbeing. 

OTHER PHARMACIES – We may use and disclose your PHI if we are contacted by another pharmacy that state they have your request and consent to transfer records to them; or likewise we may contact another pharmacy and transfer or obtain your pharmacy records at your request or as required for proper care and treatment. 

PHYSICIANS, PHYSICIANS STAFF, OR OTHER HEALTH CARE ENTITY – We may use and disclose your PHI without your authorization when the pharmacy needs to contact a physician, physicians staff, or other healthcare entity without individual written authorization.

PHARMACY, PHARMACY STAFF, PHARMACY TELEPHONES, WAITING AREA, DRIVE THROUGH SERVICE – You understand that due to the small physical size, volume of business, close proximity of telephones, storage shelves (will call), waiting areas, and other store merchandise that in spite of reasonable measures taken, and reasonable precautions and procedures in place that parts of telephone conversations, and questions that you may ask us, or questions we may ask you during our normal course of business may inadvertently disclose small amounts or parts of your PHI as a by product of taking telephone orders from you, physicians offices or healthcare facilities, call-in refills on existing prescriptions, calls to physician offices or healthcare facilities, questions from you to us or from us to you some disclosure of PHI may be inadvertently disclosed or overheard by others in close proximity as a unavoidable by product of the above functions of normal business. If at anytime during these functions either you or we may request to move to a more private area or postpone the encounter until a more suitable, appropriate, private area, or private time is available where and when the problem, question or encounter may be discussed so as to limit the oral or other incidental disclosure of your PHI, and to answer your question(s) or our question(s) or to solve the problem(s) to each others satisfaction.

DELIVERED MEDICATIONS – All delivered packages will be stapled shut and no disclosure of PHI will be visible from the outside. Disclosure of PHI may occur when delivery personnel pick up prescriptions from customers to be brought back to pharmacy. Putting those prescriptions in a sealed envelope to give to driver would be appreciated. 

VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE – We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonable believe it is necessary to prevent serious harm to you; or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.  

WORKERS COMPENSATION – We may disclose PHI to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law You also understand that your PHI may be disclosed to your spouse, child, mother, father or any other person or entity whom you request to pick up print-outs, billing or other records. Examples of this could be patient profiles for tax purposes, insurance reimbursement or records of in-store charges, records for food stamps, commodities & Section 8 housing.  The above instances are more specific instances of use and disclosures of PHI but are not specifically limiting, nor intended to cover all possible situations or circumstances, only the more common situations that arise. You have the right to request to amend, restrict or otherwise limit our use within the law as provided below.  

DURABLE MEDICAL EQUIPMENT DEPARTMENT – This notice of Privacy Practices is also valid for this department.                                  

 
C. YOUR RIGHTS WITH REGARD TO PROTECTED HEALTH INFORMATION (PHI)

Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the following rights. 

1.To amend your protected health information (PHI) as provided for in 45 CFR 164.528. If you believe that your (PHI) is incorrect or incomplete, you may request that it be amended for as long as the information is kept by or for our business. We are not required to agree to the amendment. If you fail to make the request in writing, and to state the reason for the request, we will deny your request. We may deny your request if you ask us to amend information that is: 
(a). Accurate and complete 
(b). Not part of the protected health information kept by or For our business 
(c). Not part of the protected health information that you would be permitted to inspect and copy or 
(d). Not created by our business, unless the individual or  entity that created the information is not available to amend the information. If we deny your request for the amendment, you have the right to file a statement of disagreement  with the decision and we may give a rebuttal to your statement.  A request to amend your protected health information (PHI) must be in writing. Your request must clearly state all information to be amended. You must clearly state the reason for the request and provide support to prove the information is otherwise incomplete 
and/or incorrect.See Appendix A. 

2. To file a complaint. If you believe that your privacy rights have been violated, you may file a complaint with our business or with the Secretary of the Department of Health and Human Services. You will not be penalized or suffer retribution for filing a complaint. A complaint must be made in writing. It must state as clearly as possible the circumstance of the complaint and the person(s) involved. See Appendix A. To file a complaint with the U.S. Department of Health and Human Services, please contact our Privacy officer. See Appendix A.                

3. To inspect and obtain a copy of your health record as provided for in 45 CFR 164.524. You have the right to access and copy PHI that is used or disclosed as described in this notice. Such records may include prescription profiles, medical records, and billing records.  We may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances that may include inspection of psychotherapy notes; information complied in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding and PHI that is subject to law that prohibits access. Depending on the circumstances, a decision to deny access may be reviewed. Such review will be conducted by another health care professional or by an attorney selected by the business. Such reviews will be in keeping with this notice.  A request to inspect or copy your PHI must be made in writing. See Appendix A.       

4. To obtain an Accounting of Disclosures of your health information as provided by 45 CFR164.528. We are required to document “NON-ROUTINE” disclosures of your PHI. You have the right to request an accounting of these non-routine disclosures. We are not required to document disclosures made for purposes of treatment, payment , healthcare operations (TPO), or other disclosures which do not require your authorization as described in this privacy notice that are made in a routine or recurring manner. We are not required to document disclosures we have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these non-routine disclosures that occurred after April 14, 2003. The first accounting you receive in a twelve-month period will be free. You may be charged for additional accounting of disclosures in the same time period. We will notify you of the cost involved, and you may choose to modify your request at that time. A request for an Accounting of Disclosures must be made in writing. Your request should clearly state the time period that may not exceed six (6) years and may not include dates prior to April 14, 2003  

5. To obtain a paper copy of the notice of information practices upon request. You have theright to receive a paper copy of our NOTICE OF PRIVACY PRACTICES (NOPP), even if you have agreed to accept it electronically. You may request a copy at any time. Make your request verbally when you visit our business, or in writing. See Appendix A. 

6. To request communication of your PHI through alternative means or at alternative locations. You have the right to request that we communicate with you about your PHI in a particular manner or at a particular location. For example, you may prefer that we speak with you at home, rather than at work. You may request that printed correspondence be made to a post office box rather than a street address. We will accommodate reasonable request. A request for communication through alternative means or at alternative locations must be made in writing. See Appendix A. 

7. To request a restriction on certain uses and disclosures of your information as provided by CRF 164.522. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations. You may request that we limit our disclosure of your identifiable health information to individuals involved 
in your care or the payment for your care, such as those described in this NOTICE OF PRIVACY PRACTICES. We are not required to agree to a restriction that you may request. If we do agree to the requested restriction, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. A request to restrict the use and disclosure of your PHI must be made in writing. Your request must clearly state all information to be restricted, whether you are requesting to limit our use, disclosure, or both, and to whom you want the limits to apply. See Appendix A. 

8. To revoke your authorization to use or disclose your PHI excepts to the extent that action has already been taken. All uses and disclosures that are not described in this notice and/or otherwise permitted by law will be made only after the patient’s written authorization has been obtained. These uses and/or disclosures will be made only in the context of the authorization. You have the right to revoke your authorization to use and/or disclose your PHI. Any authorization you provide to us regarding the use and disclosure of PHI may be revoked at anytime. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the initial authorization. Please note we are required to retain records of your care and treatment. To revoke your authorization, make your request in writing. State specifically the authorization that is being revoked. 

 EFFECTIVE DATE OF THIS NOTICE OF PRIVACY PRACTICES (NOPP) - APRIL 14, 2003  HIPPAPN0403  

APPENDIX A  

Make all written request to the attention of: PRIVACY OFFICER

Westside Pharmacy, Inc., PO Box 8612, Dothan, AL 36304 

For further questions:

Westside Pharmacy, Inc., 4440-1 West Main St, Dothan, AL 36305 - 334-699-6337
E-mail: westsiderx@graceba.net