Lee Silsby Compounding Pharmacy’s
NOTICE OF PRIVACY PRACTICES
under the Health Insurance Portability and Accountability Act (“HIPAA”)
PLEASE REVIEW CAREFULLY.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
This Notice of Privacy Practices (the Notice) describes the privacy practices of Lee Silsby Compounding Pharmacy (“LSCP”).
Lee Silsby Compounding Pharmacy wants you to know that we take the responsibility of protecting your health information (“Protected Health Information” or “PHI”) very seriously. PHI includes basic information that may identify you and relates to your past, present and future health or condition, the dispensing of prescriptions or pharmacy product(s) and related healthcare services.
Our Pledge Regarding Your Health Information
LSCP is required by federal and state laws, regulations and other authorities to protect the privacy of your health information and to provide you with this Notice. Our pharmacy staff is trained to protect the confidentiality of your PHI and will not disclose your PHI to a person other than yourself or your authorized representative without your written permission, except when permitted or required by federal or state law. This extends to any PHI that is oral, written or electronically received by LSCP. This Notice describes how we may use and disclose your PHI.
This Notice also describes your rights and our obligations regarding the use and disclosure or your PHI. We are required to follow the terms of this Notice currently in effect.
HIPAA’s standards may be preempted by certain state laws relating to the privacy of health information. These are reviewed at the end of this notice.
How LSCP may Use or Disclose your PHI Without Your Permission
TREATMENT, PAYMENT OR HEALTHCARE OPERATIONS MAY REQUIRE THE RELEASE OF YOUR PHI WITHOUT YOUR WRITTEN PERMISSION AS DESCRIBED BELOW.
Treatment/Dispensing Medications: PHI obtained by LSCP will be used to dispense prescription medication. LSCP will document information related to the medication(s) dispensed and services provided in your patient record. LSCP may contact you to provide treatment related services, such as how a medication is working for you, prescription refills, treatment alternatives and other health related services that may be of interest or benefit to you.
Payment: LSCP may contact your insurer, payor or other agent and share your PHI with that entity to determine payment coverage for a prescription or service. LSCP may also contact you about a payment or balance due for prescription(s) or service(s).
Healthcare Operations: Your PHI may be used to monitor the effectiveness of a pharmacy service.
OTHER SPECIAL CIRCUMSTANCES
LSCP is also permitted under federal and state law to use or disclose your PHI without your permission when certain other special circumstances arise, as described below.
LSCP may use or disclose your PHI for the following purposes:
Business Associates: LSCP provides some services through third party companies termed “Business Associates.” Federal law requires us to enter into a business associate contract to safeguard any PHI that is disclosed.
Individuals involved in your care or payment for said care: LSCP may disclose your PHI to a family member, personal representative or friend involved in your medical care if LSCP can reasonably determine that you agree that the related information can be given to the caregiver on your behalf.
Disclosures to parents or legal guardians: If you are a minor, LSCP may release your PHI to your parents or legal guardians when permitted or required under federal or state law.
Workers compensation: LSCP may disclose your PHI to the extent authorized and necessary to comply with the laws relating to workers compensation or a similar established law.
Law enforcement: LSCP may disclose your PHI for law enforcement purposes, as required by law or in response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness or missing person; about a crime related to the business or on the premises; and in emergency circumstances, to report a crime, the location, victim, or identity, description, or location of the perpetrator of a crime.
As required by law: LSCP must disclose your PHI when otherwise required to do so by federal or state law.
Judicial and administrative proceedings: If you are involved in a lawsuit or legal dispute, LSCP may disclose your PHI in response to a court order or administrative order, subpoena, discovery, request or other lawful process.
Public Health: LSCP may disclose your PHI to federal, state, or local authorities or other entities charged with preventing or controlling disease, injury, or disability for public health activities. These activities may include the following: disclosures to report reactions to medications or other products to the U.S. Food and Drug Administration or other authorized federal or state agency. Disclosure to notify individuals of recall, exposures to a disease, or risk for contracting or spreading a disease or condition.
United States Department of Health and Human Services (HHS): Under federal law, and if a request has been made, LSCP is required to disclose your PHI to HHS to determine if we are compliant with federal laws and regulations regarding the privacy of health information.
Coroners, medical examiners, and funeral directors: LSCP may release your PHI to assist in identifying a deceased person or determine a cause of death.
Administrator or executor: Upon your death LSCP may disclose your PHI to an administrator, executor, or other individual so authorized under applicable state laws.
Organ or tissue procurement organizations: Consistent with applicable law, and if your testamentary documents so state, LSCP 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: LSCP may use or disclose your PHI to assist in a disaster relief effort so that your family, personal representative, or friends may be notified about your condition, status and location.
Correctional institution: If you are or become an inmate of a correctional facility, LSCP may disclose to the facility or to its agents PHI necessary for your health and the health and safety of others.
To avert a serious threat to health or safety: LSCP may use and disclose your PHI to appropriate authorities when necessary to prevent a serious threat to your health and safety or the health and/or safety of another person or the public.
National security and intelligence activities: LSCP may release your PHI to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Military and veterans: If you are a member of the armed forces, LSCP may release your PHI as required by military command authorities. LSCP may also release PHI about foreign military personnel to the appropriate military authority.
Protective services for the President and others: LSCP may disclose your PHI to authorized federal officials so that they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.
How We May Use or Disclose Your PHI For Other Purposes Only With Your Authorization
LSCP will obtain your written permission before using or disclosing your PHI for purposes other than those described above (or as otherwise permitted or required by law}. You may revoke this authorization at any time by submitting a written notice to our Privacy Officer at the address listed below. Your revocation will become effective upon our receipt of your written notice.
Your Rights With Respect to PHI
Obtain an additional paper copy of the Notice of Privacy Practices upon request. To obtain a copy, contact the LSCP Privacy Officer at the telephone or address listed below.
Inspect and obtain a copy of your PHI: You have the right to access and copy your PHI contained in the “designated record set,” which includes prescriptions, billing records and any forms that have been filled out by you or pharmacy personnel contained within. A request to inspect or review your PHI must be made in writing and sent to our Privacy Officer. A fee may be charged for the expense of fulfilling your request. LSCP may deny your request to inspect and copy in certain limited circumstances. To the extent your information is held in an electronic health record, you may be able to receive the information in an electronic format. LSCP will respond to your request within 30 days. If LSCP denies your request, the pharmacy will notify you in writing and provide you with the opportunity to request a review of the denial.
Request an amendment of PHI: If you feel that your PHI is incomplete or incorrect, you may request that LSCP amend it for as long as we maintain the PHI. To request an amendment, submit a written request to our Privacy Officer. Requests must identify: (1) which information you seek to amend, (2) what correction you would like to make, and (3) why the information needs to be amended. LSCP will respond to you in writing within 60 days (with a possible 30 day extension). In our response, LSCP will either (1) agree to make the amendment, or (2) inform you of the denial, explain the reason and outline appeal procedures. If denied, you have the right to file a statement of disagreement with the decision. LSCP will provide a rebuttal to your statement and maintain appropriate records of your disagreement and our rebuttal in your PHI.
Right to an accounting of disclosures of PHI: You have the right to receive an accounting of certain disclosures of your protected health information. The accounting will exclude disclosures: made directly to you, made with your authorization, made incidentally, made to caregivers, made for notification purposes, for national security and certain other disclosures. To obtain accounting, submit a written request to our Privacy Officer. Requests must specify the time period, not to exceed six years. LSCP will respond in writing within 60 days from the receipt of your request (with a possible 30 day extension). LSCP will provide an accounting per 12 month period free of charge, but you may be charged for the cost of any subsequent accounting. LSCP will notify you in advance of the cost involved, and you may choose to withdraw or modify your request at that time.
Request communications of PHI by alternative means or at alternative locations: You have the right to request that LSCP communicate with you in a certain way or at a certain location. For example, you may request that LSCP contact you only in writing at a specific address. To request confidential communication of your PHI, submit a written request to our Privacy Officer. Requests must state how, where, or when you would like to be contacted. LSCP will accommodate all reasonable requests.
Right to be notified of a breach: You have the right to be notified in the event that LSCP (or one of our Business Associates) discovers a breach of your unsecured protected health information. To obtain a paper copy of this notice, contact us in writing at the address below.
Request a restriction on certain uses and disclosures of PHI: You have the right to request a restriction or limitation on LSCP’s use or disclosure of your PHI by submitting a written request to our Privacy Officer. You must identify in the request (1) what particular information you would like to limit, (2) to whom you want to limit use, disclosure or both, and (3) to whom you want the limits to apply. All requests will be carefully considered. LSCP is not required to agree to those restrictions. LSCP will provide you with a written response within 30 days of your request. If LSCP does agree to restrict use or disclosure of your PHI, LSCP may not apply these restrictions in the event of an emergency. LSCP maintains the right to terminate the restriction if: (1) you agree orally or in writing, or (2) LSCP informs you of the termination.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at the above address or with the Secretary of the United States Department of Health and Human services. All complaints must be submitted in writing. You will not be penalized in any way for filling a complaint.
Changes to this Notice: LSCP reserves the right to change our privacy practices and to make changes to the Notice of Privacy with regard to PHI received in the past and future, as of the effective date of the revised Notice. Upon request to the Privacy Officer, LSCP will provide a revised Notice.
Risks of Sharing PHI Via Email Communication
Email is inherently insecure unless it is fully encrypted. Most email for everyday use does not meet those standards. Among the many risks of using email to communicate your health information:
• Email can be forwarded, printed, and stored in numerous paper and electronic forms and be received by
many intended and unintended recipients without your knowledge or agreement.
• Emails may be sent to the wrong address by any sender or receiver.
• Email is easier to forge than handwritten or signed papers.
• Copies of email may exist even after the sender or the receiver has deleted his or her copy.
• Email service providers have a right to archive and inspect emails sent through their systems.
• Email can be intercepted, altered, forwarded, or used without detection or authorization.
• Email can spread computer viruses.
• Email delivery is not guaranteed.
• Email can be used for Phishing. Phishing is a technique of obtaining sensitive personal information from individuals by pretending to be a trusted sender.
The use of open internet email channels is not secure or encrypted, meaning that messages could potentially be viewed by unauthorized persons who might intercept or read those emails. Email is also not an appropriate method for sharing urgent or emergent information.
Effective Date: This revised Notice of Privacy Practices is effective 3/8/2021.
Contact the Lee Silsby Compounding Pharmacy Privacy Officer at 23865 Mercantile Road, Beachwood, Ohio 44122. Call us 1-800-918-8831. Our fax is (216) 321-4303 or e-mail us at email@example.com. All requests for PHI must include the patient full name, date of birth and address.