Pharmacy Care Solutions - Innovative Solutions for Individual Needs

The Health Insurance Portability and
Accountability Act (“HIPAA”)
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.
This Notice of Privacy Practices (the “Notice”) describes the privacy practices of Pharmacy Care Solutions,
Inc.
Pharmacy Care Solutions wants you to know that nothing is more central to our operations than
maintaining the privacy of your health information (“Protected Health Information” or “PHI”). PHI is
information about you, including basic information that may identify you and relates to your past, present,
or future health or condition and the dispensing of pharmaceutical products to you. We take this
responsibility very seriously.
Our Pledge Regarding Your Health Information
We are required by federal and applicable state law, regulations, and other authorities to protect the
privacy of your health information and to provide you with this Notice. Our pharmacy staff is required to
protect the confidentiality of your PHI and will disclose your PHI to a person other than you or your
personal representative only when permitted under federal or state law. This protection extends to any PHI
that is oral, written, or electronic, such as prescriptions transmitted by facsimile, modem, or other electronic
device. This Notice describes how we may use and disclose your PHI. In some circumstances, as described
in this Notice, the law permits us to use and disclose your PHI without your express permission. In all other
circumstances, we will obtain your written authorization before we use or disclose your PHI.
This Notice also describes your rights and the obligations we have regarding the use and disclosure of your
PHI. Under federal and applicable state law, we are required to follow the terms of the Notice currently in
effect.
HIPAA’s standards may be pre-empted by certain state laws relating to the privacy of health information.
Please see state provisions at the end of this Notice.
How We May Use and Disclose Your PHI Without Your Permission
TREATMENT, PAYMENT, OR HEALTH CARE OPERATIONS. Below are examples of how Federal law permits use
or disclosure of your PHI for these purposes without your permission:
1. Treatment: Dispensing medications. PHI obtained by Pharmacy Care Solutions will be used to dispense
prescription medications. We will document information related to the medications dispensed and services
provided in your record. Patient Contacts. We may contact you to provide treatment-related services, such
as refill reminders, treatment alternatives and other health related benefits and services that may be of
interest to you.
2. Payment: We may contact your insurer, payor, or other agent and share your PHI with that entity to
determine whether it will pay for your prescription and the payment amount. We may also contact you
about a payment or balance due for prescriptions dispensed to you at Pharmacy Care Solutions.
3. Health care operations: Service. Your PHI may be used to monitor the effectiveness of our services.
Transfer. Your PHI may be transferred for purposes of carrying out the pharmacy services if we buy or sell
pharmacy locations. Benefits/Research. We may also use your PHI to tell you about opportunities that may
be of interest to you, such as clinical research projects.
OTHER SPECIAL CIRCUMSTANCES:
We are permitted under federal and applicable state law to use or disclose your PHI without your
permission only when certain circumstances may arise, as described below.
We are likely to use or disclose your PHI for the following purposes:
Business associates: We provide some services through other companies termed “business associates.”
Federal law requires us to enter into business associate contracts to safeguard your PHI as required by law.
Individuals involved in your care or payment for care: We may disclose your PHI to a friend, personal
representative, or family member involved in your medical care. For example, if we can reasonably infer
that you agree, we may provide prescriptions and related information to your caregiver on your behalf.
Disclosures to parents or legal guardians: If you are a minor, we may release your PHI to your parents or
legal guardians when we are permitted or required under federal and applicable state law.
Worker’s compensation: We may disclose your PHI to the extent authorized and necessary to comply with
laws relating to worker’s compensation or similar programs established by law.
Law enforcement: We 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 death resulting from criminal conduct; about crimes
on the premises or against a member of our workforce; and in emergency circumstances, to report a
crime, the location, victims, or the identity, description, or location of the perpetrator of a crime.
As required by law: We must disclose your PHI when required to do so by applicable federal or state law.
Judicial and administrative proceedings: If you are involved in a lawsuit or a legal dispute, we may disclose
your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful
process.
Public health: We 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 entity; disclosures to notify individuals of recalls, exposure to a
disease, or risk for contracting or spreading a disease or condition.
Health oversight activities: We may disclose your PHI to an oversight agency for activities authorized by
law. These oversight activities include audits, investigations, and inspections, as necessary for our
licensure and for government monitoring of the health care system, government programs, and
compliance with federal and applicable state law.
United States Department of Health and Human Services: Under federal law, we are required to disclose
your PHI to the U.S. Department of Health and Human Services to determine if we are in compliance with
federal laws and regulations regarding the privacy of health information.
Although we may not engage in the following activities, under federal or applicable state law, we are
allowed to use or disclose your PHI without your permission for these purposes:
Research: Under certain circumstances, we may use or disclose your PHI for research purposes. However,
before disclosing your PHI, the research project must be approved by an institutional review board or
privacy board that has reviewed the research proposal and established protocols to ensure the privacy of
your PHI.
Coroners, medical examiners, and funeral directors: We may release your PHI to assist in identifying a
deceased person or determine a cause of death.
Administrator or executor: Upon your death, we may disclose your PHI to an administrator, executor, or
other individual so authorized under applicable state law.
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 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 institution, we may disclose to the
institution or its agents PHI necessary for your health and the health and safety of others.
To avert a serious threat to health or safety: We 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 safety of another
person or the public
Military and veterans: If you are a member of the armed forces, we may release your PHI as required by
military command authorities. We may also release PHI about foreign military personnel to the
appropriate military authority.
National security and intelligence activities: We may release your PHI to authorized federal officials for
intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We 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
We will obtain your written authorization 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 Office at the address listed below. Your revocation will
become effective upon our receipt of your written notice.
You have the following rights with respect to your PHI:
• Obtain a paper copy of the Notice upon request. To obtain a copy at any time, go to www.
pharmacycaresolutions.com/patientprivacy. or contact the Pharmacy Care Solutions Privacy Officer. The
address, telephone and facsimile number are set forth in the box 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 prescription and billing records. To inspect or copy your PHI, submit
a written request to the Pharmacy Care Solutions Privacy Officer. We will respond to your request in writing
within 30 days. A fee may be charged for the expense of fulfilling your request. We may deny your request
to inspect and copy in certain limited circumstances, such as if we have reasonably determined that
providing access to PHI would endanger your life or safety or cause substantial harm to you or another
person. If we deny your request, we 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
we amend it for as long as we maintain the PHI. To request an amendment, submit a written request to
the Pharmacy Care Solutions Privacy Officer. Requests must identify: (i) which information you seek to
amend, (ii) what corrections you would like to make, and (iii) why the information needs to be amended.
We will respond to your request in writing within 60 days (with a possible 30-day extension). In our
response, we will either: (i) agree to make the amendment, or (ii) inform you of our denial, explain our
reason, and outline appeal procedures. If denied, you have the right to file a statement of disagreement
with the decision. We will provide a rebuttal to your statement and maintain appropriate records of your
disagreement and our rebuttal.

• Receive an accounting of disclosures of PHI. You have the right to request an accounting of your PHI
disclosures for purposes other than treatment, payment, or health care operations. This accounting will
also exclude disclosures: made directly to you, made with your authorization, made incidentally, made to
caregivers, made for notification purposes, and certain other disclosures. To obtain an accounting, submit
a written request to the Pharmacy Care Solutions Privacy Officer. Requests must specify the time period,
not to exceed six years. We will respond in writing within 60 days of receipt of your request (with a possible
30-day extension). We will provide an accounting per 12-month period free of charge, but you may be
charged for the cost of any subsequent accountings. We 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 we communicate with you in a certain way or at a certain location. For example, you may
request that we contact you only in writing at a specific address. To request confidential communication of
your PHI, submit a written request to the Pharmacy Care Solutions Privacy Officer. Your request must state
how, where, or when you would like to be contacted. We will accommodate all reasonable requests.

• Request a restriction on certain uses and disclosures of PHI. You have the right to request a restriction or
limitation on our use or disclosure of your PHI by submitting a written request to the Pharmacy Care
Solutions Privacy Officer. You must identify in this request: (i) what particular information you would like to
limit, (ii) whether you want to limit use, disclosure, or both, and (iii) to whom you want the limits to apply.
All requests will be carefully considered, but we are not required to agree to those restrictions. We will
provide you with a written response to your request within 30 days. If we do agree to restrict use or
disclosure of your PHI, we will not apply these restrictions in the event of an emergency. We also have the
right to terminate the restriction if: (i) you agree orally or in writing, or (ii) we inform you of the
termination, which becomes effective only with respect to your PHI created or received after we inform you
of the termination.

Contact the Pharmacy Care Solutions Privacy Officer at 2323 North Marr Road, Columbus, IN 47203. Call us
at (812) 376-9650. Our fax number is (812) 376-9651. All requests for PHI must include patient’s full
name, date of birth, and address.

Complaints. If you believe your privacy rights have been violated, you can file a complaint with the
Pharmacy Care Solutions Privacy Officer at the address above or 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 filing a complaint.

Changes to this Notice: We reserve the right to change our privacy practices. We reserve the right to make
the revised Notice effective for PHI we already have about you as well as any information we receive in the
future, as of the effective date of the revised Notice. Upon request to the Privacy Office, Pharmacy Care
Solutions will provide a revised Notice to you. We will also post the revised Notice on our Web site at www.
pharmacycaresolutions.com/patientprivacy.

Effective Date: This Notice is effective as of 10/05/2006.
State Specific Provisions: INDIANA
Disclosure
We will disclose your confidential information only when it is in your best interests, when the information is
requested by the Board of Pharmacy or its representatives or by a law enforcement officer charged with the
enforcement of laws pertaining to drugs or devices or the practice of pharmacy, or when disclosure is
essential to our business operations.