Patient Privacy Statement

RICE PHARMACY
I2O9 NORTH MAIN STREET
BEAVER DAM. KY .12320
'frc!lmenl.
Our organrzation may use your identiliablc
heahh information to treat you. For exanrple, tle may perform
a follow-up interview and we may use lhc results lo hclp us
modify your treatment plan. Many ofthe people who work
lbr our organization may use ofdisclose your identifiable
hcalth infornlation in order lo reat you or lo assisl othcrs in
your lrealment. Additionally. we may disclose your
rdenlrllabl( heallh rnformati,rn lo olhers who ma) assist in
your care. such as your physician. therapists, spouse. children,
270-27,1-331E
NOTICE OF PRTVACY PRACTICES
As Required by the Privacy Regulations Promulgated
Pursuant to the Health lnsurance Pofiability and
Accounrability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOII MAY BE USED AND
DISCLOSED AND HOW YOU CAN CET ACCESS TO
YOTIR IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
.\. ol R ( oul l ltE\t
our organization
tr) \ ot
R
PRt\
is dedicated to maintaining the privacy
use and disclose your
idenlifiablc heahh information in ordcr to bill and collcct
payment for the seNices and items you may receive from us.
For exsmple. we may contact your health insurer to ceniry
that you arc eligible for benefits (and for what range of
benellts), and we may provide your insurcr with details
regarding your treatmenl to determine ifyour insurer will
cover, or pay fot, yout treatment- we also may use and
disclose your identifiable health intbrmation to obtain
paymenl from third pa(ies who may be responsibl€ lbr such
costs. such as family members. Also. wc may use your
rdenlitiable health infomation to billyou directly for serviccs
and items
will
privacy practices lhat we havc in effcct al the time.
3,
To summarize, this notice provides you with the following
imponanl information:
4.
ot rs oNs
Pl-u,\su ( o\ L\( l :
..\vu
Atx)tIt
lls Nol l('8.
(
use and
drsclose your idenlifiable heahh rnformalron to operate our
business. As examples ofthe ways in which we may use and
Appointmcnt Rcmindcrs. Our organizalion may usc and
6
1
Rclarse of Informrtion to Frmily/lriends. Our
organization may release your idenlifiablc health information
to a friend or fanlily mcmbcr who is helpiog you pay for your
health care ofwho assists in tating care ol you.
Disclosures Required By
Lxw. Our organizalion will
RICE PHARMACY
NORTH MAIN STREET
BEAVER DAM, KY 42320
270-274-331E
D
. \\'r \tAl I sti .\\D t)ts( t.oslt l'ot R }j.\l.
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use
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t,st,t
Thc follo$ing categorics describe uniquc scenarros in which we
may use or disclose your idcnlifiable health inli)rmatxnr:
t
Herlth Oversight Activitics. Our organization may disclose
your identifiable health informalion to a health oversight
agency for activities authorized by law. Oversight aclivilics
can include, fbr cxamplc, investigations, inspections. audits.
surveys. licensure, and disciplinary actions: civil,
administrative, and criminal procedures or actions:or other
activities necessar!'for lhe govemment to monitor govemment
programs. compliance with civil rights laws. and the hcalth
care syslem in general.
J.
Lrrrsoils rnd Similrr Prorccdings. Our organization may
use and disclose your identitiable health information in
response lo a court or administrative order ifyou are involved
in a lawsuit or similar procecding. We also may disclose your
identifiable health infonnation in response to a discovery
request. subpoena or other lawful process by another party
involved in the disputc, but only if we have made m cffort to
inform you of the rcquest or lo obtain an order protecling the
information the party has requested.
inform you ofhealth-related benefils or services thal may be
of interest to you.
and disclose your identiliable health infomalion when
required to do so by federal. state. or local law.
2OS
l\t.oR \ o\ l\ I lt !ot-l.oll t\(; \\,\\
Herlth Crre Operrtions. Our oBanization may
Haalth-Relslcd Benclits and Services. Our organi2lation
may use and disclos€ your identifiable health infomalion to
LEVI RICE
I
2.
disclose your identifiable health information to contact you
and remind you of visits/deliveries.
lhr
terms ofthis notice rpply to sllrecords contsining your
identifieble he!llh informetion lhst sre cresled or rctained by our
prlctice, \le rcscrve thc right to revisr or rmend our notice of
pritacy prrctices. Any revision or &mendmeni to this notic€ *ill bc
effrclive for all ofyour rccords our prrctice h&s crcf,ted or
neintf,inrd in lhe pssl, end for sn) ofyour rccords *e miy cresle or
m{intrin in the future. Our orgaoization will post r copy ofour
currenl nolice in our omces in r promincnl locrtion, rnd )ou me!'
request s copy ofour most current nolice during any ollice visit.
medicalsurveillance.
ditclose your information for our operations. our organization
may use your health information to €valuate th€ quality of care
you received from us or to conduct cost-management and
business planning aclivitres for our pracltce.
How we moy use and disclose your identifiable health
information
Your privrcy rights in your identifiable health information
Our obligalions conceming the use and disclosure of your
identifi able health infoImation.
communicable disease
Notirying a person regarding a potential risk for
spreading or contracting a disease or condition
Reporting rsactions to drugs or problems with products
or devices
Notilring individuals ifa product or device they may be
using has been recallcd
Notirying appropriate govemment agency(ies) and
authority(ies) regarding the potential abuse or neglecl of
an adult patient (including domestic violence)i however.
we llill only disclose lhis informalion ifthe patient
agrees or we are required or authorized by law to
disclore this information
Nolirying your employer under limited circumstanccs
related primarily to workplace injury or illness or
Pryment. Our organization ma]
ofyour
confidenlia,ity ofheakh information that identifies you. we also
are required by law to provide you wilh this notice oI our legal
duties and privacy practices conceming your identifiable health
information. By law. we must follow the terms ofthe notice of
Maintaining vital records, such as births and deaths
Reponing child abuse or ncglecl
Prevcnting or conlrolling disease, injury. or disability
Notilying a person regardinS potcntial exposurc to a
of parenls.
\( I
idcnlifiablc health information. ln conducting our busincss. wc
creale records regarding you and the treatment and services we
provide to you. wc arc required by law lo maintain thc
t,. tl'\ otr
Public Herlth Riskt. Our organization may drscloso your
idenlifiable heallh inlbrmation lo public health authorities who
are authori4d by la\r' to collcct inlormatron for the purpose of
The lbllowinB categories describe thc dillcrent ways in which we
ma) use and disclose your idcnlifiable hcalth inlbrmalion:
{
Lrw f,nforcement. We may
release identifiable health
information ifasked to do so by a law enforcement ofliciall
Regffding a crime victim in certain situations. ifwe are
.
.
.
.
.
.
unable to obtain the person's agreement
Concemin8 a death we believe might have resulled from
criminal conduct
Regarding criminal conducl at our offices
In response to a warant, summons, coun order.
subpoena. or similar leSal process
To idenliry/locatc a suspect. materialwitness. Ii8itivr.
or ftissinB person
In an emer8ency. to report a crime (including the
location or victam(s) oflhe orime, or $e descriptbn.
identity or localion ofthe perpetralor)
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