NOTICE OF PRIVACY PRACTICES
EFFECTIVE APRIL 14, 2003

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.

HOW WE SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI):

This Notice of Privacy Practices (Notice) explains how SMA pharmacy uses and discloses your PHI and the rights that you, as a Patient, have to access that information and to keep it private. We are required by law to protect the privacy of your PHI and to provide you with this Notice. We are also required to follow the privacy practices that are described in this Notice, which take effect on April 14th, 2003. If a State Law provides you with greater protection for your information or greater access to your records than the Federal Law, we will abide by the State Law.

We reserve the right to change our privacy practices and the terms of this Notice at any time, and to have those changes be effective for all information that we have, including PHI we created or received before the effective date of the new Notice. If we make a significant change in our privacy practices, we will make the new Notice available to you at the pharmacy, and on our website, www.SMA pharmacy.com.

For more information, please contact us using the information listed below:

Contact:
Privacy Officer

SMA pharmacy
2727 Bolton Boone #104

Desoto, TX 75115

Tel. 972-572-6644

HOW WE USE AND DISCLOSE YOUR PHI:

The following categories describe different ways that we use and disclose your PHI.

Treatment: We may use your PHI to provide you with medical treatment or health-related services. We may use your information to coordinate care with other pharmacies and healthcare providers, including concerns we may have regarding suspected prescription misuse or addiction. Other examples are filling your prescription or speaking to your physician regarding your prescription and other medications you are taking.

Payment: We may use and disclose your PHI in order to receive payment for the drugs you receive. For example, we need to give information about prescriptions we filled for you to your health plan to obtain payment.

Health Care Operations: We may use and disclose PHI about you for our health care operations, which are activities necessary to operate SMA pharmacy to ensure that all of our patients receive quality care.

Business Associates: There are some services provided by us through contracts with business associates. When these services are contracted for, we may disclose your PHI to our business associates so that they can perform the job we have asked them to do and bill you or your third-party payor for services rendered. To protect your PHI, we require business associates to appropriately safeguard the information.

Communication with Individuals Involved in Your Care or Payment for Your Care: Health professionals such as pharmacists, using their professional judgment, may disclose to your family members, friends, and persons you indicate are involved in your care, PHI that is directly relevant to their involvement in your care or payment for your care.

Health Related Educational Communications: We may contact you to provide refill reminders or information about treatment alternatives, Health Fair events in our stores, or other health-related benefits and services that may be of interest to you. We may also contact you about store openings or closings in your area.

Communication about Products and Services: We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives, or to tell you about health-related benefits or services that may be of interest to you. We may communicate with you face-to-face regarding any products or services.

Special Situations involving Public Health or Legal Requirements: We may use and disclose PHI about you:

·If required by law.
·To the FDA, or persons under the jurisdiction of the FDA relative to adverse events with respect to drugs, foods, supplements, products and product defects, or marketing surveillance information to enable product recalls, repairs, or replacement.
·For disaster relief efforts, and for public health activities, such as communicable disease reporting, or informing authorities of possible victims of abuse, neglect or domestic violence.
·For government healthcare oversight activities.
·For law enforcement purposes, in response to a valid court order or warrant, or as specifically required or permitted by law, including disclosures to an inspector or investigator whose duty is to enforce the laws relating to drugs, and who is engaged in a specific investigation involving a designated person or drug, or for reporting suspected crimes such as child abuse.
·To members, inspectors or agents of a State Board of Pharmacy.
·For research studies that meet all state and federal privacy law requirements.
·To avoid a serious threat to your health or safety, or the health and safety of the public or another person.
·To medical examiners, funeral directors, or organ procurement organizations, in regard to a deceased person.
·To a correctional institution when necessary for your health or the health and safety of others, if you are or become an inmate of a correctional institution.
·For special government functions, such as disclosures to authorized federal officials for national security activities.
·As required by military command authorities if you are a member of the armed forces, or a member of a foreign military.
·To comply with state laws relating to workers’ compensation and similar programs for work-related injuries or illness.

Uses and Disclosures You Specifically Authorize: If you give us your written authorization, we may use and disclose your PHI as permitted by that authorization. You may revoke an authorization in writing at any time, except if we have already relied on it. Without your written authorization, we may not use or disclose your PHI for any reason except those described in this Notice.

YOUR RIGHTS

Access: Each person over the age of 18 has the right to review and obtain a copy of his or her PHI contained in a designated record set, with limited exceptions. The designated record set usually will include prescription and billing records. Parents of minor children may also request the records of their minor children. We require you to send a written request to Privacy Officer, SMA pharmacy  2727 Bolton Boone #104 Desoto, TX 75115

 If you request copies, we may charge you a fee to cover the costs of copying, mailing and other supplies. We may deny your request to review and copy in certain limited circumstances. If we deny your request, you may be entitled to a review of that denial.

Some state laws allow minors to keep some records confidential from parents or guardians in certain cases. If a minor chooses to use his or her parents’ insurance or payment information, we cannot assure that the records will be kept confidential. Minors must notify SMA pharmacyin writing in situations where the minor believes the information should be kept confidential so that the pharmacy can make a determination about whether the information must be shared with a parent or guardian. The pharmacist is permitted to inform the parent or guardian if in the judgment of the pharmacist, failure to inform the parent or guardian would seriously jeopardize the health of the minor patient.

Amendment: If you feel that your PHI is incorrect or incomplete, you have the right to request that we amend it. We require you to send a written request to Privacy Officer, SMA pharmacy 2727 Bolton Boone #104 Desoto, TX 75115. You must include a reason to support your request. We may deny your request if we did not create the information you want amended or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be included in your records.

Accounting of Disclosures: You have the right to receive a list of disclosures we have made of your PHI. This right does not apply to disclosures for treatment, payment, health care operations, and certain other purposes. We require you to send a written request to Privacy Officer, SMA pharmacy 2727 Bolton Boone #104 Desoto, TX 75115. Your request must specify the time period, but may not be longer than six years from the date of this request, and must not go back further than April 14, 2003.

Restriction Requests: You have the right to request that we place restrictions on our use or disclosure of your PHI for treatment, payment, and health care operations. We are not required to agree to these restrictions, but if we do, we will abide by our agreement (except in an emergency). We require you to send a written request to Privacy Officer, SMA pharmacy 2727 Bolton Boone #104 Desoto, TX 75115 .

Confidential Communication: You have the right to request that we communicate with you in confidence about your PHI by alternative means or to an alternative location. For example, you may ask that we contact you only at work or by mail. You must specify how or where you wish to be contacted. We will accommodate all reasonable requests. We require you to send a written request to Privacy Officer, SMA pharmacy 2727 Bolton Boone #104 Desoto, TX 75115

Others Acting on Your Behalf: These rights may also be exercised by someone who has the legal right to act on your behalf.

Copy of this Notice: You are entitled to receive a printed (paper) copy of this Notice at any time. Please contact us using the information listed above.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

You may submit complaints or refer questions concerning the use of your PHI to:

Contact: HIPAA Privacy Officer
SMA pharmacy

2727 Bolton Boone #104 Desoto, TX 75115

You also may submit a written complaint to the U.S. Department of Health and Human Services at the address below:
U.S. Department of Health and Human Services
200 Independence Avenue, S. W.
Washington, D.C. 20201