HIPAA Privacy Notice

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed. For more on Scripts Rx and our patient care plan, see our Patient Welcome Packet.

Your Rights – You have the right to:

o Get a copy of your paper or electronic medical record and ask us to correct your medical record

o Get a list of those with whom we’ve shared your information and ask us to limit the information we share

o Request conﬁdential communication and communication in the language of your preference

o Get a copy of this privacy notice

o Choose someone to act on your behalf

o File a complaint if you believe your privacy rights have been violated

o Ask for a prescription reader

o Request a pricing list of top 150 medications

Your Choices – You have some choices in the way that we use and share information as we:

o Tell family and friends about your condition

o Provide mental health care

o Provide disaster relief

o Market our services and sell your information

o Include you in a hospital directory

o Raise funds

Our Uses and Disclosures – We may use and share your information as we:

o Treat you

o Run our organization

o Bill for your services

o Comply with the law

o Address workers’ compensation, law enforcement, and other government requests

o Respond to lawsuits and legal actions

Your Rights – When it comes to your health information, you have certain rights:

Get an electronic or paper copy of your medical record and ask us to correct your medical record.

You can ask to get an electronic or paper copy of your medical record, which will be provided within 30 days of the request. We may charge a reasonable, cost-based fee. You can ask us to correct health information that you think is incorrect or incomplete, and we may deny your request with an explanation in writing within 30 days.

Get a list of those with whom your information has been shared and limit where your information is shared.

You can ask for a retrospective accounting for up to six years of each instance in which your health information has been shared. One accounting will be provided for free each year, and a cost-based fee will be charged for each additional request. You may also request we restrict what information we share regarding your treatment as allowable by state or federal law and as long as such restriction would not affect your care. If you pay for a service out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Have your care managed by an appropriately licensed and trained healthcare professional.

All pharmacy staff members will identify themselves and you have a right o request your call or matter be raised to a supervisor at any point. You also have a right to have your care managed by a health professional that is appropriately trained and managed. All your interactions will also be recorded for quality assurance monitoring.

Request conﬁdential communications in the language of your preference.

You can ask us to contact you in a speciﬁc way (for example, home or ofﬁce phone) or to send mail to a different address. We will say “yes” to all reasonable requests. We will also offer you the opportunity to request your preferred language of communication, which includes the language in which medication information is provided or you’re the language a medication label is printed in.

Get a copy of this privacy notice.

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act on your behalf.

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

Ask for a prescription reader.

Upon request, a prescription reader (or acceptable alternative) will be available for the life of the prescription to assist patients with appropriately complying to prescription label instructions.

Decline enrollment in any services.

You may at any point decline enrollment or participation in any services, including refill reminders, text messages, proactive phone calls, or the pharmacy’s Specialty Patient Management Program, as long as declining participation does not directly impact your therapeutic outcomes. You may also re-enroll in these services at any point.

File a complaint if you feel your rights are violated.

You can complain if you feel we have violated your rights by contacting us. You can ﬁle a complaint with the U.S. Department of Health and Human Services Ofﬁce for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for ﬁling a complaint.

Request a pricing list of top 150 medications.

The pharmacy maintains a list of the 150 most frequently dispensed medications that is updated weekly. Patients may request access to that list by contacting the pharmacy at (800) 266-4907 or (888) 473-4002.

Your Choices – For certain health information, you can tell us your choices about what we share.

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care
Share information in a disaster relief situation
Include your information in a hospital directory

Note: If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission: Marketing purposes, sale of your information, most sharing of psychotherapy notes, and in the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures – we typically use or share your health information in the following ways:

Treat you: We can use your health information and share it with other professionals who are treating you.

Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues: We can share health information about you for certain situations such as: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing a serious threat to anyone’s health or safety.

Do research: We can use or share your information for health research.

Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests: We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, for special government functions such as military, national security, and presidential protective services.

Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities:

We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We must make sure that you are aware of any changes to your clinical or care plan and any changes to our Specialty Patient Management Program, including making sure you have accurate contact information for the pharmacy
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
We will work on your behalf to ensure that your health information is shared with appropriate members of your healthcare team, including your prescribing physician.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.