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.
When this Notice of Privacy Practices ("Notice") refers to "we" or "us," it is referring to FORHUMANITY HEALTH, INC. and all pharmacists who provide health-care services and the employees of our pharmacy. We are required by law to maintain the privacy of your protected health information ("PHI"), to follow the terms of the Notice currently in effect, to give you this Notice setting forth our legal duties and privacy practices concerning your PHI, and to notify affected individuals following a breach of unsecured PHI. This Notice describes how we may use and disclose your PHI. Additionally, this Notice explains the rights you have with respect to your PHI and certain obligations we must abide by in accordance with the law. We reserve the right to amend this Notice. If we make any material revisions, we will post a copy of the revised Notice in the pharmacy, on our website, and will offer you a copy of the revised Notice.
I. USE AND DISCLOSURE OF YOUR PHI
We will use and disclose your PHI for treatment, payment, and health-care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization. The following lists examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will only be made with your explicit written authorization, which you may revoke at any time by providing us with written notice of your revocation.
A. Treatment – We may use and disclose your PHI in order to provide you with prescription and supply services. We may disclose your PHI to other pharmacists, pharmacy technicians, and health-care providers involved in your care. You will receive an individual notice and have the opportunity to opt out of any subsidized treatment communications.
B. Payment – We will use and disclose your PHI in order to obtain payment for the health-care services we provide to you. We may also need to disclose your PHI to receive prior approval from your health plan or to determine if your health plan will cover a certain prescription or service.
C. Health-Care Operations – We may use and disclose your PHI in connection with the management of our pharmacy. This may include quality assessment and improvement, internal compliance audits, and performance evaluations. Additionally, we may use your PHI for our business management and general administrative activities.
D. Prescription Refill Reminders, Treatment Alternatives, or Health-Related Benefits – We may use and disclose your PHI to contact you to remind you about prescription refills, to tell you about treatment options or alternatives, or to inform you about health-related benefits or services that may be of interest to you.
E. Family Members, Relatives, or Close Friends – Unless you object to such disclosure, we may disclose your PHI to family members, relatives, close personal friends, or any other persons identified by you as being involved in the treatment or payment for your medical care. If you are not present to agree or object, we may use professional judgment to determine whether the disclosure is in your best interest and will disclose only PHI relevant to treatment or payment.
F. Other Permitted and Required Uses and Disclosures – We may use your PHI without obtaining your authorization and without offering you the opportunity to agree or object in situations including:
- As required by law, provided the disclosure complies with applicable statutes and regulations
- To public-health authorities for disease prevention or control, adverse-event reporting, or abuse and neglect reporting
- To health-oversight agencies for audits, inspections, investigations, or licensure actions
- For judicial or administrative proceedings in response to a subpoena or court order, after reasonable efforts to notify you or secure a protective order
- To law enforcement for certain injuries, to comply with legal process, to locate a suspect, or to report a crime
- To coroners or medical examiners for identification or cause-of-death determinations
- To funeral directors as necessary for their duties
- To organ-procurement organizations to facilitate donation and transplantation
- For approved research purposes with appropriate safeguards
- To avert a serious threat to health or safety when disclosure is made to someone able to prevent or lessen the threat
- For military or veterans activities to ensure proper execution of a military mission or benefit determinations
- For national-security and intelligence activities authorized by law
- For protection of the President or other authorized individuals and for authorized investigations
- To correctional institutions or law-enforcement custodians if you are an inmate or detainee
- To comply with workers' compensation or similar programs relating to work-related injuries
II. YOUR RIGHTS AS OUR PATIENT
A. You have the right to request restrictions or limitations on how we use and/or disclose your PHI; however, we are not required to agree to your request (except for information related to services you paid for entirely out-of-pocket). Your request must specify the information to be restricted, the type of restriction, and to whom it applies. If we agree, the restriction does not apply to disclosures to you, disclosures required by law, or disclosures in emergencies.
B. You have the right to receive confidential communications concerning your PHI by alternative means or at alternative locations. Submit written requests to the Privacy Officer specifying the preferred means or location. We will accommodate reasonable requests.
C. You have the right to access, inspect, and obtain a copy of your PHI, including electronic PHI, except for certain information exempt under HIPAA. Requests will be addressed promptly; reasonable, cost-based fees may apply. In limited cases we may deny access, and you may request a review of any denial.
D. You have the right to receive an accounting of disclosures of your PHI made by us or our business associates for up to six years prior to your request. The first request in a 12-month period is free; reasonable, cost-based fees may apply to additional requests.
E. You have the right to request an amendment to PHI you believe is incorrect or incomplete. Submit a written request with supporting reasons. We may deny requests in certain circumstances but will provide written explanations. You may submit a statement of disagreement, and we may respond with a rebuttal; all such documents will accompany future disclosures of the disputed PHI.
F. You have the right to obtain a paper copy of this Notice at any time, even if you agreed to receive it electronically. Submit requests in writing to the Privacy Officer.
G. You have the right to opt out of fundraising communications, and your PHI will not be used for fundraising purposes or sold without your prior authorization.
III. ADDITIONAL INFORMATION / QUESTIONS OR COMPLAINTS
If you need additional information about this Notice or wish to exercise any of your rights, contact:
ForHumanity Health, Inc
1111 6th Ave Ste 550 PMB 278126
San Diego, CA 92101-5211
United States
If you believe your privacy rights have been violated, you may file a complaint without fear of retaliation with the Privacy Officer or with:
Secretary of the Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
