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.
If you have any questions about this Notice, please contact our Privacy Officer, S Gupta at (855) 822-7828.
This Notice of Privacy Practices describes how we may use and/or disclose your Protected Health Information to
carry out treatment, payment or health care operations and for other purposes that are permitted or required by
law. It also describes your rights with respect to your Protected Health Information. “Protected Health
Information” is medical information about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health and related health care services.
Uses and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations
The following are examples of the types of uses and disclosures of your Protected Health Information that StatScript Pharmacy is
permitted by the HIPAA Privacy Regulations to make for the purposes of treatment, payment, and health care operations. These examples are not
meant to be exhaustive, but only to give examples of the types of uses and disclosures that may be made.
Treatment: We may use or disclose your Protected Health Information to provide, coordinate, or manage your health care and
any related services. This includes the coordination or management of your health care with a third party such as a physician’s office. For
example, we may disclose your Protected Health Information, as necessary, to your treating physician.
In addition, we may disclose your Protected Health Information to another health care provider (e.g., a pharmacy) who, at the request of your
physician, becomes involved in your care by providing assistance with your treatment.
Payment: Your Protected Health Information may be used, as needed, to obtain payment for services that we provide to you.
For example, to obtain payment from Pilgrim’s Pride for health care screenings conducted by us.
Health Care Operations: We may use or disclose your Protected Health Information in order to support the business
activities of our practice. The activities include, but are not limited to, quality assessment activities, employee review activities,
marketing activities, and conducting or arranging for other business activities. In the event that you no longer wish to receive marketing
communications from us, you may opt out of receiving future such communications by notifying our Privacy Office in writing. We may use or
disclose your Protected Health Information, as necessary, to contact you to remind you of a scheduled screening.
Other Uses and Disclosures of Your Protected Health Information
We may also use or disclose your Protected Health Information in the following ways:
Business Associates: We may share your Protected Health Information with third party "business associates" that perform various activities (e.g.,
billing, transcription services) for StatScript Pharmacy. Whenever an arrangement between our office and a business associate involves the use or
disclosure of your Protected Health Information, we will have a written contract that contains terms that will protect the privacy of your Protected
Health Information.
Appointment Reminders and Other Information: We may use your Protected Health Information to provide appointment reminders or
information about treatment alternatives or health-related benefits and services that may be of interest to you. For example, we may send you a
newsletter about the practice or services that we offer.
Other Permitted and Required Uses and Disclosures of Your Protected Health Information That May Be Made Without Your Authorization
The following are descriptions of each of the other purposes for which StaScript Pharmacy is permitted or required by the HIPAA Privacy Regulations
to use or disclose Protected Health Information without an individual's authorization.
We may use or disclose your Protected Health Information in the following situations without your authorization. These situations include:
Required by Law: We may use or disclose your Protected Health Information to the extent that the use or disclosure is required by law. The use or
disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required
by law, of any such uses or disclosures.
Public Health: We may disclose your Protected Health Information for public health activities and purposes to a public health
authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease,
injury or disability. We may also disclose your Protected Health Information, if directed by the public health authority, to a foreign government
agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your Protected Health Information, if authorized by law, to a person who may have been
exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose your Protected Health Information to a health oversight agency for activities authorized
by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee
the health care system, government benefit programs, other government regulatory programs and civil rights law.
Abuse or Neglect: We may disclose your Protected Health Information to a public health authority that is authorized
by law to receive reports of child abuse or neglect. In addition, we may disclose your Protected Health Information to the governmental
entity or agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence.
In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your Protected Health Information to a person or company required by the
Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products, to enable
product recalls, to make repairs or replacements, or to conduct post-marketing surveillance, as required.
Legal Proceedings: In the course of any judicial or administrative proceeding, we may disclose Protected Health Information
in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in response to a
subpoena, discovery request or other lawful process when certain conditions are satisfied.
Law Enforcement: We may also disclose your Protected Health Information, provided applicable legal requirements are met,
for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2)
limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death
has occurred as a result of criminal conduct, (5) in the event that a crime occurs on our premise, and (6) medical emergency (not on our
premise) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may also disclose your Protected Health Information to a coroner
or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose Protected Health Information to a funeral director, as authorized by law, in order to permit the
funeral director to carry out his or her duties. We may disclose such information in reasonable anticipation of death. Protected health
information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Research: We may also disclose your Protected Health Information to researchers when their research has been approved
by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your Protected
Health Information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your Protected Health Information,
if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. We may also disclose Protected Health Information if it is necessary for law enforcement authorities to identify
or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose Protected
Health Information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military
command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits;
or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your Protected Health
Information to authorized federal officials for conducting national security and intelligence activities, including for the provision
of protective services to the President or others legally authorized.
Workers' Compensation: Your Protected Health Information may be disclosed by us to comply with workers'
compensation laws and other similar legally-established programs.
Other Uses and Disclosures of Protected Health Information That May Be Made With Your Authorization or Opportunity to Object
We may use or disclose your Protected Health Information in certain instances where you may be given an opportunity to
agree or object. You have the opportunity to agree or object to the use or disclosure of all or part of your Protected Health
Information. If you are not present or able to agree or object to the use or disclosure of the Protected Health Information,
then your health care provider may, using professional judgment, determine whether the disclosure is in your best interest.
In this case, only the Protected Health Information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family,
a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to
that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose
such information as necessary if we determine that it is in your best interest based on our professional judgment. We may
use or disclose Protected Health Information to notify or assist in notifying a family member, personal representative or
any other person that is responsible for your care of your location, general condition or death. Finally, we may use or
disclose your Protected Health Information to an authorized public or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or other individuals involved in your health care.
Emergencies: We may use or disclose your Protected Health Information in an emergency treatment situation.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your Protected Health Information will be made only with your written authorization,
unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in
writing, except to the extent that we have taken any action in reliance on the use or disclosure indicated in the
authorization.
Your Rights With Respect to Your Protected Health Information
The following are statements of your rights with respect to your Protected Health Information and a brief description
of how you may exercise these rights.
You have the right to inspect and copy your Protected Health Information. This means you may inspect and obtain a copy
of Protected Health Information about you that is contained in a designated record set for as long as we maintain the
Protected Health Information. A "designated record set" contains medical and billing records and any other records that
StatScript Pharmacy uses for making decisions about you. Under federal law, however, you may not inspect or copy the
following records: information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative
action or proceeding, and Protected Health Information that is subject to law that prohibits access to Protected Health
Information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may
have a right to have this reviewed. Please contact our Privacy Officer if you have questions about access to your medical
record.
You have the right to request a restriction of your Protected Health Information. This means you may ask us not
to use or disclose any part of your Protected Health Information for the purpose of treatment, payment or healthcare
operations. You may also request that any part of your Protected Health Information not be disclosed to family members
or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested and to whom you want the restriction to apply.
StatScript Pharmacy not required to agree to a restriction that you may request. If StatScript Pharmacy does agree
to the requested resection, we may not use or disclose your Protected Health Information in violation of that
restriction unless it is needed to provide emergency treatment. You may request a restriction by providing the
details of such restriction in writing to our Privacy Officer.
You have the right to request to receive confidential communications from us by alternative means
or at an alternative location.
We will accommodate reasonable requests. We may also condition this accommodation by asking you for information
as to how payment will be handled or specification of an alternative address or other method of contact. We will
not request an explanation from you as to the reason for the request. Please make this request in writing to our
Privacy Officer.
You have the right to request that we amend your Protected Health Information.
This means you may request an amendment of Protected Health Information about you in a designated record set for as
long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your
request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal
to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have
questions about amending your medical records.
You have the right to receive an accounting of certain disclosures we have made, if any, of your
Protected Health Information. This right applies to disclosures for purposes other than treatment, payment or healthcare
operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility
directly, to family members or friends involved in your care, or for notification purposes. You have the right to receive
specific information regarding these disclosures that occurred after March 3, 2008, but no more than six years prior to
the date on which the accounting is requested. You may request a shorter timeframe. The right to receive this information
is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to accept
this notice electronically.
Duties of StatScript Pharmacy With Respect to Your Protected Health Information
Legal Duties: StatScript Pharmacy is required by law to maintain the privacy of Protected Health
Information and to provide individuals with notice of its legal duties and privacy practices with respect to Protected
Health Information. Through this Notice of Privacy Practices, we are providing you with this information.
Revisions to this Notice of Privacy Practices: We are required to abide by the terms of our Notice
of Privacy Practices that is currently in effect. We reserve the right to change the provisions of our Notice of Privacy
Practices. Whenever there is a material change to this Notice, we will make out best effort to provide you with a copy
of the revised Notice.
Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been
violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not
retaliate against you for filing a complaint.
You may contact our Privacy Officer at (504) 355-4191 for further information about the complaint process.
"StatScript Pharmacy" is a registered trademark of StatScript Pharmacy.
Written Requests
All written requests must be mailed to:
S Gupta, Privacy Officer
StatScript Pharmacy
2600 South Loop W, Suite 460
Houston, TX 77054
This notice was published and becomes effective on November 1, 2011.