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aboutUsVillage

Village Pharmacy Privacy Policy

Village Pharmacy of Hampstead, Inc

Village Pharmacy
14057 Hwy 17 Suite 100
Hampstead, NC 28443
910-319-6050

Emergency Contact:
Beth Caveness: 910-520-2248

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.

Village Pharmacy of Hampstead Inc. is required by law to maintain the privacy of protected health information (“PHI”) and to provide individuals with notice of Village Pharmacy of Hampstead’s legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how Village Pharmacy of Hampstead may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you.

Village Pharmacy of Hampstead is required to follow the terms of this Notice. Village Pharmacy of Hampstead will not use or disclose PHI about you without your written authorization, except as described in this Notice. Village Pharmacy of Hampstead reserves the right to change our practices and this Notice and to make the new Notice effective for all PHI Village Pharmacy of Hampstead maintains. Upon request, Village Pharmacy of Hampstead will provide any revised Notice to you.

Village Pharmacy of Hampstead will post a copy of the current policy in each pharmacy location.

YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to PHI about you:

Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. You may obtain a paper copy at any Village Pharmacy of Hampstead location or by writing to Village Pharmacy of Hampstead, Inc. 408 East Creekview Drive Hampstead, NC 28443 Attention: Pharmacy Privacy Officer.

Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by completing a Request for Additional Restriction on Use or Disclosure of Protected Health Information form (available at any Village Pharmacy location) and delivering it to the pharmacy location(s) where you have had prescription(s) filled or which you otherwise believe maintains PHI about you or sending it to Village Pharmacy of Hampstead Inc., 408 East Creekview Drive Hampstead, NC 28443, Attention: Pharmacy Privacy Officer.

Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you that is contained in a designated record set for as long as Village Pharmacy of Hampstead Inc maintains the PHI. The designated record set usually will include prescription and billing records.

Request an amendment of PHI. If you feel that PHI Village Pharmacy of Hampstead maintains about you is incomplete or incorrect, you may request that Village Pharmacy of Hampstead amend it. You may request an amendment for as long as Village Pharmacy maintains the PHI. To request an amendment, you must complete a Request to Amend Protected Health Information form (available at any Village Pharmacy of Hampstead pharmacy location) and deliver it to the pharmacy location(s) where you have had prescription(s) filled or which you otherwise believe maintains PHI about you or send it to Village Pharmacy of Hampstead Inc, 408 East Creekview Drive Hampstead, NC 28443 , Attention: Pharmacy Privacy Officer. You must include a reason that supports your request. Village Pharmacy of Hampstead may deny your request for amendment if the PHI:

  • Was not created by Village Pharmacy of Hampstead, unless the person or entity that created the PHI is no longer available to make the amendment;
  • Is not part of the PHI kept by or for Village Pharmacy of Hampstead;
  • Is not part of the PHI which you would be permitted to inspect and copy; or
  • Is accurate and complete.


If Village Pharmacy of Hampstead Inc. denies your request for amendment, you have the right to submit to Village Pharmacy of Hampstead a statement of disagreement with the decision and Village Pharmacy may give a rebuttal to your statement.

Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures Village Pharmacy of Hampstead Inc. made of PHI about you on or after August 16, 2005 for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must complete a Request for an Accounting of Disclosures form (available at any Village Pharmacy of Hampstead location) and deliver it to the Village Pharmacy of Hampstead location(s) where you have had prescription(s) filled or which you otherwise believe maintains PHI about you or send it to Village Pharmacy of Hampstead Inc, 408 East Creekview Drive Hampstead, NC 28443 Attention: Pharmacy Privacy Officer. Your request must specify the time period, but may not be longer than 6 years. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. Village Pharmacy of Hampstead will notify you of the cost involved and you may choose to withdraw or modify your request at that time.

Request communications of PHI by alternative means or at alternative locations. You have the right to request how and where Village Pharmacy of Hampstead contacts you about PHI. For instance, you may request that Village Pharmacy of Hampstead contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must complete a Request for Alternative Communications on Use or Disclosure of Protected Health Information form (available at any Village Pharmacy of Hampstead location) and deliver it to the Village Pharmacy of Hampstead location(s) where you have had prescription(s) filled or which you otherwise believe maintains PHI about you or send it to Village Pharmacy of Hampstead Inc, 408 East Creekview Drive Hampstead, NC 28443 Attention: Pharmacy Privacy Officer. Your request must state how or where you would like to be contacted. Village Pharmacy of Hampstead will accommodate all reasonable requests.

EXAMPLES OF HOW VILLAGE PHARMACY OF HAMPSTEAD INC. MAY USE AND DISCLOSE PHI
The following are descriptions and examples of ways Village Pharmacy of Hampstead uses and discloses PHI:

Village Pharmacy of Hampstead will use PHI for treatment. Example: Information obtained by the pharmacist will be used to dispense prescription medications to you. Village Pharmacy of Hampstead will document in your record information related to the medications dispensed to you and services provided to you.

Village Pharmacy of Hampstead will use PHI for payment. Example: Village Pharmacy of Hampstead will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your copayment. Village Pharmacy of Hampstead will bill you or a third-party payer for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.

Village Pharmacy of Hampstead will use PHI for health care operations. Example: Village Pharmacy of Hampstead may use information in your health record to monitor the performance of the pharmacists providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service Village Pharmacy of Hampstead provides.

Village Pharmacy of Hampstead is likely to use or disclose PHI for the following purposes:

Business associates. There are some services provided by us through contracts with business associates. Examples may include archive records storage, software support and maintenance companies, as well as select telecommunications companies assisting in transmission of electronic data for payment/treatment. When these services are contracted for, Village Pharmacy of Hampstead may disclose PHI about you to our business associate, subject to state authorization requirements, so that they can perform the job Village Pharmacy of Hampstead has asked them to do and bill you or your third-party payer for services rendered. To protect PHI about you, Village Pharmacy of Hampstead requires the business associate to appropriately safeguard the PHI.


Communication with individuals involved in your care or payment for your care. Subject to state authorization requirements, health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to that person’s involvement in your care or payment related to your care.

Health-related communications. Village Pharmacy of Hampstead may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Food and Drug Administration (FDA). As required by law, Village Pharmacy of Hampstead may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Worker’s compensation. Village Pharmacy of Hampstead may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker’s compensation or similar programs established by law.

Public health. As required by law, Village Pharmacy of Hampstead may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law enforcement. Village Pharmacy of Hampstead may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.

As required by law. Village Pharmacy of Hampstead must disclose PHI about you when required to do so by law.

Health oversight activities. Village Pharmacy of Hampstead may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and administrative proceedings. If you are involved in a lawsuit or a dispute, Village Pharmacy of Hampstead may disclose PHI about you in response to a court or administrative order, subject to state authorization requirements where applicable. Village Pharmacy of Hampstead may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI and subject to state authorization requirements where applicable.

Village Pharmacy of Hampstead is permitted to use or disclose PHI about you for the following purposes:

Research. Village Pharmacy of Hampstead may disclose PHI about you to researchers who have been approved by the Board of Pharmacy 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 information.

Coroners, medical examiners, and funeral directors. To the extent required by law, Village Pharmacy of Hampstead may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. Village Pharmacy of Hampstead may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.

Organ or tissue procurement organizations. Consistent with applicable law, Village Pharmacy of Hampstead may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Notification. To the extent permitted by state law, Village Pharmacy of Hampstead may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and your general condition.

Correctional institution. If you are or become an inmate of a correctional institution, Village Pharmacy of Hampstead may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others and to the extent required by law.

To avert a serious threat to health or safety. Village Pharmacy of Hampstead may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.


Military and veterans. If you are a member of the armed forces, Village Pharmacy of Hampstead may release PHI about you as required by military command authorities who are authorized by law to receive such information. Village Pharmacy of Hampstead may also release PHI about foreign military personnel to the appropriate military authority to the extent required by law.

National security and intelligence activities. Village Pharmacy of Hampstead may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Victims of abuse, neglect, or domestic violence. Village Pharmacy of Hampstead may disclose PHI about you to a government authority, such as a social service or protective services agency, if Village Pharmacy of Hampstead reasonably believes you are a victim of abuse, neglect, or domestic violence. Village Pharmacy of Hampstead will only disclose this type of information to the extent required by law, if you agree to the disclosure by written authorization required by state law, or if the disclosure is allowed by law and Village Pharmacy of Hampstead believes it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.

OTHER USES AND DISCLOSURES OF PHI
Village Pharmacy of Hampstead will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke any such authorization in writing at any time. Upon receipt of the written revocation, Village Pharmacy of Hampstead will stop using or disclosing PHI about you, except to the extent that has already taken action in reliance on the authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions or would like additional information about Village Pharmacy of Hampstead’s privacy practices, you may contact Village Pharmacy of Hampstead by calling the Village Pharmacy of Hampstead’s Privacy Officer at 910-686-8866 or writing to Village Pharmacy of Hampstead Inc., 408 East Creekview Drive Hampstead, NC 28443, Attention: Pharmacy Privacy Officer. If you believe your privacy rights have been violated, you can file a complaint in writing with the Village Pharmacy of Hampstead Privacy Officer or with the Secretary of the United States Department of Health and Human Services. There will be no retaliation for filing a complaint.

EFFECTIVE DATE
August 16, 2005

“Because you can’t wait to feel better

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