When you receive care from a healthcare provider, a record of that treatment is made. This record will typically contain information on your diagnosis, treatment, and future plan of treatment and is often collectively referred to as your medical record. This medical record includes protected health information and lays the foundation for determining your plan of care and treatment and allows for a successful means of communication between all healthcare professionals that contribute to your care.

HIPAA protects information found in your medical record from disclosure without your authorization. The information protected by HIPAA includes:

1. Any information related to your past, present or future physical or mental health;
2. The past, present or future payment for health services you have received;
3. The specific care that you have received, are receiving or will receive;
4. Any information that identifies you as the individual receiving the care; and
5. Any information that someone could reasonably use to identify you as receiving the care. This information is referred to as protected health information throughout this Notice.

As a Covered Entity, Richardson’s Custom Rx is required to inform you of how it may use your protected health information. In providing treatment to you, Richardson’s Custom Rx will use your protected health information for the purposes of treatment, payment, and healthcare operations.

Treatment — As it pertains to Richardson’s Custom Rx, treatment means providing to you drugs, medications, supplies and durable medical equipment services as ordered by your physician. Treatment also includes coordination and consultation with you, your physician and other health care providers. As Richardson’s Custom Rx provides these services to you, information obtained during this process will be recorded in your medical record. Richardson’s Custom Rx will use this information, in coordination with your physician, to determine the best course of treatment for you.

Payment — Payment purposes consist of activities required to obtain reimbursement from your insurance carrier for the services ordered by your physician and provided to you by Richardson’s Custom Rx. This includes, but is not limited to, eligibility determination, precertification, billing and collection activities, obtaining documentation required by your insurer, and when applicable, disclosure of limited information to consumer reporting agencies. Your Protected Health Information may be disclosed to your plan sponsor, one or several intermediaries employed by your plan sponsor including but not limited to insurers, pharmacy benefits managers, claims administrators and computer switching companies.

Healthcare operations — Operations can include, but are not limited to, review of your protected health information by members of Richardson’s Custom Rx staff to ensure compliance with all federal and state regulations. This information will then be utilized to continually improve the quality and effectiveness of the services provided to you by Richardson’s Custom Rx. Healthcare Operations also include Richardson’s Custom Rx’s business management and general administrative activities including quality assessment and improvement, provider review and training, underwriting activities, reviews and compliance activities; planning and development.

In addition, we may contact you to provide refill reminders, health screenings, wellness events, inoculations, vaccinations or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

In order to release information contained in your medical record for purposes other than treatment, payment or healthcare operations, Richardson’s Custom Rx must obtain a specific signed authorization from you. You may revoke such authorization at any time, except to the extent Richardson’s Custom Rx has taken action in reliance on the authorization.

There are a limited number of other uses and disclosures of protected health information that do not require a specific authorization from you. Richardson’s Custom Rx may in the following circumstances disclose your protected health information.

1. Richardson’s Custom Rx may disclose limited health information about you to notify local agencies (i.e. power, gas, phone company, and emergency medical services), in the event of an emergency (i.e. flood, tornados, etc.), of your need for life sustaining equipment or assistance in evacuation due to your medical condition. In addition we may use or disclose the Protected Health Information to notify, identify, or locate a member of your family, your personal representative, and any other person responsible for care of your location, general condition, or death. If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do in our judgment what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare. We will also use our judgment and experience regarding your best interest in allowing people to pick-up filled prescriptions, or other similar forms of Protected Health Information.
2. Richardson’s Custom Rx may disclose to a member of your family, other relative, or a close personal friend, or any other person identified by you, the protected health information directly relevant to such person’s involvement with your care or payment related to your health care.
3. Richardson’s Custom Rx may use your name to reference your prescriptions and pharmaceutical care services. You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this notice and the disclosure of Protected Health Information.
4. Richardson’s Custom Rx may disclose protected health information to others as required by law.
5. Richardson’s Custom Rx may disclose protected health information for certain public health activities and purposes.
6. Richardson’s Custom Rx may disclose protected health information to a legally authorized government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect or domestic violence.
7. Richardson’s Custom Rx may disclose protected health information for law enforcement purposes and in response to court orders or subpoenas.
8. Richardson’s Custom Rx may disclose protected health information to agencies authorized by law to conduct health oversight activities, including audits, investigations, licensing and similar activities.
9. Richardson’s Custom Rx may disclose protected health information to attorneys, accountants, and others acting on behalf of Richardson’s Custom Rx, provided they have signed written contracts agreeing to safeguard the confidentiality of the information.

In accordance with HIPAA you have the following rights in relation to your protected health information.

1. You may request, in writing, additional restrictions to the use or disclosure of your protected health information.
2. You have the right to request amendments or corrections to your medical record.
3. You have the right to obtain a copy of this Notice of Privacy Pracitces.
4. You have the right of access to inspect and obtain a copy of your medical record, subject to certain limitations.
5. You have the right to obtain an accounting of disclosures of your medical record for purposes other than treatment, payment, healthcare operations, disclosures to you, your caregivers specified by you, for notifications or as otherwise excluded by law.
6. You have the right to request communications of your medical record by alternative means (i.e. electronically) or at alternative locations.
7. You have the right to revoke authorization to use or disclose your protected health information except to the extent that action has already occurred.

In accordance with HIPAA, Richardson’s Custom Rx is required to:

Please be advised that in addition to these responsibilities, Richardson’s Custom Rx reserves the right to change the terms of its Notice of Privacy Practices and make those changes applicable to all protected health information maintained at the time. You may receive a copy of this notice by contacting us as outlined below or upon the receipt of pharmacy care services.

Richardson’s Custom Rx will not use or disclose your protected health information without your authorization, except as described in this notice.

If you have questions, would like additional information, or if you suspect misuse of your protected health information and believe that your rights have been violated, you may, without fear of retaliation, contact: