| |
| |
|
 |
 Medicare
Part D
Starting January 1, 2006, the new Medicare
prescription drug coverage becomes available to
everyone with Medicare Part A and/or Part B.
Enrollment period is November 15, 2005 till May
15, 2006. Beneficiaries that enroll in a
Medicare prescription drug plan are responsible
for paying the monthly premium.
Beneficiaries with limited income and resources,
may qualify for extra help paying for the
Medicare prescription drug premiums, deductible
and cost shares. For more information on who can
get extra help with prescription drug costs and
how to apply, call the Social Security
Administration at 1-800-772-1213, or visit
www.socialsecurity.gov on the web. TTY users
should call 1-800-325-0778.
For more information on Medicare Part D, visit
http://www.medicare.gov/. |
|
| |
|
|
|
| |
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.
Livernois Family Pharmacy is required by law to
maintain the privacy of Protected Health Information
("PHI") and to provide individuals with notice of our
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 we 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.
Livernois Family Pharmacy is required to follow the
terms of this Notice. We will not use or disclose PHI
about you without your written authorization, except as
described in this Notice. We reserve the right to change
our practices and this Notice and to make the new Notice
effective for all PHI we maintain. Upon request, we will
make available to you any revised Notice.
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. Even if you
have agreed to receive the Notice electronically, you
are still entitled to a paper copy.
Inspect and obtain a copy of PHI. You have the
right to access and copy PHI about you contained in a
designated record set for as long as Livernois Family
Pharmacy maintains the PHI.
The designated record set usually will include
prescription and billing records that we use to make
treatment and billing decisions. We may charge you a fee
for the costs of copying, mailing and supplies that are
necessary to fulfill your request. We may deny your
request to inspect and copy in certain limited
circumstances. In some cases, you may request that the
denial be reviewed.
Request an amendment of PHI. If you feel that PHI we
maintain about you is incomplete or incorrect, you may
request that we amend it. You may request an amendment
for as long as we maintain the PHI. You must include a
reason that supports your request. In certain cases, we
may deny your request for amendment. If we deny your
request for amendment, you have the right to file a
statement of disagreement with the decision and we may
give a rebuttal to your statement. We will include a
copy of your statement of disagreement and our rebuttal
in your record.
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, however we
are not required to agree to those restrictions.
Receive an accounting of disclosures of PHI. You have
the right to receive an accounting of the disclosures we
have made of PHI about you after April 14, 2003 other
than disclosures made: to you; based on your written
authorization; to carry out treatment; for payment or
health care operations; or as part of a limited data set
(that does not include your name or other personal
identifiers) to researchers. The right to receive an
accounting is subject to certain other exceptions,
restrictions, and limitations. Your request must specify
the time period, but may not be longer than six years.
The first accounting you request within a 12 month
period will be provided free of charge, but we reserve
the right to charge you a reasonable fee for the cost of
providing additional accountings.
Request communications of PHI by alternative means or
at alternative locations. You may request that we
communicate with you in certain ways, or at certain
locations. For instance, you may request that we contact
you about medical matters only in writing or at a
different residence or post office box. Your request
must state how or where you would like to be contacted.
We will accommodate reasonable requests.
For requests regarding the preceding items, please
contact the Privacy Officer at 313-341-3511 or write to
us at Livernois Family Pharmacy, Attention: Privacy Officer;
18254 Livernois Avenue, Detroit, MI 48221.
Examples of How We May Use and Disclose PHI
We may use and disclose your PHI, without your
authorization, for treatment, payment and health care
operations.
Using PHI for treatment. Treatment is the provision,
coordination or management of healthcare and related
services. For example, we may use your PHI to fill
prescriptions and conduct drug utilization reviews. The
pharmacy may contact you to remind you that your
prescription is ready or due to be refilled, or may
provide you information about treatment alternatives or
other health-related benefits and services that may be
of interest to you.
Using your PHI for payment. Payment includes actions
that we may take to be reimbursed by your third party
insurance provider, to make coverage determinations, and
to assist us with billing claims management. For
example, we may contact your insurer or pharmacy benefit
manager to determine whether it will pay for your
prescription and the amount of your co-payment. We may
bill you or a third-party payor 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.
Using PHI for health care operations. Our health care
operations involve a range of activities necessary to
run our business. This includes services from third
parties (or business associates) with whom we have
contracted for quality assessment and improvement,
business planning and development, information
management, general administrative activities, legal
services, and other services related to our operations.
We may disclose PHI about you to our business associates
so that they can perform the job we have asked them to
do. To protect PHI about you, we require the business
associate to safeguard the PHI.
Communication with individuals involved in your care or
payment for your care: 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.
We may also use your PHI, without your authorization,
for the following public policy purposes:
As required by law: We may use or disclose your PHI as
required by law. Examples include use or disclosure of
PHI for law enforcement purposes, for judicial or
administrative proceedings (subject to certain
conditions), for public health purposes, for health
oversight activities, in cases of suspected abuse,
neglect or domestic violence and for worker's
compensation compliance. In cases of HIV or AIDS, we
will comply with provisions of Michigan state law that
place
additional or more stringent conditions on the use and
disclosure of records related to HIV or AIDS treatment. This will
include, among other things, not disclosing information
in response to subpoenas, unless accompanied by a court
order.
For notification of relatives or representatives: We 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.
Other Information about PHI and this Notice
Livernois Family Pharmacy 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 an
authorization in writing at any time. In order to revoke
an authorization, you should write to the Privacy
Officer at the address provided below. Upon receipt of
the written revocation, we will stop using or disclosing
PHI about you, except to the extent that we have already
taken action in reliance on your previous authorization.
In addition, we will not access a common electronic file
or database used to maintain personally identifiable
dispensing information except upon your express request.
Please note that this Notice does not apply to
information that has been de-identified. De-identified
information is information that does not identify an
individual and with respect to which there is no
reasonable basis to believe that the information can be
used to identify an individual.
For More Information or to Report a Problem
If you have questions or would like additional
information about Livernois Family Pharmacy's privacy
practices, you may contact the Privacy Officer at
Livernois Family Pharmacy, Attention: Privacy Officer;
18254 Livernois Avenue, Detroit, MI 48221. If you believe your privacy
rights have been violated, you can file a complaint with
the Privacy Officer or with the Secretary of Health and
Human Services. There will be no retaliation for filing
a complaint.
Effective Date
This Notice is effective as of January 01, 2003.
Back to Top |
|
|
|
