HIPAA Privacy

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED BY

OUR PHARMACY AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS

INFORMATION.

PLEASE REVIEW IT CAREFULLY

Protecting Medical Information

Our pharmacy is required by the Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) to maintain the privacy of your Protected Health Information (PHI). PHI is considered to be your medical records and other health information that identifies you. This includes any information we keep, use or disclose in any form, whether electronically, on paper or orally. As required by HIPAA, we must provide this notice to you. This notice explains how we may use and disclose your PHI while maintaining your privacy, explains your rights with respect to PHI, and explains our duty to abide by the terms of the notice and any updates that we may make in the future.

Our Use of Your Information

Under the law we are permitted to use and disclose your PHI without your authorization for the purposes of treatment, payment and health care operations:

Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. Examples are when we contact your physician or other health care providers to obtain refill authorizations, ask questions about medication doses, inform them of potential drug interactions, or to determine validity of prescription orders. We may also use and disclose your information when your physician, health care provider, or another pharmacy contacts us and says that you have requested them to provide health care services.

Payment means such activities as obtaining payment for services, confirming health plan coverage, and billing or collection activities. An example would be if we submit claim information on you behalf to your insurance company for reimbursement to you. Insurance companies or health plans may also contact us about services we provide to you.

Health care operation includes business aspects of running our pharmacy, such as planning and customer service. An example is when we look at records to evaluate how well our pharmacists and technicians provide service to you.

We may also use your PHI without your authorization to provide you with information about alternatives to medications or services you receive through our pharmacy; or notices of special events or other wellness activities we may conduct.

We may release information about you to a family member or others who are involved in your medical care. Examples include if a family member picks up a prescription for you or if you have a nursing aide that assists you with your medications.

Whenever anyone receives PHI on your behalf we will provide only the minimum amount of information necessary to insure your quality of care. We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena.

Our pharmacy may use and disclose your PHI when necessary to reduce or prevent serious threat to your health and safety or the health and safety of another individual or the public.

Any other uses and disclosures other than those provided for above (or as otherwise permitted or required by law) will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except for actions we have already taken relying on your authorization.

Your Rights

You have the following rights with respect to your PHI, which you can exercise by presenting a written request to the Privacy Official:

The right to request restrictions on certain uses and disclosures, including any group of persons or person identified by you. We are, however, not required to agree to a requested restriction.

The right to reasonable requests to receive confidential communications from us by alternative means.

The right to inspect and copy your PHI.

The right to amend your PHI.

The right to receive a list of disclosures of your PHI.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

You have the right to request and receive a written copy of this notice.

This notice is effective as of January 1, 2013, and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice or Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will provide any revised notice on our pharmacy.

Contact Information

Please contact us for more information:

Doyle’s Pharmacy

2425 Sunset Blvd.

Houston, Texas 77005

For more information about HIPAA or how to file a complaint, you may contact Department of Health and Human Services.