BROOKVALE PHARMACY
Notice of Privacy Practices
Effective Date: 01/01/2023
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.
Our Responsibilities - Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), we are required to maintain the privacy of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and inform you of your rights. We are also required to notify you in the event of a breach of your unsecured PHI. We will only use or disclose your PHI as described in this notice or as required by law.
Uses and Disclosures of PHI - We may use or disclose your PHI for the following purposes:
1. Treatment - We will use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. For example, we may share information about your prescriptions with your doctor or another healthcare provider to manage your care.
2. Payment - We will use and disclose your PHI to obtain payment for healthcare services we provide to you. For example, we may share your PHI with your health plan to obtain reimbursement for medication you receive.
3. Healthcare Operations - We will use and disclose your PHI for our healthcare operations, including activities such as quality assessment, training, compliance reviews, and audits. For example, we may use your PHI to monitor the quality of service you receive.
4. Business Associates - We may disclose your PHI to third-party business associates who perform services on our behalf (e.g., billing services or data storage). All business associates are required to protect your PHI and comply with HIPAA regulations.
5. Communication with Family or Others Involved in Your Care - We may disclose your PHI to a family member, relative, close friend, or other individuals involved in your care or payment for your care, unless you object.
6. Required by Law - We may disclose your PHI when required to do so by law, including in response to court orders, subpoenas, or government investigations.
Special Circumstances - We may also disclose your PHI under the following circumstances, in accordance with applicable laws:
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Breach Notification: If there is a breach of your unsecured PHI, we will notify you in accordance with the HIPAA Breach Notification Rule.
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Public Health Activities: For purposes such as controlling disease, injury, or disability, and reporting adverse drug reactions.
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Health Oversight: To federal or state agencies that oversee healthcare operations.
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Law Enforcement: To law enforcement officials as part of investigations or in response to legal processes.
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Workers’ Compensation: In compliance with laws related to workers’ compensation.
Other Uses and Disclosures - For any purposes not described in this notice, we will require your written authorization before using or disclosing your PHI. This includes:
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Marketing: We will obtain your authorization for any marketing activities that involve your PHI, except for communications about refill reminders or services related to drugs or biologics currently prescribed to you.
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Sale of PHI: We will not sell your PHI without your express written consent.
You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed your information based on your prior authorization.
Your Rights - You have the following rights regarding your PHI:
1. Right to Access - You have the right to inspect and obtain a copy of your PHI. If your PHI is maintained in an electronic format, you may request an electronic copy, and we will provide it in the format you request if readily producible. You may also request that we transmit your PHI to another entity or person.
2. Right to Amend - If you believe your PHI is incorrect or incomplete, you have the right to request an amendment. We may deny your request under certain circumstances, but you have the right to submit a statement of disagreement.
3. Right to an Accounting of Disclosures - You have the right to request an accounting of disclosures we have made of your PHI, except for disclosures made for treatment, payment, or healthcare operations, or certain other exceptions.
4. Right to Request Restrictions - You may request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. While we are not required to agree to most restrictions, if you pay for a service entirely out-of-pocket, you may request that we not disclose information about that service to your health plan, and we must comply.
5. Right to Request Confidential Communications - You may request that we contact you in a specific way (e.g., at a specific phone number or address) or send mail to a different location. We will accommodate reasonable requests.
6. Right to a Paper Copy of This Notice - You have the right to receive a paper copy of this notice upon request, even if you have agreed to receive this notice electronically.
Changes to This Notice - We reserve the right to change the terms of this notice at any time. If we make changes, we will update this notice and provide it to you upon your request. Any changes will apply to all PHI we maintain.
Complaints - If you believe your privacy rights have been violated, you can file a complaint with us or with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Contact Information - If you have questions about this notice or want to file a complaint, please contact us at:
Brookvale Pharmacy
2089 Vale Road, STE 31
San Pablo, CA 94806
(510) 235-4443