North East BRONX
located across from HIP Center
Between Zerega and Castle Hill Avenues
Bronx, NY 10462
PHONE: (718) 409-3537
FAX: (718) 409-3543
Notice Describes How Medical Information About You May Be Used And Disclosed And
How You Can Get Access To This Information.
Date of Notice: 03/06/03
SECTION A: Uses and Disclosures of Protected Health
Under applicable law, we are required to protect the privacy
of your individual health information (information we refer to in this notice
as “Protected Health Information”).
We are also required to provide you with this notice regarding our
policies and procedures regarding your Protected Health Information and to
abide by the terms of this notice, as it may be updated from time to
We are permitted to make certain types of uses and disclosures
under applicable law for treatment, payment, and healthcare operations
purposes. We may obtain
information to dispense prescriptions and for the documentation of pertinent
information in your records that may assist us in managing your medication
therapy or your overall health.
For treatment purposes, such use and disclosure will take place in
providing, coordinating, or managing healthcare and its related services by
one or more of your providers, such as when your pharmacist consults with your
physician or a specialist regarding your medications, treatment or
For payment purposes, such use and disclosure will take
place to obtain or provide reimbursement for providing pharmaceutical care
services, such as when your case is reviewed to ensure that appropriate care
was rendered. For reimbursement
purposes, your Protected Health Information may be disclosed to one or several
intermediaries employed by your plan sponsor including but not limited to
insurers, pharmacy benefits managers, claims administrators and computer
For healthcare operations purposes, such use and
disclosure will take place in a number of ways, including for quality
assessment and improvement, provider review and training, underwriting
activities, reviews and compliance activities; planning, development,
management and administration.
Your information could be used, for example, to assist in the
evaluation of the quality of care that you were provided.
We store some
of your Protected Health Information in electronic computer files. We backup our electronic records daily
with backups made weekly and kept off site by the privacy officer and we
employ other precautions to safeguard the integrity of your Protected Health
Information. In spite of these
precautions it is possible but unlikely that a computer crash or other
technological failure could cause the loss of data. In addition reasonable safeguards are
employed to protect your Protected Health Information stored on electronic
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 addition, we may disclose your health information to your plan
sponsor. In addition we may
contact you for the purpose of fund raising activities.
We may use and
disclose your Protected Health Information, without your authorization when
the pharmacy needs to contact a physician or physician’s staff and is
permitted or required to do so without individual written authorization. We may use and disclose your Protected
Health Information if we are contacted by another pharmacy who states they
have your request and consent to transfer pharmacy records to
From time to time we may employ the services of business
associates who may assist us in one or more tasks and who may use, change or
create Protected Health Information.
Business associates are required to comply with all the privacy
regulations on your behalf.
disclose Protected Health Information about you without your authorization to
comply with workers compensation laws, as required by law enforcement, legal
proceedings, public health requirements, health oversight activities and as
required by law.
Other uses and disclosures will be made only with your
written authorization, and you may revoke your authorization by notifying us
as described in Section B.
You may ask us to restrict uses and disclosures of your
Protected Health Information to carry out treatment, payment, or healthcare
operations, or to restrict uses and disclosures to family members, relatives,
friends, or other persons identified by you who are involved in your care or
payment for your care. However,
we are not required to agree to your request.
You have the right to request the following with respect to
your Protected Health Information: (i) inspection and copying; (ii) amendment or correction; (iii) an
accounting of the disclosures of this information by us (we are not required
to account to you for disclosures made for treatment, payment, operations,
disclosures to you, disclosures to your care givers, for notifications or as
otherwise excluded by law); and (iv) the right to receive a paper copy of this
notice upon request. We may
require you to pay for this request to cover our costs of copying, labor and
In addition, you may request, and we must accommodate the request,
if reasonable, to receive communications of Protected Health Information by
alternative means or at alternative locations. To make this request please contact,
Neubauer, Privacy Officer
2315-17 Westchester Avenue
We 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 as outlined herein.
This information may be disclosed by us to other persons who ask for
you or your prescriptions by name.
You may restrict or prohibit these uses and disclosures by notifying a
pharmacy representative orally or in writing of your restriction or
prohibition. We are not required
to honor those requests. We are
able to provide treatment services to you even if you object to sign the
acknowledgment of the receipt of this notice or if we decide not to honor a
request regarding the information in this document. In the event of an emergency or your
incapacity, we will do in our reasonable judgment what is consistent with your
known preference, and what we determine to be in your best interest. We will inform you of any such uses or
disclosures if uses and disclosures would require your signed authorization
under such circumstances and give you an opportunity to object as soon as
We may disclose to one of your family members, to a
relative, to a close personal friend, or to any other person identified by
you, Protected Health Information that is directly relevant to the person’s
involvement with your care or payment related to your care. In addition we may use or disclose the
Protected Health Information to notify, identify, or locate a member of your
family, your personal representative, another person responsible for care, or
certain disaster relief agencies 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.
We reserve the right to change the terms of this notice and
to make new notice provisions effective for all Protected Health Information
we maintain. You may receive a
copy of this notice by contacting us as outlined in Section B or upon the
receipt of pharmacy care services.
If you believe that your privacy rights have been violated,
you may complain to us at the location described in Section B or to the
Secretary of the Department of Health and Human Services, Hubert H. Humphrey
Building, 200 Independence Avenue SW, Washington, DC 20201. You will not be retaliated against for
filing a complaint.
Section B: Contacting Us
contact us for further information at:
2315-17 Westchester Avenue
Copyright © PAAS National, Inc. 2002 All rights