Notice of Privacy Practices

Effective Date: September 23, 2013

This notice describes how your health information may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Commitment and Responsibilities Regarding Your Medical Information

In the course of providing healthcare, we collect protected health information (“PHI”) from patients and other sources, including other healthcare providers. PHI is information about you, including identifiers such as your name and social security number, and is related to your past, present, and future health, your healthcare provision, or the payments for healthcare. For simplicity, in this notice, we will use the term “medical information” instead of “PHI”, but both terms will have the same meaning.

We understand that your information and health is a personal matter. We are committed to protecting your health information. We will disclose information to others, apart from you, only when permitted under federal or state laws. In some circumstances, the law allows us to use and disclose your medical information without your express permission, as described in this notice. In all other circumstances, we will obtain your written authorization before using or disclosing your medical information.

By law, we are required to:

• Ensure that health information that identifies you is kept private (with certain exceptions);
• Inform you about your rights and our legal duties regarding your medical information; and
• Comply with the terms of the current Notice of Privacy Practices.

How We May Use and Disclose Your Medical Information

Disclosure at Your Request We may disclose information when requested by you. We may require that you submit a request in writing using an AHF form.

For Treatment We may use your medical information to offer you pharmaceutical products or services, for example, to propose medications. We may contact you to provide treatment-related services, such as refill reminders or to inform you about treatment alternatives (such as generics) or other health-related services or benefits, including those offered by AHF, that may be of interest to you. We may disclose your information to other healthcare providers for treatment purposes.

For Payment We may use your medical information to receive payments for the products and services provided to you. For example, we may communicate with your insurer, payer, or other agent and share your medical information to determine if they will pay for your prescription.

For Healthcare Operations We may use or disclose your medical information for our healthcare operations. For instance, we may use your information for quality control of our pharmacy services and for training our pharmacy staff.

Fundraising Activities We may use your medical information or disclose it to a partner or a commercial foundation for the purpose of fundraising for our charitable activities. We will only disclose demographic information and the dates you received treatment or services. If you do not wish to be contacted about these fundraising efforts, notify our Privacy Officer in writing (see below for contact information).

Marketing or Commercialization Activities We will not use or disclose your medical information for third-party marketing purposes without your written authorization.

Sale of Medical Information We will not sell your medical information without your written authorization, and the written authorization must acknowledge that we will receive compensation for the medical information.

Business Associates We may engage business associates to perform certain functions or activities on our behalf, such as payments and healthcare operations. These business associates must agree to protect your medical information.

Persons Involved in Your Care or Payment for Your Care We may disclose your medical information to a friend or family member involved in your medical care. If you have not previously authorized this in writing and are not present or unable to make decisions to consent to the disclosure to a friend or family member, we will use our professional judgment to determine if it is in your best interest to disclose your medical information. For example, we may allow someone to pick up a prescription for you. We may also provide information to someone who helps pay for your care.

Research Under certain circumstances, we may use and disclose your medical information for research purposes. However, all research projects are subject to a special approval process and protocols to protect your privacy.

As Required by Law We will disclose your medical information when required by federal, state, or local law.

To Avert a Serious Threat to Health or Safety We may use and disclose your medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. However, any disclosure would only be to someone who can help prevent or lessen the threat.

Special Situations

Organ and Tissue Donation We may disclose medical information to organizations that handle organ procurement, transplantation of organs, tissues, or eyes, or to an organ donation bank, as necessary to facilitate organ and tissue donation and transplantation.

Military and Veterans If you are a member of the armed forces, we may disclose your medical information as required by military command authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation We may disclose your medical information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Activities We may disclose your medical information for public health activities. These activities generally include the following:

• Preventing or controlling disease, injury, or disability;
• Reporting reactions to medications or problems with products;
• Notifying people of product recalls used by them;
• Notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition;
• Notifying the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Health Oversight Activities We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes If you are involved in a lawsuit or a dispute, we may disclose your medical information in response to a court or administrative order. We may also disclose your medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you or your lawyer) or to obtain an order protecting the information requested.

Law Enforcement We may disclose your medical information if requested by a law enforcement official, including:

• In response to a court order, subpoena, warrant, summons, or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime if, under certain limited circumstances, we cannot obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the pharmacy; and
• In emergency situations to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.

Coroners, Health Examiners, and Funeral Directors We may disclose your medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose medical information about patients to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities We may disclose your medical information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others We may disclose your medical information to authorized federal officials, so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.

Correctional Institution If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your medical information to the correctional institution or law enforcement official. This disclosure would be necessary, for example, (1) for the institution to provide you with medical care; (2) to protect your health and safety or the health and safety of others; or (3) for the health and safety of the correctional institution.

Multidisciplinary Personnel Teams We may disclose your medical information to multidisciplinary personnel teams concerning the prevention, identification, management, or treatment of an abused child and the child’s parents or elder abuse and neglect.

Special Categories of Information In certain circumstances, your health information will be subject to restrictions that may limit or exclude some uses or disclosures described in this notice. For example, there are special restrictions on the use or disclosure of certain categories of information, e.g., HIV testing or treatment for mental health conditions or drug or alcohol abuse. In some states, such as California, there are additional patient privacy laws, which we will comply with. (See the appendix). Likewise, government health benefit programs, such as Medi-Cal in California, may also limit disclosure of beneficiary information for purposes not related to the program.

Your Rights Regarding Medical Information About You

You have the following rights regarding the medical information we maintain about you.

• Right to Inspect and Copy You have the right to inspect and copy your medical information. This usually includes medical and billing records but does not include psychotherapy notes or other information that may be withheld by law. To inspect and copy medical information that we use to make decisions about you, you must submit your request in writing to our Privacy Officer (see below for contact information). If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain limited circumstances. If access to medical information is denied, you may request a review of the denial. Another healthcare professional chosen by AHF will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
• Right to Amend If you believe that the medical information we have about you is incorrect or incomplete, you may request us to amend the information. You have the right to request an amendment for as long as the information is kept by or for AHF.

  To request an amendment, your request must be made in writing and directed to our Privacy Officer (see below for contact information). You must also provide a reason that supports your request.

  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for AHF;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

  Even if we deny your request for amendment, you have the right to submit a written addendum, not exceeding 250 words, concerning any item or statement in your record you believe is incomplete or incorrect. If you clearly state in writing that you want the addendum to be part of your medical record, we will attach it to your record and include it whenever we make a disclosure of the item or statement you believe is incomplete or incorrect.

  Right to be Notified of a Breach of Unsecured Medical Information You have the right to be notified of any breach of unsecured medical information, unless our risk assessment determines that there is a low probability that your medical information has been compromised.

  Right to an Accounting of Disclosures You have the right to request an “accounting of disclosures.” This is a list of the disclosures we make of your medical information, other than our own uses for treatment, payment, and healthcare operations (as those functions are described above) and with some other exceptions provided by law.

  To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer (see below for contact information). Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should state the form in which you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

  Right to Request Restrictions You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a restriction or limitation on the disclosure of your medical information to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

  We are not required to agree to your request, unless you ask us to restrict your medical information to a health plan, provided that (a) the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law, and (b) the medical information pertains solely to a healthcare item or service for which you have paid us in full. If we agree to your requested restriction, we will comply with your request unless the information is needed to provide you with emergency treatment.

  To request restrictions, you must make your request in writing to our Privacy Officer (see below for contact information). In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

  Right to Request Confidential Communications You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

  To request confidential communications, you must make your request in writing to our Privacy Officer (see below for contact information). We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

  Right to a Paper Copy of This Notice You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, please contact our Privacy Officer (see below for contact information).

  Changes to This Notice

  We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. If we make a significant change in our notice, we will mail or make it available on our website. You can also obtain a copy of our current notice at any time by contacting our Privacy Officer (see below for contact information). The notice will include the effective date on the first page, in the top right-hand corner.

  Concerns About Our Use of Your Medical Information

  If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint, contact our Privacy Officer (see below for contact information). All complaints must be submitted in writing. You will not be penalized for filing a complaint.

  Other Uses of Medical Information

  Other uses and disclosures of your medical information not covered by this notice or by the laws that apply will only be made with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your medical information for the purposes covered by your written authorization, except where we have already acted based on your permission. Understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

  If you have questions about this notice, please contact us:

  Kevin Harvey
  183 Hagley Park Road, Kingston 11,
  [email protected]