NOTICE OF PRIVACY PRACTICES

As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, we at Belle Meade Pharmacy (Pharmacy) have created this Notice of Privacy Practices (Notice). This Notice describes the Pharmacy's privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected Health Information (PHI). Your PHI is information about you, or that could be used to identify you, as it relates to your past and present physical and mental health care services. The HIPAA regulations require that the Pharmacy protect the privacy of your PHI that the Pharmacy has received or created.

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This Pharmacy will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below, the Pharmacy will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at any time, as explained in more detail below. The Pharmacy reserves the right to change the Pharmacy's privacy practices and this Notice.

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HOW WE MAY USE AND DISCLOSE YOUR PHI

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The following is an accounting of the ways that the Pharmacy is permitted, by law, to use and disclose your PHI.

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Treatment: We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care.

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Payment: The Pharmacy will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.

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Health Care Operations: We may use and disclose your PHI for our health care operations. Health care operations are activities necessary for us to operate our pharmacy. For example, we may use your PHI to monitor the performance of the staff and pharmacists providing treatment to you. We may use your PHI as part of our efforts to continually improve the quality and effectiveness of the health care products and services we provide. We may also analyze PHI to improve the quality and efficiency of health care, for example, to assess and improve outcomes for health care conditions. We may also disclose your PHI to other HIPAA covered entities that have provided services to you so that they can improve the quality and effectiveness of the health care services that they provide. We may use your PHI to create de-identified data, which is stripped of your identifiable data and no longer identifies you

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Public Health Activities: The Pharmacy may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability. This includes the FDA so that it may monitor any adverse effects of drugs, foods, nutritional supplements and other products as required by law.

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Victims of abuse, neglect or domestic violence: The Pharmacy may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence.

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Health Oversight Activities: The Pharmacy may use or disclose PHI about you to a health oversight agency for oversight activities which may include audits, investigations, inspections as necessary for licensure, compliance with civil laws, or other activities the health oversight agency is authorized by law to conduct.

Individuals Involved in your Care: The Pharmacy may disclose PHI about you to individuals involved in your care.

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Judicial and Administrative Proceedings: The Pharmacy may disclose PHI about you in the course of any judicial or administrative proceedings, provided that proper documentation is presented to the Pharmacy.

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Law Enforcement Purposes: The Pharmacy may disclose PHI about you to law enforcement officials for authorized purposes as required by law or in response to a court order or subpoena.

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About the Deceased: The Pharmacy may disclose PHI about a deceased, or prior to, and in reasonable anticipation of an individual's death, to coroners, medical examiners, and funeral directors.

Cadaveric organ, eye or tissue donation purposes: The Pharmacy may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.

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Research Purposes: The Pharmacy may use and disclose PHI about you for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board. Otherwise, the Pharmacy will request a signed authorization by the individual for all other research purposes.

To avert a serious threat to health or safety: The Pharmacy may use or disclose PHI about you, if it believed in good faith, and is consistent with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.

Specialized Government Functions: The Pharmacy may use or disclose PHI about you for specialized government functions including; military and veteran's activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations.

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Workers' Compensation: The Pharmacy may disclose PHI about you as authorized by and to the extent necessary to comply with workers' compensation laws or programs established by law.

Disaster Relief Purposes: The Pharmacy may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts and for family and personal representative notification.

Business Associates: The Pharmacy may disclose PHI about you to the Pharmacy's business associates for services that they may provide to or for the Pharmacy to assist the Pharmacy to provide quality health care. To ensure the privacy of your PHI, we require all business associates to apply appropriate safeguards to any PHI they receive or create.

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Victims of Abuse or Neglect: We may disclose PHI about you to a government authority if we reasonably believe you are a victim of abuse or neglect. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else.

OTHER USES AND DISCLOSURES:

The Pharmacy may contact you for the following purposes:

Information about treatment alternatives: The Pharmacy may contact you to notify you of alternative treatments and/or products.

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Health related benefits or services: The Pharmacy may use your PHI to notify you of benefits and services the Pharmacy provides.

Fundraising: If the Pharmacy participates in a fundraising activity, the Pharmacy may use demographic PHI to send you a fundraising packet, or the Pharmacy may disclose demographic PHI about you to its business associate or an institutionally related foundation to send you a fundraising packet. No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization. You will be provided with an opportunity to opt-out of all future fundraising activities.

YOUR HEALTH INFORMATION RIGHTS

The following are a list of your rights in respect to your PHI. Please contact the pharmacist for more information about the below.

You have the right to request additional restrictions of the Pharmacy's uses and disclosures of your PHI; however, the Pharmacy is not required to accommodate a request. This includes the right to restrict disclosures to Insurances for those products and services you pay out-of-pocket for.

You have the right to request that the Pharmacy communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require the Pharmacy to have an accurate address and home phone number in case of emergencies. The Pharmacy will consider all reasonable requests.

You have the right to request access and/or obtain a copy of your PHI that is contained in the Pharmacy for the duration the Pharmacy maintains PHI about you. There may be a reasonable cost-based charge for providing these documents. You will be notified in advance of incurring such charges, if any.

You have the right to request an amendment of the PHI the Pharmacy maintains about you, if you feel that the PHI the Pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services ("HHS"), or their appropriate designee, to review such a denial.

You have the right to receive an accounting of certain disclosures of your PHI made by the Pharmacy.

You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically.

You will be notified of any breaches that have compromised the privacy of your PHI.

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REVISIONS TO THE NOTICE OF PRIVACY PRACTICES

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The Pharmacy reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The Pharmacy will also post the revised version of the Notice in the Pharmacy.

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COMPLAINTS

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If you believe your privacy rights have been violated, you may file a complaint with the Pharmacy and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with the Pharmacy, please contact the pharmacist-in-charge by visiting our location or calling us. If you wish to file a complaint with the Secretary, please visit: https://www.hhs.gov/hipaa/filing-a-complaint/index.html 

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The Pharmacy will not take any adverse action against you as a result of your filing of a complaint.

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CONTACT INFORMATION

If you have any questions on the Pharmacy's privacy practices or for clarification on anything contained within the Notice, please contact:

BELLE MEAD PHARMACY INC.

196 N Belle Mead Rd Ste 8

E. Setauket, NY 11733

631-444-0784

Effective Date: This Notice is effective as of January 24, 2018.