PRIVACY NOTICE REGARDING USE AND DISCLOSURE OF TREATMENT INFORMATION
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.
1. Purpose of this Notice
In general, any information that concerns your treatment, payment for treatment or related operations is considered confidential and is protected as confidential by Big Country Dermatology Pharmacy. This Privacy Notice describes Big Country Dermatology Pharmacy Privacy Practices, specifically – the use and disclosure the pharmacy may make of your treatment information and what rights you have with respect to your treatment information. Treatment information includes, but is not limited to, your name; address; other personal identifying data; health status; and record of treatment services that have been, are being, and will be provided to you in the future. Big Country Dermatology Pharmacy requires that all programs, employees, staff, and any party in a working or business relationship with Big Country Dermatology Pharmacy comply with these Privacy Practices.
2.Use and Disclosure of Medical Information for Treatment, Payment, and Health Care Operations
Laws governing treatment programs and procedures conducted by Big Country Dermatology Pharmacy allow use and disclosure of your personal information for the purposes of treatment, payment and health care operations.
Treatment means the provision, coordination or management of health care related, pharmaceuticals, and therapeutic services provided completely or in part by Big Country Dermatology Pharmacy. Big Country Dermatology Pharmacy can share your treatment information and records with another provider involved in your health care for the benefit of your coordinated care. Also, Big Country Dermatology Pharmacy may contact you by phone or other means to remind you of a refill, new prescription needed or address a specific aspect of your care.
Payment refers to reimbursement to Big Country Dermatology Pharmacy by your healthcare insurer for services and medications that may have been provided to you. In order to process payment, your healthcare insurer may require that Big Country Dermatology Pharmacy provide treatment information to confirm your eligibility for services provided, to coordinate benefits with other payers who may be responsible for reimbursement for the services, and as part of the payers claims management procedures which covers billings, collections, appeals, medical necessity review activities, utilization review activities, or for disclosure to consumer reporting agencies.
Health Care Operations covers a range of internal operations performed by Big Country Dermatology Pharmacy or its Business Associates to manage information, data and services on behalf of Big Country Dermatology Pharmacy and the individuals Big Country Dermatology Pharmacy serves. These operations include, but are not limited to, quality assessment and improvement activities including research; peer review; credentialing and licensing; training programs; legal and financial PRIVACY NOTICE REGARDING USE AND DISCLOSURE OF TREATMENT INFORMATION services; business planning and development; implementing and monitoring Big Country Dermatology Pharmacy’s compliance and privacy practices; customer services; internal grievances; and other purposes including research; fundraising, marketing and due diligence activities.
3. Consent and Authorization
Big Country Dermatology Pharmacy must obtain your consent prior to initiating treatment, payment or health care operations on your behalf. You will be required to give your consent before any treatment services begin. This consent will remain in effect until completion of your treatment services with Big Country Dermatology Pharmacy. However, you have the right to revoke your consent, in writing, at any time during the course of treatment services except to the extent that Big Country Dermatology Pharmacy has taken action in reliance on the consent. A written Authorization is required for the use and disclosure of all or part of your treatment information requested by a third party for purposes other than general treatment, payment or health care operations. The Authorization will be time restricted and contain a prohibition against the use of the information for any purpose other than the purpose stated on the Authorization and against re-release of the information for any purpose.
To the extent the Products enables you to send or receive SMS messages, the standard text messaging rates or other carrier charges may apply to such use. Further, to the extent the Products has push notification capability, by downloading such a Product and clicking to allow push notifications, you consent to receive communications, including commercial communications from or on behalf of web designers, Big Country Dermatology Pharmacy, and partners.
4. The Use and Disclosure of Treatment Information when your Consent or Authorization are not required
Under the following circumstances, Big Country Dermatology Pharmacy is permitted by law to use or disclose your treatment information without further Consent or Authorization:
a. To those caregivers actively engaged in your treatment at Big Country Dermatology Pharmacy or to providers who are actively coordinating with Big Country Dermatology Pharmacy in your care or treatment plan;
b. To insurers and those third-party payors or co-payers whom you have identified to Big Country Dermatology Pharmacy as being responsible for payment for your treatment services and who require information to verify that services were provided (information to be released hereunder is limited to the staff names, the dates, types and costs of therapies or services, and a short description of the general purpose of each treatment session or service);
c. To reviewers and inspectors, including the Utilization Review Accreditation Committee or similar agencies and Commonwealth licensure or certification, when necessary to obtain certification as an eligible provider of services;
d. In response to a Court Order when Production of Documents is properly ordered by law;
e. In response to an emergency medical situation when release of information is necessary to prevent serious risk of bodily harm or death (only that specific information minimum and necessary to the relief of the emergency may be released on a non-consensual basis);
f. To attorneys assigned to represent the subject of a commitment hearing.
Treatment information made available shall be limited to that information which is minimum and necessary to the purpose for which the information is sought.Treatment information may not be released to additional parties or entities or used for additional purposes without your consent.
5. Authorization for Other Uses and Disclosures of Treatment Information
Big Country Dermatology Pharmacy is prohibited, by law, from using or disclosing your treatment information without a written authorization for any purpose other than those purposes listed above. For purposes other than those listed above, Big Country Dermatology Pharmacy must obtain a signed Authorization and disclose only that treatment information which is minimum and necessary to the specific purpose requested.
An Authorization serves as written permission that specifically identifies the information being sought for use or disclosure and clearly states the purpose for which the use or disclosure is being requested. Further, you may revoke your information at any time except: (1) to the extent that treatment information has been used or disclosed in reliance on your Authorization or (2) your Authorization was obtained as a condition of obtaining insurance coverage.
Please note that Big Country Dermatology Pharmacy cannot guarantee that once your treatment information has been released to the third party named in an authorization, that the third party will abide by rules stated in Big Country Dermatology Pharmacy’s Privacy Notice.
6. Individual Rights with respect to Treatment Information
An individual of appropriate age and legal capacity, who understands the nature of the treatment information and the purpose for which treatment information may be used or disclosed, shall control access to his or her personal treatment information.
a. Access refers to physical examination of treatment information, but does not include physical possession of the information. A person who has received or is receiving treatment may request access to treatment information including records, but shall be denied such access to all or part of the treatment information if:
ii. Upon documentation by the team treatment leader it is determined that granting such access will constitute a substantial detriment to the treatment process; and/or
iii. When disclosure of specific treatment information will reveal the identity of persons or breach the trust or confidentiality of persons who have provided information upon an agreement to maintain their confidentiality.
1v. The limitations on access to treatment information are applicable to parents, guardians, and others who may otherwise have the right to control access over treatment records, except that the possibility of substantial detriment to the parent, guardian, or other person may also be considered.
b. Restrictions on the use and disclosure of your treatment information for treatment, payment, and operational purposes may be requested by you. Big Country Dermatology Pharmacy shall be bound by all reasonable and appropriate requests for such restrictions which it agrees to in writing, except in emergency circumstances. Big Country Dermatology Pharmacy reserves the right to request the withdrawal of certain restrictions at any time during your treatment. However, Big Country Dermatology Pharmacy is not bound to accept your requested restrictions if the treatment team does not believe that it reasonably can or should comply with the requested restrictions. Big Country Dermatology Pharmacy reserves the right to its treatment teams to exercise such discretion and give a written refusal in response to your request for restrictions. Please address any written requests for restriction to the Medical Records Department at Big Country Dermatology Pharmacy.
c. Confidential Communications may be requested by you about Big Country Dermatology Pharmacy communicating information regarding your treatment, health care services, and payment for services, and payment for services.
Example – you may request that all communication be directed to your home and not to you at work.
Also, as a part of Big Country Dermatology Pharmacy quality improvement practices, Big Country Dermatology Pharmacy may call to remind you about a refill, new prescription needed or follow up by phone after services have been provided to confirm the service and quality of service provided. On such phone calls, Big Country Dermatology Pharmacy may appear on your “Caller ID” service. You may request the Big Country Dermatology Pharmacy call you on a phone which will not identify Big Country Dermatology Pharmacy on your “Caller ID”. Such requests for confidential communication must be made in writing. Big Country Dermatology Pharmacy will do its best to reasonably accommodate such requests. Please address any requests for confidential communication to the Big Country Dermatology Pharmacy Compliance Officer.
d. Electronic or paper copy of your record
We will provide a copy of a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
e. Correct/Amend your Personal Health Information
You can ask us to correct/amend health care information about you that you think is incorrect or incomplete. Ask us how to do this. We may say no to your request, but we’ll tell you why in writing within 60 days.
f. Limit what we use or share about you
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
g. Get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations,and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
h. Choose someone to act on your behalf
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights to make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
i. Complaints alleging inappropriate use or disclosure of your treatment information by Big Country Dermatology Pharmacy employees or agents may be directed to the Big Country Dermatology Pharmacy Manager at (325) 704-5222.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
Big Country Dermatology Pharmacy is required by law to maintain the privacy of your documented and protected treatment information and to provide you with Notice of its legal obligations and Privacy Practices with respect to your treatment information. Big Country Dermatology Pharmacy must date and comply with the Privacy Notice currently in effect Big Country Dermatology Pharmacy reserves the right to amend and/or update its Privacy Notice from time to time upon change of practices or revisions of laws. If its Privacy Notice is revised, copies of revised and dated Policy Notice shall be posted in the Big Country Dermatology Pharmacy service areas and accessible on the Big Country Dermatology Pharmacy website. Big Country Dermatology Pharmacy reserves the right to implement the changes prior to issuing the revised Privacy Notice.