Medly Pharmacy is committed to protecting your privacy and personal health information (“PHI”). PHI is information about you, including basic demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI about you to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The notice also describes your rights under federal and state law relating to your PHI.
Medly Pharmacy is required to abide to the terms of this notice, which explains our legal duties and privacy practices with respect to PHI that we collect and maintain. We will not use or disclose PHI about you without your written authorization, except as described in this notice. We reserve the right to change the privacy practices outlined in this notice, and make the new notice effective for PHI we maintain. Should we make such a change, we will display the revised notice to you online, and make it available to you upon request.
YOUR HEALTH INFORMATION RIGHTS
You have the following rights with respect to PHI about you as a patient. These rights include:Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at anytime. Even if you have agreed to receive the notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact email@example.com or call 718-782-7539. Request a restriction on certainuses and disclosures of PHI. You havethe right to request additional restrictions on our use or disclosure of PHIabout you by sending a written request to firstname.lastname@example.org. We are not required to agree to thoserestrictions. Inspect and obtain a copy of PHI. You have the right to access and copy PHIabout you contained in a designated record set for as long as the Pharmacymaintains the PHI. The designated recordset usually will include prescription and billing records. To inspect or copy PHI about you, you mustsend a written request to email@example.com or speak to Medly PharmacyPharmacy’s Privacy Officer by calling 718-782-7539. We may charge you a fee for the costs ofcopying, mailing, postage, or other supplies that are necessary to fulfill yourrequest. Upon receiving your request toaccess your PHI, we are required to respond to you no later than 30 days afterthe receipt of your request. We may denyyour request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, youmay request that the denial be reviewed. Request an amendment of PHI. If you feel that PHI we maintain about you isincomplete or incorrect, you may request that we amend it. You may request an amendment for as long as wemaintain the PHI. To request anamendment, you must send a request to firstname.lastname@example.org or call718-782-7539 and speak to the Privacy Officer. You must include a reason that supports yourrequest. We will respond to your requestwithin 60 days with up to 30-day extension, if needed. In certain cases, we may deny your request foramendment. If we deny your request foramendment, you have the right to file a statement of disagreement with thedecision and we give a rebuttal to your statement. Receive an accounting ofdisclosures of PHI. You have the rightto receive an accounting of the disclosures we have made of PHI about you formost purposes other than treatment, payment, or health care operations. The accounting will exclude certaindisclosures, such as disclosures made directly to you, disclosures youauthorize, disclosures to friends or family members involved in your care, anddisclosures for notification purposes. The right to receive an accounting is subjectto certain other exemptions, restrictions, and limitations. To request an accounting, you must submit arequest send a request to email@example.com or call 718-782-7539 andspeak to the Privacy Officer. Yourrequest must specify the time period, but may not be longer than six years. We are required to provide you the accountingwithin 60 days and with one 30-day extension, if needed. Request communicationsof PHI by alternative means or at alternative locations. For instance, you may request that we contactyou about medical matters only in writing, or at a different residence or postoffice box. To request confidentialcommunication of PHI about you, you must send a request to firstname.lastname@example.org call 718-782-7539 and speak to the Privacy Officer. Your request must state how or where you wouldlike to be contacted. We will attempt toaccommodate all reasonable requests, and will not request an explanation fromyou to the basis for your request. We are likely to use or disclose PHI for thefollowing purposes:Business associates: There are some services provided by usthrough contracts with business associates. When these services are contracted for, we maydisclose PHI about you to our business associates so that they can perform thejob we have asked them to do and bill you or your third-party payor forservices rendered. To protect PHI aboutyou, we require the business associate to appropriately safeguard the PHI. Communicationwith individuals involved in your care or payment for your care: Healthprofessionals such as pharmacists, using their professional judgment, maydisclose to a family member, other relative, close personal friend or any personyou identify, PHI relevant to that person’s involvement in your care or paymentrelated to your care. Health-related communications: We may contact you toprovide refill reminders or information about treatment alternatives or otherhealth-related benefits and services that may be of interest to you. Food andDrug Administration (FDA): We may disclose to the FDA, or persons under thejurisdiction of the FDA, PHI relative to adverse events with respect to drugs,foods, supplements, products and product defects, or post marketingsurveillance information to enable product recalls, repairs, or replacement. Worker’scompensation: We may disclose PHI about you as authorized by and as necessaryto comply with laws relating to worker’s compensation or other similar programsestablished by law. Public health: As required by law, we may disclose PHIabout you to public health or legal authorities charged with preventing orcontrolling disease, injury, or disability. Law enforcement: We may disclosePHI about you for law enforcement purposes as required by law or in response toa valid subpoena or other legal process. As required by law: We must disclosePHI about you when required to do so by law. Health oversight activities: Wemay disclose PHI about you to an oversight agency for activities authorized bylaw. These oversight activities includeaudits, investigations, and inspections, as necessary for our licensure and forthe government to monitor the health care system, government programs, andcompliance with civil rights laws. Judicial and administrative proceedings: Ifyou are involved in a lawsuit or a dispute, we may disclose PHI about you inresponse to a court or administrative order. We may also disclose PHI about you in responseto a subpoena, discovery request, or other lawful process by someone elseinvolved in the dispute, but only if efforts have been made to tell you aboutthe request or to obtain an order protecting the requested PHI. We are alsopermitted to use or disclose PHI about you for the following purposes: Research:We may disclose PHI about you to researchers when their research has beenapproved by an institutional review board that has reviewed the researchproposal and established protocols to ensure the privacy of your information. Coroners,medical examiners, and funeral directors: We may release PHI about you to acoroner or medical examiner. This may benecessary, for example, to identify a deceased person or determine the cause ofdeath. We may also disclose PHI tofuneral directors consistent with applicable law lo carry out their duties. Organor tissue procurement organizations: Consistent with applicable law, we maydisclose PHI about you to organ procurement organizations or other entitiesengaged in the procurement, banking, or transplantation of organs for thepurpose of tissue donation and transplant. Notification: We may use or disclosePHI about you to notify or assist in notifying a family member, personalrepresentative, or another person responsible for your care, your location, andgeneral condition. Correctional institution: If you are or become an inmate ofa correctional institution, we may disclose PHI to the institution or itsagents when necessary for your health or the health and safety of others. Toavert a serious threat to health or safety: We may use and disclose PHI aboutyou when necessary to prevent a serious threat to your health and safety or thehealth and safety of the public or another person. Military and veterans: Ifyou are a member of the armed forces, we may release PHI about you as requiredby military command authorities. We mayalso release PHI about foreign military personnel to the appropriate militaryauthority. National security and intelligence activities: We may release PHIabout you to authorized federal officials for intelligence,counterintelligence, and other national security activities authorized by law. Protectiveservices for the President and others: We may disclose PHI about you toauthorized federal officials so they may provide protection to the President,other authorized persons or foreign heads of state or conduct specialinvestigations. Victims of abuse, neglect, or domestic violence: We maydisclose PHI about you to a government authority, such as a social service orprotective services agency, if we reasonably believe you are a victim of abuse,neglect, or domestic violence. We willonly disclose this type of information to the extent required by law, if youagree to the disclosure, or if the disclosure is allowed by law and we believeit is necessary to prevent serious harm to you or someone else or the lawenforcement or public official that is to receive the report represents that itis necessary and will not be used against you.
OTHER USES AND DISCLOSURES OF PHI
The Pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided above or as otherwise permitted or required by law. You may revoke this authorization in writing at any time. Upon receipt of the written revocation we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions or would like additional information about the Pharmacy’s privacy practices, you may send a request to email@example.com or call 718-782-7539 and speak to the Privacy Officer. If you believe your privacy rights have been violated, you have the right to report a complaint to firstname.lastname@example.org, call 718-782-7539 and speak to the Privacy Officer, or to the Secretary of Health and Human Services. Rest assured, there will be no retaliation for filing a complaint regarding our privacy practices.
Please do not hesitate to contact us, if you would like to review the personal information that we hold about you, or if you have any questions about our policies, our websites and apps, or how we collect, use and disclose information, using the information below:
ATTN: Privacy Officer
c/o Medly Pharmacy
104 Graham Ave
Brooklyn, NY 11206
Effective as of June 15, 2017