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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information
to carry out treatment, payment or health care operations and for other purposes that are permitted or
required by law. It also describes your rights to access and control your protected health information.
"Protected health information" is information about you, including demographic information, that may identify
you and that relates to your past, present or future physical or mental health or condition and related health
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our
notice, at any time. The new notice will be effective for all protected health information that we maintain at
that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing
our website OlympicPharmacy.com, calling the pharmacy and requesting that a revised copy be sent to
you in the mail or asking for one at the pharmacy.
Your Health Information Rights
Although your health record is the physical property of the healthcare facility that compiled it, the information
belongs to you. You have the right to:
Request a restriction on certain uses and disclosures of your information
Obtain a paper copy of the notice of privacy practices upon request
Inspect and obtain a copy of your health record
Amend your health record
Obtain an accounting of disclosures of your health information for purposes other than treatment,
payment, healthcare operations, as required by law, pursuant to an authorization made by you,
or directly to you
Request communications of your health information by alternative means or at alternative locations
Revoke your authorization to use or disclose health information except to the extent that action has
already been taken
This organization is required to:
Maintain the privacy of your health information
Provide you with a notice as to our legal duties and privacy practices with respect to
information we collect and maintain about you
Abide by the terms of this notice
Notify you if we are unable to agree to a requested restriction
Accommodate reasonable requests you may have to communicate health information by alternative
means or at alternative locations.
We will request your authorization to disclose your health information for reasons other than described
in this notice.
If you believe your privacy rights have been violated, you can file a complaint with our Privacy Contact
or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
You may contact Duncan Hizzey at 858-9941. You may also email us at Duncan@OlympicPharmacy.com
for further information about the complaint process.
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment.
For example: Information obtained by a therapist or other member of your healthcare team will be recorded
in your record and used to determine the course of treatment that should work best for you. We may
provide your physician or a subsequent healthcare provider with copies of various reports that should
assist him or her in treating you.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the
bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations.
For example: Members of our team may use information in your health record to assess the care and
outcomes in your case and others like it. This information will then be used in an effort to continually
improve the quality and effectiveness of the healthcare and service we provide.
Business associates: There are some services provided in our organization through contacts with business
associates. Examples include our software vendor. When these services are contracted, we may disclose
your health information to our business associate so that they can perform the job we’ve asked them to do
and maintain our software so that we can bill your third-party payer for services rendered. To protect your
health information, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal
representative, or another person responsible for your care, your location, and general condition.
Communication with family: Health professionals, using their best judgment, may disclose to a family
member, other relative, close personal friend or any other person you identify, health information relevant
to that person’s involvement in your care or payment related to your care. For example: We may dispense
a prescription to a family member or caregiver for you as we believe appropriate for your healthcare.
Research: We may disclose information to researchers when their research has been approved by an
institutional review board that has reviewed the research proposal and established protocols to ensure
the privacy of your health information.
Organ procurement organizations: Consistent with applicable law, we may disclose health information
to organ procurement organizations or other entities engaged in the procurement, banking, or
transplantation of organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide monthly order reminders or information about treatment
alternatives or other health-related benefits and services that may be of interest to you.
Fund raising: We may contact you as part of a fund-raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse
events with respect to food, supplements, product and product defects, or post marketing surveillance
information to enable product recalls, repairs, or replacement.
Workers compensation: We may disclose health information to the extent authorized by and to the extent
necessary to comply with laws relating to workers compensation or other similar programs established
Public health: As required by law, we may disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury, or disability.
Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the
institution or agents thereof health information necessary for your health and the health and safety of
Law enforcement: We may disclose health information for law enforcement purposes as required by
law or in response to a valid subpoena.
Federal law makes provision for your health information to be released to an appropriate health oversight
agency, public health authority or attorney, provided that a work force member or business associate
believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional
or clinical standards and are potentially endangering one or more patients, workers or the public.
This notice was published and becomes effective on April 14, 2003
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