FRED’S STORES OF TENNESSEE, INC. NOTICE OF PRIVACY PRACTICES
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.The pharmacies operated by Fred’s Stores of Tennessee, Inc. (“Fred’s Pharmacy”) are required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide you with notice of our legal duties and privacy practices with respect to PHI. PHI is 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 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 with respect to PHI about you.
Fred’s Pharmacy is required by law to follow the terms of the Notice currently in effect and maintain the privacy of your PHI. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We will notify affected individuals if there is a breach of unsecured PHI unless we determine there is a low probability that the PHI has been compromised. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. When we make changes to our notice, copies of the revised Notice will be available upon request in our pharmacies. A copy will also be posted in all of our pharmacies and will be available on our web site at www.fredsinc.com.
Your Health Information Rights
You have the following rights with respect to PHI about you:
Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, request a copy at a Fred’s Pharmacy or via U.S. mail at P.O. Box 18640, Memphis, TN 38181-0640.
Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to Fred’s Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640, Attn: Privacy Office. We are not required to agree to those restrictions.
Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as we maintain the PHI. The designated record set usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to Fred's Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640, Attn: Privacy Office. We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to Fred’s Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640, Attn: Privacy Office. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement.
Receive and accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations To request an accounting, you must submit a request in writing to Fred’s Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640, Attn: Privacy Office. Your request must specify the time period, but may not be longer than six years and may not include dates before April 14, 2003. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Request communications of PHI by alternative means or at alternative locations. For instance, you may request that we contact you about pharmacy matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must submit a request in writing to Fred’s Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640, Attn: Privacy Officer. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.
Examples of How We May Use and Disclose PHI
Subject to applicable state law, a summary of which is attached in the Addendum to this Notice, the following are descriptions and examples of ways we use and disclose PHI:
Treatment. For example, we will use PHI to dispense prescription medications to you. We will document in your record information related to the medications dispensed to you and services provided to you. We also may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. To coordinate your care, we also may contact your physician or other health care provider who is treating you.
Payment. For example, we will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment. We will bill you or a third-party payor for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.
Health Care Operations. For example, we may use information in your health record to monitor the performance of the pharmacists and staff providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.
Subject to applicable state law, a description of which is attached in the Addendum to this Notice, we also are permitted to use or disclose your PHI for the following purposes. However, we may never have reason to make some of these disclosures.
Business Associates: There are some services provided by us through contracts with third parties, which are known as “business associates.” When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do and, if applicable, bill you or your third-party payor for services rendered. To protect your PHI, we require the business associate to appropriately safeguard the PHI.
Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to that person’s involvement in your care of payment related to your care. For example, we may allow a friend or family member to pick up a prescription on your behalf.
Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Worker’s compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker’s compensation or similar programs established by law.
Public health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.
As required by law: We must disclose PHI about you when required to do so by law.
Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you 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 notify you about the request to allow you to obtain an order protecting the requested PHI.
Research: We may disclose PHI about you 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 information.
Coroners, medical examiners, and funeral directors: We may release PHI about you 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 PHI to funeral directors consistent with applicable law to carry out their duties.
Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation or organs for the purpose of tissue donation and transplant.
Fundraising: We may contact you as part of a fundraising effort. You have the right to elect not to receive fundraising communications by contacting the Privacy Office at Fred’s Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640 or via telephone at (901) 362-3733. Treatment or payment terms will not be impacted if you elect not to receive fundraising communications.
Notification: We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for you care, your location, and your general condition.
Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.
To avert a serious threat to health or safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.
National security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: Wemay disclose PHI about you to authorized federal official so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. 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 or the law enforcement of public official that is to receive the report represents that it is necessary and will not be used against you.
Other Uses and Disclosures of PHIExcept for uses and disclosures described in this Notice or as permitted by law, we will obtain your written authorization before using or disclosing PHI about you. This includes, excepted for limited circumstances allowed by law, selling your PHI or using or disclosing PHI for certain promotional communications that are prohibited marketing communications. You may revoke an 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 or as otherwise permitted by law.
If you are a minor who has lawfully provided consent for treatment and you would like the pharmacy, to the extent permitted by your state’s laws, to treat you as an adult for purposes of access to and disclosure of records related to such treatment, please notify the pharmacist
We make reasonable efforts to avoid any inadvertent oral disclosure of your protected health information. In some locations we offer customers the convenience of picking up their prescriptions at a drive-thru window where a conversation with the pharmacy could be overheard by a passerby. If you are concerned about the possibility of someone overhearing your drive-thru communications, we recommend that you obtain any consultations from the pharmacy counter inside the store.
For More Information or to Report a Problem
If you have questions or would like additional information about our privacy practices, you may contact the Privacy Officer at Fred’s Pharmacy, P.O. Box 18640, Memphis, TN 38181-0640 or via telephone at (901) 362-3733, ext. 2510. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
This Notice is effective as of September 23, 2013.
State Law Addendum
The following requirements modify the listed “Examples of How We May Use and Disclose PHI” in the states indicated, except as otherwise permitted or required by law:
Alabama<br /> We will not disclose your professional records to anyone without your authorization, except where it is in your best interest or where the law requires the disclosure.
For Medical recipients: We will disclose information pertaining to your treatment (including billing statements and itemized bills) only to: (a) the Medicaid Fiscal Agent; (b) the Social Security Administration; (c) the Alabama Vocational Rehabilitation Agency; (d) the Alabama Medicaid Agency; (e) insurance companies requesting information about a Medicaid claim filed by the provider, an insurance application, payment of life insurance benefits, or payment of a loan; or (f) other providers who need the information for treatment of a patient.
We will not disclose your pharmacy records without your written authorization, except to: (a) you; (b) your legal representative; (c) the Department of Health pursuant to existing law; (d) in the event that you are incapacitated or unable to request your records, you spouse; and (e) in any civil or criminal proceeding, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to you or your legal representative by the party seeking the records.
Unless authorized by you , we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities: (a) the prescriber, or other licensed health care practitioners caring for you; (b) another licensed pharmacist for purposes of transferring a prescription or as part of a patient’s drug utilization review, or other patient counseling requirements; (c) the Board of Pharmacy, or its representative; or (d) any law enforcement personnel duly authorized to receive such information.
We may also disclose your confidential information without your consent pursuant to a subpoena issued and signed by an authorized government official or a court order issued and signed by a judge of an appropriate court.
We will not disclose AIDS confidential information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
We will disclose your confidential information only when it is in your best interests, when the information is requested by the Board of Pharmacy or its representatives or by a law enforcement officer charged with the enforcement of laws pertaining to drugs or devices or the practice of pharmacy, or when disclosure is essential to our business operations.
We will not disclose your patient information or the nature of professional services rendered to you without your express consent or without a court order, except to the following authorized persons: (a) members, inspectors, or agents of the Board of Pharmacy; (b) you, your agent, or another pharmacist acting on your behalf; (c) another person, upon your request; (d) licensed health care personnel who are responsible for your care; (e) certain state government agents charged with enforcing the controlled substances laws; (f) federal, state, or municipal government officers who are investigating a specific person regarding drug charges; and (g) a government agency that may be providing medical care to you, upon that agency’s written request for information. We will only use your information to provide pharmacy care.
Unless specifically authorized by you, we will not release your pharmacy records to anyone other than: (a) you or any other person authorized by you to receive the information; (b) the authorized prescriber who issued the prescription order, or a licensed health professional who is currently treating you; (c) in response to lawful requests from a court or grand jury; (d) a person authorized by a court order; (e) to transfer medical or prescription information between pharmacists as provided by law; or (f) government agencies acting within the scope of their statutory authority.
For Medicaid recipients: We will restrict disclosure of your information to purposes directly related to your treatment, for promotion of improved quality of care, and to assist with an investigation, prosecution, or civil or criminal proceeding related to the administration of the Medicaid program.
We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
We will not disclose or provide a copy of your prescription orders on file, except to: (a) you; (b) your parent or guardian or other person acting in loco parentis if you are a minor and have not lawfully consented to the treatment of the condition for which the prescription was issued; (c) the licensed practitioner who issued the prescription or who is treating you; (d) a pharmacist who is providing pharmacy services to you; (e) anyone who presents a written authorization for the release of pharmacy information signed by you or your legal trust, or corporation who by laws or by contract is responsible for providing or paying for medical care for you; (f) any person authorized by subpoena; (g) any member or designated employee of the Board of Pharmacy; (h) the executor, administrator or spouse of a deceased patient; (i) Board-approved researchers, if there are adequate safeguards to protect the confidential information; and (j) the person who owns the pharmacy or his licensed agent.
Wewill not disclose your prescription drug information without first obtaining your consent, except in the following circumstances: (a) the lawful transmission of a prescription drug order in accordance with state and federal laws pertaining to the practice of pharmacy; (b) communications among licensed practitioners, pharmacists and other health care professionals who are providing or have provided services to you; (c) information gained as a result of a person requesting informational material from a prescription drug or device manufacturer or vendor; (d) information necessary to effect the recall of a defective drug or device or protect the health and welfare of an individual or the public: (e) information whereby the release is mandated by other state or federal laws, court order, or subpoena or regulations (e.g., accreditation or licensure requirements); (f) information necessary to adjudicate or process payment claims for health care, if the recipient makes no further use or disclosure of the information; (g) information voluntarily disclosed by you to entities outside of the provider-patient relationship; (h) information used in clinical research monitored by an institutional review board, with your written authorization; (i) information which does not identify you by name, or that is encoded so that identifying you by name or address is generally not possible, and that is used for epidemiological studies, research, statistical analysis, medical outcomes, or pharmacoeconomic research; (j) information transferred in connection with the sale of a business; (k) information necessary to disclose to third parties in order to perform quality assurance programs, medical records review, internal audits or similar programs, if the third party makes no other use or disclosure of the information; (l) information that may be revealed to a party who obtains a dispensed prescription on your behalf; or (m) information necessary in order for a health plan licensed by the South Carolina Department of Insurance to perform case management, utilization management, and disease management for individuals enrolled in the health plan, if the third party makes no other use or disclosure of the information.
We will not disclose your information or the nature of professional pharmacy services rendered to you, without your express consent or the order or direction of a court, except to: (a) you, or your agent, or another pharmacist acting on our behalf; (b) the practitioner who issued the prescription drug order; (c) certified/licensed health care personnel who are responsible for your care; (d) an inspector, agent or investigator from the Board of Pharmacy or any federal, state, county, or municipal officer whose duty is to enforce the laws of South Carolina or the United States relating to drugs or devicesand who is engaged in a specific investigation involving a designated person or drug; and (e) a government agency charged with responsibility of providing medical care for you upon written request by an authorized representative of the agency requesting the information.
We will not disclose your name and address or other identifying information, except to: (a) a health or government authority pursuant to any reporting required by law; (b) an interested third-party payor for the purpose of utilization review, case management, peer reviews, or other administrative functions; or (c) in response to a subpoena issued by a court of competent jurisdiction.
We will obtain your authorization before we disclose your patient records for any reason, except where: (a) the disclosure is in your best interest; (b) the law requires the disclosure; or (c) the disclosure is to an authorized prescriber or to communicate a prescription order where necessary to: (1) carry out prospective drug use review as required by law; (2) assist prescribers in obtaining a comprehensive drug history on you; or (3) prevent abuse or misuse or a drug or device and the diversion of controlled substances.
We will not sell your name and address or other identifying information for any purpose.
We will only release your confidential record to you, your agent, or to: (a) a practitioner or another pharmacist if, in the pharmacist’s professional judgment, the release is necessary to protect your health and well-being; (b) the pharmacy board or another state or federal agency authorized by law to receive the record; (c) a law enforcement agency engaged in investigation of a suspected violation of the controlled substances laws, or the Comprehensive Drug Abuse Prevent Control Act of 1970; (d) a person employed by a state agency that licenses a practitioner, if the person is performing the person’s official duties; or (e) an insurance carrier or other third party payor authorized by the patient to receive the information.