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.
EFFECTIVE SEPTEMBER 2ND, 2014
SECTION A: Uses and Disclosures of Protected Health Information (PHI)
1. Under applicable law, including the Health Insurance Portability and Accountability Act of 1996, as amended, and its regulations (“HIPAA”) and the Health Information Technology for Economic and Clinical Health Act and its regulations (“HITECH”) (collectively provisions of HIPAA and HITECH are referred to as “HIPAA Provisions”), Dohmen Life Science Services, LLC (we or us) are required to protect the privacy of your individual health information (information we refer to in this Notice as “PHI”). We are also required to provide you with this Notice regarding our policies and procedures regarding your PHI, to abide by the terms of this Notice, as it may be updated from time to time, and to notify you following the breach of your unsecured PHI.
We are permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and healthcare operations purposes. We may obtain information to dispense prescriptions, manage your condition, and document pertinent information in your records that may assist us in managing your medication therapy or your overall health.
For treatment purposes, such use and disclosure will take place in providing, coordinating, or managing healthcare and its related services by one or more of your providers, such as when your pharmacist consults with your physician or a specialist regarding your medications, treatment or condition.
For payment purposes, such use and disclosure will take place to obtain or provide reimbursement for providing pharmaceutical care services, such as when your case is reviewed to ensure that appropriate care was rendered. For reimbursement purposes, your PHI may be disclosed to one or several intermediaries employed by your plan sponsor including but not limited to insurers, pharmacy benefits managers, claims administrators and computer switching companies.
For healthcare operations purposes, such use and disclosure will take place in a number of ways by us and a contracted patient advocacy group, including for quality assessment and improvement; provider review and training; and compliance activities. Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided. Your information could also be used by the contracted patient advocacy group to assist in your initial patient intake and case management.
We store some of your PHI in electronic computer files. Reasonable safeguards are employed to protect your PHI stored on electronic media. We backup our electronic records nightly, and employ other precautions to safeguard the integrity of your PHI. In spite of these precautions it is possible, but unlikely, that a computer crash or other technological failure could cause the loss of data.
In addition, we, or the contracted patient advocacy group, may contact you to provide refill reminders, to arrange shipment of your orders, or inform you about treatment alternatives or other health-related benefits and services that may be of interest to you. In addition, we may disclose your health information to your plan sponsor or the manufacturer in case of product recalls.
We may use and disclose your PHI without your authorization when the pharmacy needs to contact a physician or other clinician involved in your health care and is permitted or required to do so without individual written authorization. We may use and disclose your PHI if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them. We may disclose PHI about you without your authorization to comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, health oversight activities and as required by law.
Certain specific uses and disclosures have particular rules regarding authorization. Except in certain circumstances, we may not use or disclose your PHI without authorization if the PHI is considered psychotherapy notes. We also may not use or disclose your PHI for marketing, which is broadly defined under the HIPAA Provisions to include communications about products or services that encourage the use of those products or services, except in certain circumstances. This includes communications that could be considered for your treatment if we receive financial support to make the communication (e.g., from the drug manufacturer). We cannot sell your PHI.
Any uses and disclosures not described in this Notice and uses and disclosures that require your authorization will be made only with your written authorization, and you may revoke your authorization by notifying us as described in Section B.
From time to time we may employ the services of business associates who may assist us in one or more tasks and who may use, change or create PHI. Business associates are required to comply with all the privacy regulations on your behalf. The contracted patient advocacy group referred to in this document is classified as a business associate.
2. You may ask us to restrict uses and disclosures of your PHI to carry out treatment, payment, or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care. However, we are not required to agree to your request, except in limited circumstances as required by law.
3. You have the right to request: (i) inspection and copying of your PHI; (ii) amendment or correction to your PHI; (iii) an accounting of the disclosures of your PHI by us (we are not required to account to you for certain disclosures excluded by law); and (iv) a paper copy of this Notice. We may require you to pay for this request to cover our costs of copying, labor and postage.
You may request, and we must accommodate the request, if reasonable, to receive communications of PHI by alternative means or at alternative locations. To make this request please contact, in writing:
Dohmen Life Science Services, LLC
Attn: Gary Sobocinski
17877 Chesterfield Airport Rd.
Chesterfield, MO 63005
4. We may use your name to reference your prescriptions and pharmaceutical care services. We request that you sign the attached signature form to acknowledge receipt of service, to acknowledge receipt of this Notice and the disclosure of PHI as outlined herein. This information may be disclosed by us to other persons who ask for you or your prescriptions by name. You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative orally or in writing of your restriction or prohibition. We are not required to honor those requests, except in limited circumstances as required by law. We are able to provide treatment services to you even if you object to signing the acknowledgment of the receipt of this Notice or if we decide not to honor a request regarding the information in this document. In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preference, and what we determine to be in your best interest. We will inform you of any such uses or disclosures if uses and disclosures would require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable.
5. We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, PHI that is directly relevant to the person’s involvement with your care or payment related to your care. In addition we may use or disclose the PHI to notify, identify, or locate a member of your family, your personal representative, another person responsible for care, or certain disaster relief agencies of your location, general condition, or death. If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do in our judgment what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare.
6. DLSS will promptly advise our patients whenever there is a material change to the uses or disclosures, individual rights, legal duties, or other privacy practices stated in this Notice. DLSS may distribute the revised documents, or provide an internet web location where the documents may be viewed.
7. If you believe that your privacy rights have been violated, you may complain to us at the location described in Section B or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201. You will not be retaliated against for filing a complaint.
8. Please refer to the Attachment E (State Laws More Stringent than HIPAA) and locate your state to see if your state has a law or regulation that is more stringent than HIPAA.
Section B: Contacting Us
You may contact us for further information at:
Dohmen Life Science Services, LLC
Attn: Gary Sobocinski
17877 Chesterfield Airport Rd.
Chesterfield, MO 63005
Toll Free: 866.849.4481
Section C: Who Will Follow this Notice
Addendum to Notice of Privacy Practices
STATE LAWS MORE STRINGENT THAN HIPAA
Alabama: Except where it is in your best interest or where the law requires, we will not disclose your medical records to anyone without your authorization. If you are a Medicaid recipient, we will disclose information about your treatment (including billing information) only as follows: (1) to Medicaid’s Fiscal Agent, the Social Security Administration, Alabama’s Vocational Rehabilitation Agency, or the Alabama Medicaid Agency; (2) to an insurance company that requests information about you for a Medicaid claim we have filed for you, or for an insurance application, to pay life insurance benefits, or to pay a loan; or (3) to other health care providers who need the information to treat you.
California: California law puts more limits on how we can disclose your medical information than federal law does. In the situations described below, we may disclose your medical information as follows:
(a) We may disclose your information to health care providers, health care service plans, contractors or other health care professionals or facilities so they can diagnose or treat you. In an emergency situation, we may communicate your information by radio transmission or other means to licensed emergency medical personnel at the scene of an emergency, in an emergency medical transport vehicle, or at a health facility;
(b) We will disclose your information a person or entity responsible for paying for your health care services (for example an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor or any other person or entity responsible for paying) to the extent needed for them to determine if they are responsible for paying for the your care. If you are comatose or have another disabling medical condition that makes you unable to consent to our disclosure of medical information and no other arrangements have been made to pay for your health care, we may also disclose your information to a governmental authority to the extent necessary to determine your eligibility for, and to obtain, payment under a governmental program for health care services provided to you. We may also disclose your information to another health care provider or health care service plan as necessary to assist the other provider or health care service plan in obtaining payment for health care services they render to you;
(c) We may disclose your information to any person or entity that provides billing, claims management, medical data processing, or other administrative services for health care providers or health care service plans or for any of the persons or entities specified above in paragraph (b). However, without your authorization, the information disclosed to them may not be further disclosed in any way that would violate California laws governing the use and disclosure of medical information;
(d) We may disclose your information to organized committees and agents of professional societies or of medical staffs of licensed hospitals, licensed health care service plans, professional standards review organizations, independent medical review organizations and their selected reviewers, utilization and quality control peer review organizations, contractors or persons or organizations insuring, responsible for, or defending professional liability that a provider may incur, if the committees, agents, health care service plans, organizations, reviewers, contractors or persons are engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges;
(e) If we provide care to you at your employer’s specific prior written request, we may disclose the medical information we create as a result of that employment-related health care service to if the information: (i) is relevant in a law suit, arbitration, grievance, or other claim or challenge to which the employer and the employee are parties and in which you has placed in issue his or her medical history, mental or physical condition, or treatment, provided that information may only be used or disclosed in connection with that proceeding; (ii) describes functional limitations of you that may entitle you to leave from work for medical reasons or limit your fitness to perform your present employment, provided that no statement of medical cause is included in the information disclosed;
(f) Unless we are otherwise notified in writing of an agreement by a sponsor, insurer, or administrator, we may disclose information we created as the result of providing you services the specifically requested in writing (and paid for by) the sponsor, insurer, or administrator to that sponsor, insurer, plan administrator, or policy administrator that you seek coverage by or benefits from, for the purpose of evaluating your application for coverage or benefits;
(g) We may disclose your information to a health care service plan that we contract with and that information may be transferred to other health care providers that contract with the health care service plan, for the purpose of administering the health care service plan. Medical information may not otherwise be disclosed by a health care service plan except as allowed by law;
(h) We may disclose your information to insurance institutions, agents, or support organizations that comply with all requirements for obtaining the information pursuant to the requirements of the California Insurance Code provisions;
(i) We may disclose your information to an organ procurement organization or a tissue bank processing the tissue of a decedent for transplantation into the body of another person, but only with respect to the donating decedent for the purpose of aiding the transplant;
(j) We may disclose basic information about you, including your name, city of residence, age, sex, and general condition, to a state or federally recognized disaster relief organization for the purpose of responding to disaster welfare inquiries;
(k) We may disclose your information to a third party for purposes of encoding, encrypting, or otherwise anonymizing data. However, no information may be further disclosed by the recipient in any way that would be unauthorized manipulation of coded or encrypted medical information that reveals individually identifiable medical information;
(l) We may disclose your information for purposes of disease management programs and services to any entity contracting with a health care service plan or the health care service plan's contractors to monitor or administer care of enrollees for a covered benefit, provided that the disease management services and care are authorized by a treating physician or to any disease management organization that complies fully with the physician authorization requirements, provided that the health care service plan or its contractor provides or has provided a description of the disease management services to a treating physician or to the health care service plan's or contractor's network of physicians;
(m) If you are a minor, we may disclose your information to a county social worker, a probation officer, or any other person who is legally authorized to have custody of or care of you so they can coordinate health care services and medical treatment provided to you;
(n) We may disclose your information to an employee welfare benefit plan, to the extent that the employee welfare benefit plan provides you medical care, and your information may also be disclosed to an entity contracting with the employee welfare benefit plan for billing, claims management, medical data processing, or other administrative services related to the provision of medical care to persons enrolled in the employee welfare benefit plan for health care coverage; and
(o) We may disclose your information to the appropriate authorities if there is suspected elder abuse.
Connecticut: We will not disclose any information about your pharmaceutical services without your consent, except to the following persons: (a) the prescribing practitioner or a pharmacist or another prescribing practitioner presently treating you when deemed medically appropriate; (b) a nurse who is acting as an agent for a prescribing practitioner that is presently treating you or a nurse providing care to you in a hospital; (c) third party payors who pay claims for pharmaceutical services rendered to you or who have a formal agreement or contract to audit any records or information in connection with such claims; (d) any governmental agency with statutory authority to review or obtain such information; (e) any individual, the state or federal government or any agency thereof or court pursuant to a subpoena; and (f) any individual, corporation, partnership or other legal entity which has a written agreement with the pharmacy to access the pharmacy's database provided the information accessed is limited to data which does not identify specific individuals. We will not sell your individually identifiable medical record information.
Florida: We will not disclose your pharmacy records without your written authorization, except to the following persons: (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, your 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.
Georgia: Unless you authorize us, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities: (a) prescribers, or other licensed health care practitioners caring for you; (b) another licensed pharmacist to transfer a prescription, for your drug utilization review, or to counsel you; (c) the Board of Pharmacy, or its representatives; 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.
Hawaii: We will not disclose your AIDS confidential information, except if you have 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.
Idaho: We will not release your identifiable prescription information to anyone other than you or your designee, unless requested by any of the following persons or entities: (a) the Board of Pharmacy, or its representatives, acting in their official capacity; (b) the practitioner, or the practitioner's designee, who issued your prescription; (c) other licensed health care professionals who are responsible for your care; (d) agents of the Department of Health and Welfare when acting in their official capacity with reference to issues related to the practice of pharmacy; (e) agents of any board whose practitioners have prescriptive authority, when the board is enforcing laws governing that practitioner; (f) an agency of government charged with the responsibility for providing medical care for you; (g) the federal Food and Drug Administration, for purposes relating to monitoring of adverse drug events in compliance with the requirements of federal law, rules or regulations adopted by the FDA; and (h) the authorized insurance benefit provider or health plan that provides your health care coverage or pharmacy benefits.
Indiana: 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.
Iowa: We will not disclose you HIV/AIDS-related information, except if you have 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.
Kentucky: We will not disclose your patient information or the nature of professional services we 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) certified or 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.
Maine: We will not disclose your health care information for fund raising purposes or to coroners or funeral directors, without your authorization. We will only disclose patient identifiable communicable disease information to Department of Human Services for adult or child protection purposes or to other public health officials, agents or agencies or to officials of a school where a child is enrolled, for public health purposes. In a public health emergency, as declared by the state health officer, we may also release your information to private health care providers and agencies for the purpose of preventing further disease transmission.
Massachusetts: If you are a Medicaid recipient, we will disclose your information only for purposes directly connected with Medicaid program administration.
Michigan: Unless authorized by you, we will not disclose your prescription or equivalent record on file, except to the following persons: (a) you; (b) another pharmacist acting on your behalf; (d) the authorized prescriber who issued the prescription; (d) a licensed health professional who is currently treating you; (e) an agency or agent of government responsible for the enforcement of laws relating to drugs and devices; (f) a person authorized by a court order; or (g) a person engaged in research projects or studies with protocols approved by the Michigan Board of Pharmacy. We will not disclose AIDS-related information about you except where you have 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.
Minnesota: We will not disclose the nature of the pharmaceutical services rendered to you or your prescription orders to anyone except for to: (a) you; (b) your agent; (c) another pharmacist acting on your behalf or your agent's behalf; (d) the licensed practitioner who issued the prescription; (e) a licensed practitioner who is currently treating you; (f) a member, inspector, or investigator of the board or any federal, state, county, or municipal officer whose duty it is to enforce the laws of this state or the United States relating to drugs and who is engaged in a specific investigation involving a designated person or drug; (g) an agency of government charged with the responsibility of providing medical care for you; (h) an insurance carrier or attorney on receipt of written authorization signed by you or your legal representative, authorizing the release of such information; (i) any person duly authorized by a court order; or (j) pursuant to an order or direction of a court.
Missouri: Unless you specifically authorize us, we will not release your pharmacy records to anyone other than: (a) to you; (b) to any other person you authorize; (c) to the prescriber who issued your prescription; (d) to a licensed health professional who is currently treating you; (e) in response to lawful requests from a court or grand jury; (g) to a person authorized by a court order;
(h) to transfer medical or prescription information between pharmacists as provided by law; (i) government agencies acting within the scope of their statutory authority; or (j) a person or entity who is allowed to receive such information under HIPAA. If you are a Medicaid recipient, we will disclose your information only if it is directly related to treating you, to promote improved quality of care, or 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 if you have provided us with a written authorization allowing the release or if we are authorized or required by state or federal law to do so.
Montana: If you are a Medicaid recipient, we will only use your information only for purposes directly connected with Medicaid program administration and except for disclosing to state authorities, we will not disclose your information without your written consent. If you are a CHIP participant, we disclose your information only for CHIP program administration. For all patients, we will not disclose any information about you if you are infected with, or are reasonably suspected to be infected with a sexually transmitted disease, except to: (a) the Montana Department of Public Health and Human Services; (b) a physician who has obtained your written; or (c) a local health officer.
Nevada: We will not disclose the contents of your prescriptions except to: (a) you; (b) the practitioner who issued the prescription; (c) a practitioner who is currently treating you; (d) the Board of Pharmacy, the FDA, or a Department of Public Safety agent; (e) a state agency charged with providing medical care for you; (g) an insurance carrier, on receipt of your written authorization or your legal guardian authorizing the release of information; (g) any person authorized by an order of a district court; (h) a member, inspector, or investigator of a professional licensing board that licenses the practitioner who orders the prescriptions filled at the pharmacy; (i) other registered pharmacists to the extent needed to exchange information about persons suspected of misusing prescriptions to obtain excessive amounts of drugs or failing to use a drug in conformity with the directions for its use, or taking a drug in combination with other drugs in a manner that could result in injury to that person; (j) a peace officer employed by a local government for the limited purpose of and to the extent necessary to investigate an alleged crime committed at the pharmacy and reported by an employee or to carry out a search warrant or subpoena issued pursuant to a court order; and (k) a county coroner, medical examiner or investigator employed by an office of a county coroner for the purpose of identifying a deceased person; determining a cause of death; or performing other duties authorized by law.
New Hampshire: We will only disclose your professional records if: (a) we have obtained your permission to do so; (b) during an emergency situation it is in your best interest for us to disclose the information; or (c) the law requires us to disclose the information. We will not use, release, or sell your identifiable medical information for the purpose of sales or marketing of services or products unless you have provided us with a written authorization permitting such activity.
New Jersey: If you are a recipient of the Pharmaceutical Assistance to the Aged and Disabled Program, we will not disclose you personally identifiable information without you or your agent’s consent, except for purposes directly connected to the administration of the PAAD program or as otherwise permitted by state or federal law.
New York: We may not give you a copy of your controlled substance prescriptions. We may give you a copy of other types of prescriptions, but we must indicate that the copy is for informational purposes only. We use a common database among our related pharmacies to store prescription information.
North Dakota: Unless you consent, we will not disclose information about the nature of the services we provide to you to anyone other than you, another pharmacy; your physician; or as ordered or directed by a court.
Ohio: Unless we have obtained your written consent, we will only disclose your pharmacy records to: (a) you; (b) the prescriber who issued the prescription or medication order; (c) certified/ licensed health care personnel who are responsible for your care; (d) a member, inspector, agent, or investigator of the state board of pharmacy or any federal, state, county, or municipal officer whose duty is to enforce the laws of this state or the United States relating to drugs and who is engaged in a specific investigation involving a designated person or drug; (e) an agent of the state medical board or state board of nursing when enforcing the statutes governing physicians, limited practitioners, or nurses; (f) an agency of government charged with the responsibility of providing medical care for you, upon a written request by an authorized representative of the agency requesting such information; (g) an agent of a medical insurance company who provides prescription insurance coverage to you, upon authorization and proof of insurance by you or proof of payment by the insurance company for those medications whose information is requested; (h) an agent who contracts with the pharmacy as a "business associate" in accordance with the regulations promulgated by the secretary of the United States Department of Health and Human Services pursuant to the federal standards for privacy of individually identifiable health information; or (i) in emergency situations, when it is in your best interest.
Oklahoma: We will not divulge the nature of your problems or ailments or any confidence you have entrusted to us in our professional capacity, except in response to legal requirements or where it is in your best interest. Unless authorized by you or permitted by state law, we will not disclose information identifying that you have or may have a communicable or venereal disease. Whenever possible, we will de-identify such information prior to disclosure.
Pennsylvania: We will not disclose any HIV-related information, except if you have provided us with written consent allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Rhode Island: We will only disclose your prescription information to our agents and persons directly involved in your care. We will not disclose your confidential health care information without your consent, except in the following situations:
(a) to a physician, dentist, or other medical personnel who believe in good faith that the information is necessary to diagnose or treat you in a medical or dental emergency;
(b) to medical and dental peer review boards, or the board of medical licensure and discipline, or board of examiners in dentistry;
(c) to qualified personnel for the purpose of conducting scientific research, management audits, financial audits, program evaluations, actuarial, insurance underwriting, or similar studies, provided that personnel does not identify, directly or indirectly, you in any report of that research, audit, or evaluation, or otherwise disclose your identity in any manner;
(d) to appropriate law enforcement personnel, or to a person if the pharmacist believes that you may pose a danger to that person or his or her family; or to appropriate law enforcement personnel if you have attempted or are attempting to obtain narcotic drugs from the pharmacy illegally; or to appropriate law enforcement personnel or appropriate child protective agencies if you are a minor child or the parent or guardian of such child and the pharmacist believes, after providing services to you, that the child is or has been physically, psychologically or sexually abused and neglected as reportable pursuant to R.I. Gen. Laws § 40-11-3; or to law enforcement personnel in the case of a gunshot wound reportable under section 11-47-48; the disclosures authorized by this subsection being limited to the minimum amount of information necessary to accomplish the intended purpose of the release of information;
(e) between or among qualified personnel and health care providers within the health care system for purposes of coordination of health care services given to you and for purposes of education and training within the same health care facility;
(f) to third party health insurers for the purpose of adjudicating health insurance claims including to utilization review agents, third party administrators, and other entities that provide operational support;
(g) to a malpractice insurance carrier or lawyer if we have reason to anticipate a medical liability action;
(h) to our own lawyer or medical liability insurance carrier if you initiate a medical liability action against our pharmacy;
(i) to public health authorities in order to carry out their designated functions. These functions include, but are not restricted to, investigations into the causes of disease, the control of public health hazards, enforcement of sanitary laws, investigation of reportable diseases, certification and licensure of health professionals and facilities, and review of health care such as that required by the federal government and other governmental agencies;
(j) to the state medical examiner in the event of a fatality that comes under his or her jurisdiction;
(k) in relation to information that is directly related to a current claim for workers' compensation benefits or to any proceeding before the workers' compensation commission or before any court proceeding relating to workers' compensation;
(l) to our attorneys whenever we consider the release of information to be necessary in order to receive adequate legal representation;
(m) to appropriate school authorities of disease, health screening and/or immunization information required by the school; or when a school age child transfers from one school or school district to another school or school district;
(n) to a law enforcement authority to protect the legal interest of an insurance institution, agent, or insurance-support organization in preventing and prosecuting the perpetration of fraud upon them;
(o) to a grand jury or to a court of competent jurisdiction pursuant to a subpoena or subpoena duces tecum when that information is required for the investigation or prosecution of criminal wrongdoing by a health care provider relating to his or her or its provisions of health care services and that information is unavailable from any other source; provided, that any information so obtained is not admissible in any criminal proceeding against you;
(p) to the state board of elections pursuant to a subpoena or subpoena duces tecum when the information is required to determine your eligibility to vote by mail ballot and/or the legitimacy of a certification by a physician attesting to a voter's illness or disability;
(q) to certify the nature and permanency of your illness or disability, the date when you were last examined and that it would be an undue hardship for you to vote at the polls so that you may obtain a mail ballot;
(r) to the Medicaid fraud control unit of the attorney general's office for the investigation or prosecution of criminal or civil wrongdoing by a health care provider relating to his or her or its provision of health care services to then Medicaid eligible recipients or patients, residents, or former patients or residents of long term residential care facilities; provided, that any information obtained is not admissible in any criminal proceeding against you;
(s) to the state department of children, youth, and families pertaining to the disclosure of health care records of children in the custody of the department;
(t) to the foster parent or parents pertaining to the disclosure of health care records of children in the custody of the foster parent or parents; provided, that the foster parent or parents receive appropriate training and have ongoing availability of supervisory assistance in the use of sensitive information that may be the source of distress to these children;
(u) to the workers' compensation fraud prevention unit for purposes of investigation; or,
(v) to a probate court of competent jurisdiction, petitioner, respondent, and/or their attorneys, when the information is contained within a decision-making assessment tool that conforms to applicable state law.
South Carolina: We will not disclose your prescription drug information without first obtaining your consent, except in the following circumstances: (a) to transmit a prescription drug order as allowed by laws pertaining to the practice of pharmacy; (b) to communicate with licensed practitioners, pharmacists and other health care professionals who are providing or have provided services to you; (c) if you request informational material from a prescription drug or device manufacturer or vendor; (d) if needed to recall a defective drug or device or protect the health and welfare of an individual or the public; (e) where the release is mandated by other state or federal laws, a court order, or subpoena or regulations, including by not limited to accreditation or licensure requirements; (f) 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 your 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 devices and who is engaged in a specific investigation involving a designated person or drug; and (e) a government agency charged with the responsibility of providing medical care for you upon written request by an authorized representative of the agency requesting the information.
South Dakota: If you are a recipient of Medical Assistance, we will only use your information for purposes directly connected to administering the medical assistance program and we will not disclose your information without obtaining your approval.
Tennessee: 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) it is required by law; (c) the disclosure is to an authorized prescriber; or (d) to communicate a prescription order where necessary to: carry out prospective drug use review as required by law; assist prescribers in obtaining a comprehensive drug history on you; prevent abuse or misuse of a drug or device and the diversion of controlled substances; or provide a medication therapy management program or a quality assurance program.
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; (c) a health care provider from whom you receive or are seeking care; or (d) to the office of inspector general or the Medicaid fraud control unit with respect to an ongoing investigation; (e) in response to a subpoena issued by a court of competent jurisdiction. We will not sell your name and address or other identifying information for any purpose.
Texas: We will only release your confidential record to you, your agent, or to: (a) a practitioner or another pharmacist if, in the our professional judgment, it is necessary to protect your health and well-being; (b) the pharmacy board or another state or federal agency authorized by law to receive it; (c) a law enforcement agency engaged in investigation of a suspected violation of the controlled substances laws, or the Comprehensive Drug Abuse Prevention and 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 payer authorized by you to receive the information.
Utah: We will not release or discuss information in your prescription or medication profile to anyone except to: (a) you; (b) your legal guardian or designee; (c) a lawfully authorized federal, state, or local drug enforcement officer; (d) a third party payment program authorized by you; (e) another pharmacist, pharmacy intern, pharmacy technician, or prescribing practitioner providing services to you or to whom you have requested us transfer a prescription; (f) your attorney, with a written authorization signed before a notary public by either you, your lawful guardian, or if you are a minor, your parent; or your personal representative, if you are deceased. We may submit your personally identifiable information to state databases to determine if you are eligible for Medicaid or the Children's Health Insurance Program.
Vermont: Unless we have your consent or a court order, we will not disclose your information or the nature of services rendered to you, except to the following persons: (a) you; (b) your agent; (c) another pharmacist acting on your behalf; (d) the practitioner who issued the prescription drug order; (e) certified or licensed health care personnel who are responsible for your care; (f) a Board of Pharmacy or federal, state, county, or municipal officer that enforces state or federal law relating to drugs or devices, pursuant to an investigation of a designated drug or person; or (g) a government agency responsible for providing medical care for you, upon a written request by an authorized agency representative.
Washington: Unless you authorize us, we will not disclose your health care information, except if the recipient needs to know the information and the disclosure is: (a) to a person who the pharmacist reasonably believes is providing health care to you; (b) to any other person who requires health care information for healthcare education, or to provide planning, quality assurance, peer review, or administrative, legal, financial, or actuarial services to the pharmacy; or for assisting the pharmacy in the delivery of health care and the pharmacist reasonably believes that the person will not use or disclose the health care information for any other purpose and will take appropriate steps to protect the health care information; (c) to any other health care provider reasonably believed to have previously provided health care to you, to the extent necessary to provide health care to you, unless you have instructed the pharmacy in writing not to make the disclosure; (d) to any person if the pharmacist reasonably believes that disclosure will avoid or minimize an imminent danger to your or another individual's health or safety, however there is no obligation on the part of the pharmacist to so disclose; (e) to your immediate family members, or any other individual with whom you have a close personal relationship, if made in accordance with good medical or other professional practice, unless you have instructed us in writing not to make the disclosure; (f) to a health care provider who is the successor in interest to the pharmacy; (g) to a person who obtains information for purposes of an audit, if that person agrees in writing to remove or destroy, at the earliest opportunity consistent with the purpose of the audit, information that would enable you to be identified and not to disclose the information further, except to accomplish the audit or report unlawful or improper conduct involving fraud in payment for health care by a health care provider or patient, or other unlawful conduct by the pharmacy; (h) to an official of a penal or other custodial institution in which you are detained; or (i) to provide directory information, unless you have instructed the pharmacy not to make the disclosure.
We will not disclose any information regarding an individual's treatment for a sexually transmitted diseases, 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.
West Virginia: We will not disclose confidential information relating to you if you are obtaining or have obtained treatment for a mental illness, except in the following circumstances: (a) with your (or your legal guardian’s) signed, written; (b) in certain proceedings involving involuntary examinations; (c) if a court orders us to disclose the information; (d) to notify the National Instant Criminal Background Check System; (e) to protect against clear and substantial danger of imminent injury by you to yourself or to another person; or (f) to staff of the mental health facility where you are being cared for or to other health professionals involved in your treatment, for treatment or internal review purposes.
Wyoming: We will only disclose your confidential information to: (a) you; (b) another person you direct us to disclose the information to; (c) practitioners and other pharmacists where, in our pharmacist's professional judgment we think it is necessary to treat or protect you; (d) such other persons or governmental agencies authorized by law to investigate controlled substance law violations; (e) your third party payer; (f) your agent; or (g) if you are a minor, your parent or guardian