Notice of Privacy Practices
Effective Date: January 1, 2025
RxVIP Concierge Quality Pharmacy 1601 S. Congress Ave. Delray Beach, FL 33445 Phone: (561) 272-0015 Email: info@rxvip.com
Your Rights
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.
Who Will Follow This Notice
This Notice of Privacy Practices describes how RxVIP Concierge Quality Pharmacy may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations, and for other purposes permitted or required by law. It also describes your rights to access and control your protected health information.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your protected health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this Notice while it is in effect.
This Notice takes effect January 1, 2025, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all protected health information that we maintain, including protected health information we created or received before we made the changes.
Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.
Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other than as stated below, we will not disclose your health information other than with your written authorization. You may revoke your authorization in writing at any time. If you revoke your authorization, we will not make any further uses or disclosures of your health information under that authorization, unless we have already taken action in reliance on your authorization.
Uses and Disclosures of Protected Health Information for Treatment, Payment, and Health Care Operations
We may use or disclose your protected health information (PHI) for treatment, payment, and health care operations purposes without your authorization. To help clarify these terms, here are some definitions:
Treatment: We may use or disclose your PHI to provide you with medication and pharmacy services. For example, we may use your PHI to fill your prescriptions, provide medication therapy management, conduct drug utilization reviews, or coordinate your care with your physicians and other healthcare providers.
Payment: We may use and disclose your PHI to obtain payment for services we provide to you. For example, we may disclose your PHI to your health insurance plan to obtain payment for prescription medications or pharmacy services.
Healthcare Operations: We may use and disclose your PHI to support the business activities of our pharmacy. For example, we may use your PHI to conduct quality assessment and improvement activities, conduct or arrange for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs.
Uses and Disclosures That Can Be Made Without Your Authorization
We may use or disclose your PHI without your authorization in the following circumstances:
As Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is required by law.
Public Health: We may disclose your PHI for public health activities and purposes, such as reporting adverse events or product defects to the FDA, reporting disease/injury, reporting child abuse or neglect, or reporting domestic violence.
Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
Judicial and Administrative Proceedings: We may disclose your PHI in the course of any judicial or administrative proceeding in response to a court order or lawful subpoena.
Law Enforcement: We may disclose your PHI for law enforcement purposes in response to a law enforcement official's request, such as to identify or locate a suspect, fugitive, material witness, or missing person.
Decedents: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.
Research: We may disclose your PHI 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 PHI.
Serious Threat to Health or Safety: We may use or disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Business Associates: We may disclose your PHI to our business associates who perform functions on our behalf or provide us with services if the PHI is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Military: If you are a member of the armed forces, we may release your PHI as required by military command authorities.
Workers' Compensation: We may release your PHI for workers' compensation or similar programs.
Marketing: We will not use your PHI for marketing purposes or sell your PHI without your written authorization. We may contact you to refill your prescriptions or provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Your Rights Regarding Your Protected Health Information
You have the following rights regarding your PHI:
Right to Inspect and Copy
You have the right to inspect and copy your PHI that may be used to make decisions about your care or payment for your care. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
To inspect and copy your medical information, you must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to your medical information, in most cases, you may request that the denial be reviewed.
Right to Amend
If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice.
To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
- Is not part of the medical information kept by or for the practice
- Is not part of the information which you would be permitted to inspect and copy
- Is accurate and complete
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of your PHI for purposes other than treatment, payment, and healthcare operations.
To request this list or accounting of disclosures, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists within the same 12-month period, we may charge you for the costs of providing the list.
Right to Request Restrictions
You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request unless the disclosure is to a health plan for purposes of carrying out payment or healthcare operations and the PHI pertains solely to a healthcare item or service for which you, or someone on your behalf, has paid us in full out-of-pocket.
To request restrictions, you must make your request in writing to our Privacy Officer. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure or both, and to whom you want the limits to apply.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
To obtain a paper copy of this notice, contact our Privacy Officer.
Changes to This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the pharmacy. The notice will contain the effective date on the first page.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
To file a complaint with our practice, contact:
Privacy Officer RxVIP Concierge Quality Pharmacy 1601 S. Congress Ave. Delray Beach, FL 33445 Phone: (561) 272-0015 Email: info@rxvip.com
To file a complaint with the Department of Health and Human Services:
Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Phone: 1-877-696-6775 Website: www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be penalized or retaliated against for filing a complaint.
Contact Information
If you have any questions about this Notice or want to request a form to exercise your rights, please contact:
Privacy Officer RxVIP Concierge Quality Pharmacy 1601 S. Congress Ave. Delray Beach, FL 33445 Phone: (561) 272-0015 Email: info@rxvip.com
Acknowledgment of Receipt
I acknowledge that I have been provided with a copy of RxVIP Concierge Quality Pharmacy's Notice of Privacy Practices.
Patient Name: ___________________________
Signature: ______________________________
Date: ___________________________________
This Notice of Privacy Practices complies with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, 45 CFR Parts 160 and 164.