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Privacy Statement

NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.

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.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated
Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds
Our Uses and Disclosures

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do evaluation and research
  • Comply with the law
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions
Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete.

Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us using the information on page 1.

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling +1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.
Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures

How do we typically use or share your health information?
We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety
Do research
  • We can use or share your information for health research.
Comply with the law
  • We will share information about you if state or federal laws require it, including the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
  • Limit the access to your individually identifiable health information collected by the pharmacy only to those staff members with a need to access the information for conducting the functions stated above.

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available upon request, in our office, and on our website.
If you need any additional information about this Notice or wish to exercise any of your rights set forth in this Notice, please contact Express Specialty Pharmacy’s Compliance Officer at the following address:


1 Royal Heights Center
Belleville, Illinois 62226

Telephone: 1-833-797-9791
Fax: 1-833-797-9792 www.exspecialty.com


PATIENT BILL OF RIGHTS AND RESPONSIBILITIES

Patient Rights

You have the right to:

  1. Receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance will be provided so you can make informed health care decisions.
  2. A choice of health care providers (pharmacies) that is sufficient to provide you with access to appropriate high-quality health care.
  3. Know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.
  4. Considerate, respectful, and non-discriminatory care from your doctors, health plan representatives, and other health care providers.
  5. Talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medication record and request that your record be amended if it is not accurate, relevant, or complete.
  6. Have your property and person treated with respect, consideration, and recognition of patient dignity and individuality.
  7. Be informed, both orally and in writing, in advance of care being provided, of the charges, including payment for care/service expected from third parties, and any charges for which the patient will be responsible.
  8. Receive information about the scope of services that the organization will provide and specific limitations on those services.
  9. To know about the philosophy, characteristics and eligibility criteria of the Patient Management Program.
  10. Be fully informed, in advance, about the care/service to be provided, including the health professionals and disciplines that will furnish the care and follow-up, frequency of interventions, as well as any modifications to the plan of care.
  11. To identify the staff member of the program and their job title, and to speak with a supervisor of the staff member, if requested.
  12. Speak to a health care professional.
  13. Receive information about a clinical program offered by the pharmacy, e.g. Patient Management Program.
  14. Participate in the development and periodic revision of the patient’s plan of care.
  15. Refuse care or treatment after the consequences of refusing care or treatment are fully presented.
  16. Decline participation, revoke consent or cease to participate from the program at any point in time.
  17. Be informed of patient rights under state law to formulate an Advance Directive, if applicable.
  18. To be able to identify visiting staff members through proper identification.
  19. Be free from mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of an unknown source, and misappropriation of patient property.
  20. Voice complaints regarding treatment of care, lack of respect of property or recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or retaliation.
  21. Confidentiality and privacy of all information contained in the patient record and of Protected Health Information (PHI).
  22. Be advised on Express Specialty Pharmacy policies and procedures regarding disclosure of clinical records.
  23. To have personal health information shared with other healthcare providers only in accordance with state and federal law.
  24. Be informed of financial benefits, when referred to another organization for service.
  25. Receive administrative information regarding changes in or termination of clinical programs including, but not limited to, the Patient Management Program; and
  26. Be fully informed of one’s responsibilities.
Patient Responsibilities

You have the responsibility:

  1. To give accurate clinical and contact information, and to notify the pharmacy of any changes;
  2. To submit any forms or information that are necessary to obtain needed services or participate in a clinical program as required by law;
  3. Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet;
  4. Become involved in your health care decisions;
  5. To notify their treating provider of their participation in clinical programs offered by the pharmacy including, but not limited to, the Patient Management Program;
  6. Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans;
  7. Disclose relevant information regarding medications and medical history to your pharmacist;
  8. Clearly communicate your wants and needs regarding your pharmaco-therapeutic regimen and management;
  9. Become an active participant in achieving compliance and adherence to your medication regimen;
  10. Use the health plan’s internal complaint and appeal process to address concerns that may arise, should you not receive an adequate and appropriate response from Express Specialty Pharmacy;
  11. Avoid knowingly spreading disease;
  12. Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional;
  13. Be aware of a health care provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community;
  14. Become knowledgeable about your health plan coverage and health plan options (when available) including all covered benefits, limitations and exclusions, rules regarding the use of information, and the process to appeal coverage decisions;
  15. Show respect for other patients and health workers;
  16. Make a good-faith effort to meet financial obligations; and
  17. Abide by administrative and operational procedures of the health plans and health care providers.