Notice of Privacy Practices

Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSEDAND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Bayn Lab will ask you to sign an Acknowledgement that you have received this Notice of Privacy Practices (Notice). This Notice describes how Bayn Lab may use and disclose your protected health information in accordance with the HIPAA Privacy Rule. It also describes your rights and Bayn Lab’s duties with respect to protected health information about you. Section A: Uses and Disclosures of Protected Health Information
1.Treatment, Payment and Health Care Operationsa.We will use your health information to provide treatment. This may involve receiving or sharinginformation with other health care providers such as your physician. This information may bewritten, verbal, electronic or via facsimile. This will include receiving prescription orders so thatwe may dispense prescription medications. We may also share information with other healthcare providers who are treating you to coordinate the different things you need, such asmedications, lab work or other appointments. We may also contact you to provide treatment-related services, such as refill reminders, treatment alternatives and other health related servicesthat may be of benefit to you.b.We will use your health information to obtain payment. This will include sending claims forpayment to your insurance or third-party payer. It may also include providing health informationto the payer to resolve issues of claim coverage.c.We will use your health information for our health care operations necessary to run thepharmacy. This may include monitoring the quality of care that our employees provide to youand for training purposes.2.Permitted or Required Uses and Disclosuresa.Our pharmacists, using their professional judgment may disclose your protected healthinformation to a family member, other relative, close personal friend or other person you identifyas being involved in your health care. This includes allowing such persons to pick up filledprescriptions, medical supplies or medical records on your behalf.b.We also have contracts with entities called Business Associates that perform some services for usthat require access to your protected health information. Examples may include companies thatroute claims to your insurance company or that reconcile the payments we receive from yourinsurance. We require our Business Associates to safeguard any protected health informationappropriately.c.Under certain circumstances Bayn Lab may be required to disclose health information as requiredor permitted by federal or state laws. These include, but are not limited to:i.To the Food and Drug Administration (FDA) relating to adverse events regarding drugs,foods, supplements and other health products or for post-marketing surveillance toenable product recalls, repairs or replacement.ii.To public health or legal authorities charged with preventing or controlling disease,injury or disability.iii.To law enforcement agencies as required by law or in response to a valid subpoena orother legal process.
PAAS National® provides this HIPAA template to help to facilitate the efficiency of your pharmacy’s FWAC/HIPAA program and attests that good faith efforts are
conducted at all times to provide accurate, timely and complete HIPAA templates. PAAS National® makes no representations, warranties or guarantees to the
accuracy of this service or such information provided. Your pharmacy is solely responsible for compliance with FWAC and HIPAA requirements.
iv.To health oversight agencies (e.g., licensing boards) for activities authorized by law suchas audits, investigations and inspections necessary for Bayn Lab’s licensure and formonitoring of health care systems.v.In response to a court order, administrative order, subpoena, discovery request orother lawful process by another person involved in a dispute involving a patient, butonly if efforts have been made to tell the patient about the request or to obtain anorder protecting the requested health information.vi.As authorized by and as necessary to comply with laws relating to worker’scompensation or similar programs established by the law.vii.Whenever required to do so by law.viii.To a Coroner or Medical Examiner when necessary. Examples include: identifying adeceased person or to determine a cause of death.ix.To Funeral Directors to carry out their dutiesx.To organ procurement organizations or other entities engaged in procurement, bankingor transplantation of organs for the purpose of tissue donation and transplant.xi.To notify or assist in notifying a family member, personal representative or anotherperson responsible for the patient’s care of the patient’s location or general condition.xii.To a correctional institution or its agents if a patient is or becomes an inmate of such aninstitution when necessary for the patient’s health or the health and safety of others.xiii.When necessary to prevent a serious threat to the patient’s health and safety or thehealth and safety of the public or another person.xiv.As required by military command authorities when the patient is a member of thearmed forces and to appropriate military authority about foreign military personnel.xv.To authorized officials for intelligence, counterintelligence and other national securityactivities authorized by law.xvi.To authorized federal officials so they may provide protection to the president, otherauthorized persons or foreign heads of state or to conduct special investigations.xvii.To a government authority, such as social service or protective services agency, if BaynLab reasonably believes the patient to be a victim of abuse, neglect or domestic violencebut only to the extent required by law, if the patient agrees to the disclosure or if thedisclosure is allowed by law and we believe it is necessary to prevent serious harm to thepatient or to someone else or the law enforcement or public official that is to receive thereport represents that it is necessary and will not be used against the patient.
3.Authorized Use and Disclosure
a.Use or disclosure other than those previously listed or as permitted or required by law, will notbe made unless we obtain your written Authorization in advance. You may revoke any suchAuthorization in writing at any time. Upon receipt of a revocation, we will cease using ordisclosing protected health information about you unless we have already taken action based onyour Authorization.
4.More Stringent Laws
a.Some states may have laws that are more stringent than HIPAA. Please refer to the end of theNotice for the laws that may apply.
Section B: Patient’s Rights
1.Restriction Requests
a.You have a right to request a restriction be placed on the use and disclosure of your protectedhealth information for purposes of carrying out treatment, payment or health care operations.
PAAS National® provides this HIPAA template to help to facilitate the efficiency of your pharmacy’s FWAC/HIPAA program and attests that good faith efforts are
conducted at all times to provide accurate, timely and complete HIPAA templates. PAAS National® makes no representations, warranties or guarantees to the
accuracy of this service or such information provided. Your pharmacy is solely responsible for compliance with FWAC and HIPAA requirements.
Restrictions may include requests for not submitting claims to your insurance or third-party payer or limitations on which persons may be considered personal representatives.
b.Bayn Lab is not required to accept restrictions other than payment related uses not required bylaw that have been paid in full by the individual or representative other than a health plan.c.If we do agree to requested restrictions, they shall be binding until you request that they beterminated.d.Requests for restrictions or termination of restrictions must be submitted in writing to the PrivacyOfficer listed in Section D of this Notice.
2.Alternative Means of Communicationa.You have a right to receive confidential communications of protected health information byalternate methods or at alternate locations upon reasonable request. Examples of alternativesmay be sending information to a phone or mailing address other than your home.b.Bayn Lab shall make reasonable accommodation to honor requests.c.Requests must be submitted in writing to the Privacy Officer listed in Section D of this Notice.3.Access to Health Informationa.You have a right to inspect and copy your protected health information. The designated recordset will usually include prescription and billing records. You have the right to request theprotected health information in the designated record set for as long as we maintain yourrecords.b.You have the right to request that your protected health information be provided to you in anelectronic format if available.c.Requests must be submitted in writing to the Privacy Officer listed in Section D of this Notice.d.Any costs or fees associated with copying, mailing or preparing the requested records will becharged prior to granting your request.e.Bayn Lab may deny your request for records in limited circumstances. In case of denial, you mayrequest a review of the denial for most reasons. Requests for review of a denial must also besubmitted to the Privacy Officer listed in Section D of this Notice.4.Amendments to Health Informationa.If you believe that your protected health information is incomplete or incorrect, you may requestan amendment to your records. You may request amendment to any records for as long as wemaintain your records.b.Requests must be submitted in writing to the Privacy Officer listed in Section D of this Notice.c.Requests must include a reason that supports the amendment to your health information.d.Bayn Lab may deny amendment requests in certain cases. In case of denial, you have the right tosubmit a Statement of Disagreement. We have the right to provide a rebuttal to your statement.5.Accounting of Uses and Disclosuresa.You have the right to request an accounting of uses and disclosures that are not for treatment,payment or health care operations. This accounting may include up to the six years prior to thedate of request and will not include an accounting of disclosures to yourself, your personalrepresentatives or anything authorized by you in writing. Other restrictions may apply asrequired in the Privacy Rule.b.Requests must be submitted in writing to the Privacy Officer listed in Section D of this Notice.c.The first accounting in any 12-month period will be provided to you at no cost. Any additionalrequests within the same 12-month period will be charged a fee to cover the cost of providing
PAAS National® provides this HIPAA template to help to facilitate the efficiency of your pharmacy’s FWAC/HIPAA program and attests that good faith efforts are
conducted at all times to provide accurate, timely and complete HIPAA templates. PAAS National® makes no representations, warranties or guarantees to the
accuracy of this service or such information provided. Your pharmacy is solely responsible for compliance with FWAC and HIPAA requirements.
the accounting. This fee amount will be provided to you prior to completing the request. You may choose to withdraw your request to avoid paying this fee.
6.Notice of Privacy Practices
a.You have a right to receive a paper copy of this Notice even if you previously agreed to receive acopy electronically.
b.Please submit a request to the Privacy Officer listed in Section D of this Notice.
Section C: Bayn Lab’s Duties Bayn Lab is required by law to maintain the privacy of protected health information, to provide individuals with notice of its legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. Bayn Lab is required to abide by the terms of this Notice. We reserve the right to change the terms of this Notice and to make the new notice provisions effective for all protected health information that we maintain. Any such revised Notice will be made available upon request. Section D: Contacting Us
1.Additional Questions, Submitting Requests or Complaintsa.If you have questions about this Notice or how Bayn Lab uses and discloses your protected health information please contact our Privacy Officer below.b.You may obtain forms needed for request submission from our pharmacy or from our Privacy Officer.c.If you believe your privacy rights have been violated you may file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint.
Section E: State Specific Requirements
Version # (2362806}-PAAS-2013-2.0
Effective Date
This Notice of Privacy Practices is effective as of {10/1/2013}