the For Good Health Group
Carnegie-Sargent’s Pharmacy, Inc.
Integrated Health Care Systems, Inc.
Water Tower Nursing and Home Care, Inc.
NOTICE OF PRIVACY PRACTICES (“NOPP”)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
DATE OF NOTICE:
1. Introduction: Under applicable law, we are required to protect the privacy of your personal health information (“PHI”). We are also required to provide you with this NOPP to detail our policies and procedures regarding your PHI and to abide by the terms of this NOPP.
2. Primary Permitted Uses & Disclosures of PHI: We may obtain PHI to provide health care services and for the documentation of pertinent information in your records that may assist us in managing your health. We are permitted to utilize your PHI under applicable law for treatment, payment, and healthcare operations purposes.
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 healthcare providers, such as when one of our providers consults with another one of your chosen health care providers regarding your condition and/or current or proposed plan of care.
For payment purposes, such use and disclosure will take place to obtain or provide reimbursement for services, such as when your case is reviewed by your health plan 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, case managers, and computer switching companies.
For healthcare operations purposes, such use and disclosure will take place in a number of ways, including, but not limited to, quality assessment and improvement, provider review and training, compliance activities, and planning, development, management and administration of daily business operations.
3. Electronic Storage Use & Disclosure of PHI: We store some of your PHI in electronic computer files. We backup our electronic records daily and employ other precautions. In spite of these precautions, it is possible, but unlikely, that a technological failure could cause loss of data.
In addition, we may use your electronically stored PHI to contact you regarding refill reminders, notify you of health screenings, or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
4. Storage of Physical PHI Records: As requested by law, we also maintain physical records that contain your PHI. All physical records are stored in areas that are protected from outside parties and are accessed only for authorized purposes permitted in this NOPP.
5. Other Uses & Disclosures of PHI: 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 without your permission. As required by law, we enter into agreements with all business associates who have access to your PHI. Said agreements require all business associates to comply with all the privacy regulations on your behalf.
We may disclose PHI without your authorization to comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, health oversight activities, and as otherwise required by law
We may use your name to reference your patient care services. You may be required to sign a signature log to acknowledge receipt of health care product(s) or services, PHI, or to acknowledge receipt of this NOPP. PHI may be disclosed by us to other persons who ask for you or your prescriptions by name.
In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preferences, and what we determine to be in your best interest. We will inform you of any such uses or disclosures if uses and disclosures require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable.
Any other uses and disclosures will be made only with your written authorization, and you may revoke your authorization by notifying us as described below.
6. Other Patient Rights Regarding PHI: 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 honor your request.
You have the right to request the following with respect to your PHI: (i) inspection and copying; (ii) amendment or correction; (iii) an accounting of the disclosures of this information by us (although we are not required to account to you for disclosures listed in Sections 2,3, and 5 of this NOPP); and (iv) the right to receive a paper copy of this notice upon request. We may require you to pay for this request to cover our costs of copying, labor and postage.
In addition, 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 such a request, follow instructions listed below in Section 9.
7. Changes to the For Good Health Group’s NOPP: We reserve the right to change the terms of this NOPP and to make new NOPP provisions effective for all PHI we maintain. You may receive a copy of this NOPP by contacting us as outlined in Section 9 or upon the receipt of services.
8. If You Believe Your PHI Right’s Have Been Violated: If you believe that your privacy rights have been violated, you may complain to us as described in Section 9 of this NOPP, 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.
9. Contacting Us: You may contact us for further information regarding this NOPP, to file a complaint, or to make a request as described in this NOPP by writing to:
the For Good Health Group SM is comprised of: Carnegie-Sargent’s Pharmacy, Inc., Integrated Health Care Systems, Inc., Water Tower Nursing and Home Care, Inc., located at 845 North Michigan Avenue, Suite 902 West, Chicago, Illinois 60611.
For more information please call 312.280.1220.