Effective: December 1, 2020
Privacy Officer: Ryan Phillips, 1406 McGavock Pike #A, Nashville, TN 37216
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.As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, Riverside Village Pharmacy has created this Notice of Privacy Practices (Notice). This Notice describes Riverside Village Pharmacy’s privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected Health Information (PHI). Your PHI is information about you, or that could be used to identify you, as it relates to your past and present physical and mental health care services.
HIPAA regulations require that Riverside Village Pharmacy protect the privacy of your PHI that Riverside Village Pharmacy has received or created. Riverside Village Pharmacy will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below (Including Marketing and Selling of PHI), Riverside Village Pharmacy will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at any time, as explained in more detail below.
Riverside Village Pharmacy reserves the right to change the Riverside Village Pharmacy’s privacy practices and this Notice.The following is an accounting of the ways that the Riverside Village Pharmacy is permitted, by law, to use and disclose your PHI.
Uses and disclosures of PHI for Treatment:We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care.
Uses and disclosures of PHI for Payment:Riverside Village Pharmacy will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.
Uses and disclosures of PHI for Health Care Operations:Riverside Village Pharmacy may use the minimum necessary amount of your PHI to conduct quality assessments, improvement activities, and evaluate Riverside Village Pharmacy workforce.
The following is an accounting of additional ways in which Riverside Village Pharmacy is permitted or required to use or disclose PHI about you without your written authorization.
Uses and disclosures as required by law:Riverside Village Pharmacy is required to use or disclose PHI about you as required and as limited by law.
Uses and disclosure for Public Health Activities:Riverside Village Pharmacy may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability. This includes the FDA so that it may monitor any adverse effects of drugs, foods, nutritional supplements and other products as required by law.
Uses and disclosure about victims of abuse, neglect or domestic violence:Riverside Village Pharmacy may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence.
Uses and disclosures for health oversight activities:Riverside Village Pharmacy may use or disclose PHI about you to a health oversight agency for oversight activities which may include audits, investigations, inspections as necessary for licensure, compliance with civil laws, or other activities the health oversight agency is authorized by law to conduct.
Disclosures to Individuals Involved in your Care:Riverside Village Pharmacy may disclose PHI about you to individuals involved in your care.
Disclosures for judicial and administrative proceedings:Riverside Village Pharmacy may disclose PHI about you in the course of any judicial or administrative proceedings, provided that proper documentation is presented to Riverside Village Pharmacy.
Disclosures for law enforcement purposes:Riverside Village Pharmacy may disclose PHI about you to law enforcement officials for authorized purposes as required by law or in response to a court order or subpoena.
Uses and disclosures about the deceased:Riverside Village Pharmacy may disclose PHI about a deceased, or prior to, and in reasonable anticipation of individual’s death, to coroners, medical examiners, and funeral directors.
Uses and disclosures for cadaveric organ, eye or tissue donation purposes:Riverside Village Pharmacy may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.
Uses and disclosures for research purposes:Riverside Village Pharmacy may use and disclose PHI about you for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board. Otherwise, Riverside Village Pharmacy will request a signed authorization by the individual for all other research purposes.
Uses and disclosures to avert a serious threat to health or safety:Riverside Village Pharmacy may use or disclose PHI about you, if it believed in good faith, and is consistent with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.
Uses and disclosures for specialized government functions:Riverside Village Pharmacy may use or disclose PHI about you for specialized government functions including; military and veteran’s activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations.
Disclosure for workers’ compensation:Riverside Village Pharmacy may disclose PHI about you as authorized by and to the extent necessary to comply with workers’ compensation laws or programs established by law.
Disclosures for disaster relief purposes:Riverside Village Pharmacy may disclose PHI about as authorized by law to a public or private entity to assist in disaster relief efforts and for family and personal representative notification.
Disclosures to business associates:Riverside Village Pharmacy may disclose PHI about you to Riverside Village Pharmacy’s business associates for services that they may provide to or for Riverside Village Pharmacy to assist the Pharmacy to provide quality health care. To ensure the privacy of your PHI, we require all business associates to apply appropriate safeguards to any PHI they receive or create.
Riverside Village Pharmacy may contact you for the following purposes:
Information about treatment alternatives:Riverside Village Pharmacy may contact you to notify you of alternative treatments and/or products.
Health related benefits or services:Riverside Village Pharmacy may use your PHI to notify you of benefits and services the Riverside Village Pharmacy provides.
Fundraising:If Riverside Village Pharmacy participates in a fundraising activity, Riverside Village Pharmacy may use demographic PHI to send you a fundraising packet, or Riverside Village Pharmacy may disclose demographic PHI about you to its business associate or an institutionally related foundation to send you a fundraising packet. No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization. You will be provided with an opportunity to opt‐out of all future fundraising activities.
Riverside Village Pharmacy will obtain a written authorization from you for all other uses and disclosures of PHI, and Riverside Village Pharmacy will only use or disclose pursuant to such an authorization. In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact the PRIVACY OFFICER, to obtain a Request for Restriction of Uses and Disclosures
The following are a list of your rights in respect to your PHI. Please contact the PRIVACY OFFICER, for more information about the below.
Request restrictions on certain uses and disclosures of your PHI:You have the right to request additional Riverside Village Pharmacy’s uses and disclosures of your PHI; however, Riverside Village Pharmacy is not required to accommodate a request. This includes the right to restrict disclosures to Insurances for those products and services you pay out‐of‐pocket for.
The right to have your PHI communicated to you by alternate means or locations:You have the right to request that Riverside Village Pharmacy communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require Riverside Village Pharmacy to have an accurate address and home phone number in case of emergencies. Riverside Village Pharmacy will consider all reasonable requests.
The right to inspect and/or obtain a copy of your PHI:You have the right to request access and/or obtain a copy of your PHI that is contained in Riverside Village Pharmacy for the duration Riverside Village Pharmacy maintains PHI about you. There may be a reasonable cost‐based charge for photocopying documents. You will be notified in advance of incurring such charges, if any.
The right to amend your PHI:You have the right to request an amendment of the PHI Riverside Village Pharmacy maintained about you, if you feel that the PHI Riverside Village Pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services (“HHS”), or their appropriate designee, to review such a denial.
The right to receive an accounting of disclosures of your PHI:You have the right to receive an accounting of certain disclosures of your PHI made by Riverside Village Pharmacy.
The right to receive additional copies of Riverside Village Pharmacy’s Notice of Privacy Practices:You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically.
Notification of Breaches:You will be notified of any breaches that have compromised the privacy of your PHI.
Riverside Village Pharmacy reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. Riverside Village Pharmacy will also post the revised version of the Notice in Riverside Village Pharmacy.
If you believe your privacy rights have been violated, you may file a complaint with Riverside Village Pharmacy and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with Riverside Village Pharmacy, please contact the PRIVACY OFFICER]. If you wish to file a complaint with the Secretary, please write to http://www.hhs.gov/ocr/office/about/rgn‐hqaddresses.html . Riverside Village Pharmacy will not take any adverse action against you as a result of your filing of a complaint.
If you have any questions on Riverside Village Pharmacy’s privacy practices or for clarification on anything contained within the Notice, please contact:
RIVERSIDE VILLAGE PHARMACYRyan Phillips, Privacy Officer 1406 McGavock Pike #A, Nashville, TN 37216Tel: (615) 650-444
©[copywrite] by Riverside Village Pharmacy.
©[copywrite] by Riverside Village Pharmacy.
1406 McGavock Pike #A, Nashville, TN 37216
