U.S. Pharmacy Notice of Privacy Practices
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.
I. Our Commitment to Your Privacy
The Great Atlantic & Pacific Tea Company, Inc. (“A&P”)
and its family of U.S. companies (all of which are sometimes
called “the Company”), including the pharmacies it operates
in its stores, is committed to protecting the privacy
of your Protected Health Information (“PHI”) that we receive
in accordance with federal and state privacy laws, as
well as the Company’s own privacy policies, practices
and procedures. The Company is required by law to provide
(or to have its pharmacies provide) individuals with notice
of its legal duties and privacy practices with respect
to PHI. PHI is information about you, including basic
demographic information, that may identify you and that
relates to your past, present or future physical or mental
health or condition and related health care services.
This Notice of Privacy Practices (“Notice”) describes
how the Company’s pharmacies (and certain related areas
within the Company) may use and disclose PHI to carry
out treatment, payment, or health care operations and
for other specified purposes that are permitted or required
by law. This Notice also describes your rights with respect
to PHI about you. To help you better understand this Notice,
please note the following: (1) whenever this Notice uses
the word “Pharmacy” or “Pharmacies”, it means one or more
of the pharmacies that the Company operates in its stores;
(2) whenever this Notice uses the word “we”, “us” or “our”,
it means the Pharmacies and certain groups within the
Company that are involved in Pharmacy operations in certain
ways.
We are required to follow the terms of this Notice. We
will not use or disclose PHI about you without your written
authorization, except as described in this Notice.
II. Changes to this Notice
We reserve the right to revise, change, or amend our
practices and this Notice and to make the new Notice effective
for all PHI that we already have about you, as well as
any of your PHI that we may receive, create, or maintain
in the future. We will post a copy of our current Notice
in a prominent location, and you may request a paper copy
of our current Notice from us. We will also post our Notice
on our web site at www.aptea.com
and will post links from the web sites for the Company’s
different banners to the Company web site.
III. Your Health Information Rights
You have the following rights with respect to PHI about
you:
Obtain a paper copy of the Notice upon request.
You may request a copy of the Notice at any time. Even
if you have agreed to receive the Notice electronically,
you are still entitled to a paper copy. To obtain a paper
copy, simply stop by your local Pharmacy to pick up a
copy, or by sending a written request to the Company’s
Privacy Officer addressed as follows: The Great Atlantic
& Pacific Tea Company, Inc., Attn.: Privacy Officer, 2
Paragon Drive, Montvale, New Jersey 07645, or a different
address that the Company may designate at a later date
(the Notice Address).
Request a restriction on certain uses and
disclosures of PHI. You have the right to
request additional restrictions on our use or disclosure
of PHI about you by sending a written request to the Company’s
Privacy Officer addressed to the Notice Address. Please
clearly and concisely identify: (i) the information you
wish to be restricted; (ii) how you want the information
restricted; and (iii) to whom you want the limits to apply.
We are not required to agree to those restrictions. However,
if we do agree, we will comply with the restrictions,
except to the extent when otherwise required by law, in
emergencies, or when the information is necessary to treat
you.
Inspect and obtain a copy of PHI.
You have the right to access and copy PHI about you that
may be used to make decisions about you - a “designated
record set” - for as long as Waldbaum's Pharmacy maintains the
PHI. The designated record set usually will include prescription
and billing records. To inspect or copy PHI about you,
you must send a written request to the Company’s Privacy
Officer at the Notice Address that is provided in section
VII of this Notice. We may charge you a fee for the costs
associated with copying and mailing your request. We may
deny your request to inspect and copy in certain limited
circumstances. If you are denied access to PHI about you,
you may request that the denial be reviewed by sending
a written request to the Company’s Privacy Officer at
the Notice Address.
Request an amendment of PHI.
If you feel that PHI we maintain about you is incomplete
or incorrect, you may request that we amend it. You may
request an amendment for as long as we maintain the PHI.
To request an amendment, you must send a written request
to the Company’s Privacy Officer at the Notice Address.
You must include a reason that supports your request.
In certain cases, we may deny your request for amendment.
If we deny your request for amendment, you have the right
to file a statement of disagreement with the decision
by sending your statement to with the Privacy Officer
at the Notice Address, and we may give a rebuttal to your
statement.
Receive an accounting of disclosures of PHI.
You have the right to receive an accounting of the disclosures
we have made of PHI about you after April 14, 2003 for
certain purposes. The accounting will exclude certain
uses and disclosures, such as those made for treatment,
payment, or healthcare operations, disclosures made directly
to you, disclosures you authorize, and disclosures to
friends or family members involved in your care. The right
to receive an accounting is subject to certain other exceptions,
restrictions, and limitations. To request an accounting,
you must submit a request in writing to the Company’s
Privacy Officer at the Notice Address. Your request must
specify the time period, but may not be longer than six
years. The first accounting you request within a 12 month
period will be provided free of charge, but you may be
charged for the cost of providing additional accountings.
We will notify you of the cost involved and you may choose
to withdraw or modify your request at that time.
Confidential communications.
You have the right to request that we communicate with
you about your health and related issues in a particular
manner, or at a certain location. For instance, you may
request that we contact you about medical matters only
in writing, rather than by telephone, or at work, rather
than at home. To request confidential communication of
PHI about you, you must submit a request in writing to
the Company’s Privacy Officer at the Notice Address. Your
request must state how or where you would like to be contacted,
but you do not need to provide a reason for your request.
We will accommodate all reasonable requests.
IV. Examples of How We May Use and Disclose PHI
The following are descriptions and examples of ways we
will, or may, use and disclose your PHI. Please note that
each particular use or disclosure is not listed below.
However, the different ways that we are permitted to use
and disclose your PHI fall within one of the categories
listed in this section.
We will use PHI for treatment.
Example: Information obtained by the pharmacist
will be used to dispense prescription medications to you.
We may request information from the prescribing physician
or another physician to whom we are referred by the prescribing
physician. In addition, we will document in your record
information related to the medications dispensed to you
and services provided to you.
We will use PHI for payment.
Example: We will contact your insurer or pharmacy
benefit manager to determine whether it will pay for your
prescription and the amount of your co-payment. We will
bill you or a third-party payor for the cost of prescription
medications dispensed to you. The information on or accompanying
the bill may include information that identifies you,
as well as the prescriptions you are taking.
We will use PHI for health care operations.
Example: We may use information in your health
record to monitor the performance of the pharmacists providing
treatment to you, or to conduct cost-management and business
planning activities. This information will be used in
an effort to improve the quality and/or effectiveness
of the health care services and products that we provide.
Business associates: We
may share your PHI with certain business associates that
perform services for us through contracts that we have
with them. Examples include any company that we engage
to administer any of our prescription drug benefit programs,
to process health benefit claims and/or payments, process
Medicare claims, maintain or service the computer systems
that process any such types of data or store PHI. When
these services are contracted for, we may disclose PHI
about you to a business associate so that the business
associate can perform the job we have asked it to do and
bill you or your third-party payor for services rendered.
To protect PHI about you, we require the business associate
to safeguard appropriately the PHI.
Communication with individuals involved
in your care or payment for your care: Our
pharmacists, using their professional judgment, may disclose
to a family member, other relative, close personal friends
or any person you identify, PHI relevant to that person’s
involvement to your care or to payment related to your
care.
Health-related communications:
We may use or disclose your PHI in order to communicate
with you, by telephone or otherwise, about a product or
service related to your treatment (such as prescriptions
and refill reminders), or to help coordinate or manage
your care, or to direct or recommend treatment alternatives,
therapies, providers, settings of care, or other health-related
benefits and services that may be of interest to you.
Food and Drug Administration (FDA):
We may disclose to the FDA, or persons under the jurisdiction
of the FDA, PHI relative to adverse events with respect
to drugs, foods, supplements, products and product defects,
or post-marketing surveillance information to enable product
recalls, repairs, or replacement.
Worker’s compensation: We
may disclose PHI about you as authorized by, and as necessary
to comply with, laws relating to worker’s compensation
or similar programs established by law.
Public health: As required
by law, we may disclose PHI about you to public health
or legal authorities charged with preventing or controlling
disease, injury, or disability. Law enforcement: We may
disclose PHI about you for law enforcement purposes as
required by law or in response to a valid subpoena or
other legal process.
As required by law: We must
disclose PHI about you when required to do so by law.
Health oversight activities:
We may disclose PHI about you to an oversight agency for
activities authorized by law. These oversight activities
can include, for example, audits, investigations, and
inspections, as necessary for our licensure and for the
government to monitor government programs, compliance
with civil rights laws, and the health care system in
general.
Judicial and administrative proceedings:
If you are involved in a lawsuit or a dispute, we may
disclose PHI about you in response to a court or administrative
order. We may also disclose PHI about you in response
to a subpoena, discovery request, or other lawful process
by someone else involved in the dispute, but only if efforts
have been made to tell you about the request or to obtain
an order protecting the requested PHI.
Coroners, medical examiners, and funeral
directors: We may release PHI about you to
a coroner or medical examiner. This may be necessary,
for example, to identify a deceased person or determine
the cause of death. We may also disclose PHI to funeral
directors consistent with applicable law to carry out
their duties.
Notification: We may use
or disclose PHI about you to notify, or assist in notifying,
a family member, personal representative, or another person
responsible for your care, of your location and your general
condition.
Correctional institution:
If you are or become an inmate of a correctional institution,
we may disclose PHI to the institution or law enforcement
officials when necessary to provide health services to
you, for the safety and security of the institution, and/or
to protect your health and safety or the health and safety
of others.
To avert a serious threat to health or
safety: We may use and disclose PHI about
you when necessary to reduce or prevent a serious threat
to your health and safety or the health and safety of
the public or another person.
Military and veterans: If
you are a member of the armed forces, we may release PHI
about you as required by military command authorities.
We may also release PHI about foreign military personnel
to the appropriate military authority.
National security and intelligence activities:
We may release PHI about you to authorized federal officials
for intelligence, counterintelligence, and other national
security activities authorized by law.
Protective services for the President
and others: We may disclose PHI about you
to authorized federal officials so they may provide protection
to the President, other authorized persons or foreign
heads of state, or to conduct special investigations.
Victims of abuse, neglect, or domestic
violence: We may disclose PHI about you to
a government authority, such as a social service or protective
services agency, if we reasonably believe you are a victim
of abuse, neglect, or domestic violence. We will only
disclose this type of information to the extent required
by law, if you agree to the disclosure, or if the disclosure
is allowed by law and we believe it is necessary to prevent
serious harm to you or someone else, and if the law enforcement
or public official that is to receive the report represents
that it is necessary and will not be used against you.
V. Authorization for Other Uses and Disclosures
of PHI
We will obtain your written authorization before using
or disclosing PHI about you for purposes other than those
provided for above or as otherwise permitted or required
by law. You may revoke an authorization in writing at
any time. Upon receipt of the written revocation, we will
stop using or disclosing PHI about you, except to the
extent that we have already taken action in reliance on
the authorization. However, please note that we may be
required by applicable law to retain certain PHI about
you, particularly regarding the provision of health care
services and products.
VI. For More Information or to Report a Problem
If you have questions or would like additional information
about the Waldbaum's Pharmacy’s privacy practices, you may contact
the Company’s Privacy Officer at privacyofficer@aptea.com
or at the Notice Address. If you believe your privacy
rights have been violated, you can file a written complaint
with the Company’s Privacy Officer at the Notice Address
or with the Secretary of the federal Department of Health
and Human Services. There will be no retaliation for filing
a complaint.
VII. Notice Address
Please send all correspondence, requests, questions and
complaints related to the permitted or required uses and
disclose of your PHI by the Company and your rights with
respect to your PHI to the following address (Notice Address)
in written form:
VIII. Effective Date
This Notice is effective as of April 14, 2003.
The following is a summary of state laws in those states
where the Company currently operates pharmacies that are
more stringent than the Privacy Rule and/or the Company
policies and practices described in this Notice. Each
Company pharmacy located in any of the states listed below
will comply with the more stringent laws of the state
where that pharmacy is located, as set forth below:
CONNECTICUT
Except as otherwise permitted by applicable law, we will
not disclose information about pharmaceutical services
rendered to you to third parties without your consent,
except to the following persons:
-
the prescribing practitioner or a pharmacist or another
prescribing practitioner presently treating you when
deemed medically appropriate;
- a nurse who is acting as an agent for a prescribing
practitioner that is presently treating you or a nurse
providing care to you in a hospital;
- third party payors who pay claims for pharmaceutical
services rendered to you or who have a formal agreement
or contract to audit any records or information in connection
with such claims;
- any governmental agency with statutory authority to
review or obtain such information;
- any individual, the state or federal government or
any agency thereof or court pursuant to a subpoena;
and
- any individual, corporation, partnership or other
legal entity which has a written agreement with the
pharmacy to access the pharmacy’s database provided
the information accessed is limited to data which does
not identify specific individuals.
Except as otherwise permitted by applicable law, and
except in connection with the sale or merger of a pharmacy
business, we will not sell your individually identifiable
medical record information.
MICHIGAN
We will not disclose HIV- or AIDS-related information
about an individual except in situations where the subject
of the information has provided us with a written authorization
allowing the release, or where we have removed any information
that identifies the individual from the material to be
disclosed (unless the identifying information is reasonably
necessary to prevent further transmission of such disease),
or where we are authorized or required by state or federal
law to make the disclosure.
NEW JERSEY
Except as permitted under applicable law, we will not
disclose HIV- or AIDS-related information health information
that identifies the individual who is the subject of such
information.
NEW YORK
We will not access a common electronic file or database
used to maintain required personally identifiable dispensing
information except upon your, or your agent’s, express
request.
We will not disclose confidential HIV-related information
(including confidential HIVrelated information that has
been disclosed to us), except as follows:
-
To the extent such disclosure is authorized or otherwise
permitted by law
- To the individual
- To the individual’s foster parent, or prospective
adoptive parent
- To health care providers, when necessary to provide
appropriate treatment
- To a person who is authorized to consent to health
care on the patient’s behalf (and as necessary to notify
health care providers who have been exposed to the risk
of infection)
- To a funeral director in the ordinary course of business
- To a law guardian of a minor, for representing the
minor
- To a governmental agency that regulates, supervises
or monitors us or our agents
- To the extent we have received a specific authorization
to make such disclosure
- To certain of our agents who maintain or process medical
or billing records for reimbursement
- To third party reimbursers or their agents to the
extent necessary for reimbursement, provided that, if
the disclosure is for any purpose other than reimbursement,
such disclosure has been authorized.
Except as permitted under applicable law, we will not
disclose HIV-related information in accordance with a
subpoena, although we may disclose such information in
accordance with a court order, if an adequate showing
of necessity is made to such court
OHIO
Except as permitted under applicable law, we will not
disclose your pharmacy records or the individually identifiable
health information contained therein, except to:
-
you the prescriber who issued the prescription or
medication order;
- certified/licensed health care personnel who are responsible
for your care;
- a member, inspector, agent, or investigator of the
state board of pharmacy or any federal, state, county,
or municipal officer whose duty is to enforce the laws
of this state or the United States relating to drugs
and who is engaged in a specific investigation involving
a designated person or drug;
- an agent of the state medical board when enforcing
the statutes governing physicians and limited practitioners;
- an agency of government charged with the responsibility
of providing medical care for you, upon a written request
by an authorized representative of the agency requesting
such information;
- an agent of a medical insurance company who provides
prescription insurance coverage to you, upon authorization
and proof of insurance by you or proof of payment by
the insurance company for those medications whose information
is requested;
- an agent who functions as a “business associate” with
the pharmacy in accordance with the regulations promulgated
by the secretary of the United States department of
health and human services pursuant to the federal standards
for privacy of individually identifiable health information;
or
- in emergency situations, when it is in your best interest.
WISCONSIN
Except as permitted under applicable law, we will not
disclose your prescription records to anyone other than
you or someone authorized by you without first obtaining
your written informed consent.
|
