Summary of Notice of Privacy Practices

Effective July 1, 2005

This summary is provided to assist you in understanding our full Notice of Privacy Practices.

The full Notice of Privacy Practices contains a detailed description of how our office will protect your health care information, your rights as a patient and our common practices in dealing with patient health information. Please refer to that Notice for further information.

Uses and Disclosures of Health Information

We will use and disclose your health information in order to obtain payment for services rendered to you by our Pharmacy or to allow insurance companies to process insurance claims for services rendered to you. Finally, we may disclose your health information for certain operational activities such as quality assessment, licensing, accreditation and training.

Uses and Disclosures Based on Your Authorization

Except as stated in more detail in the Notice of Privacy Practices, we will not use or disclose your health information without your written authorization.

Uses and Disclosures Not Requiring Your Authorization

In the following circumstances, we may disclose your health information without your written authorization.

Payment
Health Care Operations
For certain limited research purposes;
To government agencies for purposes of their audits, investigations and other oversight activities;
To government authorities to prevent child abuse or domestic violence;
To law enforcement authorities to protect public safety or to assist in apprehending criminal offenders;
When required by court orders, search warrants, subpoenas and as otherwise required by law.

Patient Rights*

To have access to and/or a copy of your health information;
To receive an accounting of certain disclosures we have made of your health information;
To request restrictions as to how your health information is used or disclosed;
To request that we communicate with you in confidence;
To request that we amend your health information;
To receive notice of our privacy practices.

*Normally your requests will be made directly to your health care provider. If you have a question, concern or complaint regarding our privacy practices, please refer to the full Notice of Privacy Practices for the person or persons whom you may contact.