MIDWEST LONG TERM CARE SERVICES, LLC d/b/a SENIOR SCRIPTS
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.
This Notice applies to all health records that we maintain for you. Information protected by this Notice includes information Senior Scripts receives or creates that identifies you and concerns: your past, present, or future physical or mental health or condition; the medical services you receive; or the past, present, or future payment for medical services you receive. We are required by law to maintain the confidentiality of your health information, to give you this Notice describing our practices and legal duties, to follow the terms of the current Notice, and to notify you if your unsecured protected health information has been breached. Senior Scripts understands that medical information about you and your health is personal. We are committed to protecting medical information about you in compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").
How We May Use and Disclose Your Medical Information:
Uses and Disclosures That Do Not Require Your Prior Authorization
Except where prohibited by federal or state laws that require special privacy protections, we may use and disclose your medical information for treatment, payment and health care operations without your prior authorization as follows:
Treatment: We may use medical information about you to provide you with medical treatment or services. For example, we may disclose medical information about you to pharmacists, doctors, nurses, technicians, or other personnel who are involved in taking care of you in order to dispense prescription medications to you or provide you with information and counseling on your drug therapy. Payment: We may use your medical information to verify your insurance coverage or to determine the amount of your co- payment responsibility. A bill and explanation of benefit will be sent to you, your insurer or other third party identified as a payer for your claim. We may disclose billing information to other health care providers involved in your care so that they have correct billing information. Health Care Operations: We may use your medical information for our health care operations. Health care operations are activities necessary for us to operate our health care business. For example, we may use your medical information to review the performance of our pharmacists and to develop compliance programs in order to offer more effective and comprehensive treatment to you. Contacting you: We may contact you via telephone or mail regarding your prescriptions or other matters. We may leave voice messages at the number you have provided us. Health Care Coordination, Related Services and Products: We may use or disclose your information to coordinate your care, and to advise you of alternative therapies, settings of care, or providers. We may use or disclose your information so that someone may contact you about services available at or through Senior Scripts. If you do not wish us to contact you about treatment alternatives or other health-related benefits or services, you must notify us in writing at the address at the bottom of this Notice. Business Associates: We may disclose your health information to certain third parties known as Business Associates who contract with us to perform certain services on our behalf. These third parties are obligated by law and by their contract to protect your medical information. Limited Data Sets and De-Identified Information: We may disclose some of your medical information as a ‘limited data set’ for use in research, certain public health purposes or for our operational needs. Information that does not identify you in any way is considered to be ‘de-identified’ and can be used or disclosed for any purpose. Family Members and Friends: We may disclose your medical information to a family member, friend, or any other person identified by you who is involved in your health care or payment for your health care. For example, we may provide prescriptions and related information to your caregiver on your behalf.
Uses or Disclosures for Research or When Authorized by Law
We may use or disclose your health information without your permission in the following circumstances, subject to all applicable laws.
For research activities under certain limited circumstances and subject to a special approval process.
When required to do so by federal, state or local law
To prevent a serious threat to the health and safety of you, another person or the general public.
To organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as
necessary to facilitate organ or tissue donation and transplantation.
If required by the appropriate military command authority (military patients only).
To report findings and treatment of your workers’ comp injury to your employer, case manager, other health care providers and insurer as permitted or required by state law.
To local, state or federal public health authorities for various public health activities including: recording births and deaths; reporting certain illnesses, injuries or communicable diseases; reporting unanticipated medication reactions, problems with medical devices or other unanticipated problems with your care; tracking, recall and post market surveillance of FDA regulated products; notifying you that you may have been exposed to a disease or may be at risk for contracting or spreading a disease.
To report known or suspected child or adult abuse, neglect or endangerment to the appropriate agencies or law enforcement authorities.
To health oversight agencies who monitor our compliance with the law. In addition, individual employees, volunteers, students-in-training or Business Associates may use or disclose information about you in a ‘whistleblower’ action.
In response to a court or administrative order or other court action that compels release of the information.
To local, state or federal law enforcement officials when required by law, to identify or locate persons in our facilities, to report known or suspected criminal activity or when necessary to provide for national or state security.
To a coroner or medical examiner or funeral director as authorized by law.
Other Uses and Disclosures of Health Information
Records of Mental Health and Alcohol or Substance Abuse Patients: If you are receiving mental health, alcohol or substance abuse treatment, your records may be subject to additional protections under federal or state law. Please contact the Privacy Officer with any questions you may have using the address or telephone number provided below. Because of federal law, we will not release your medical information if it contains information about drug or alcohol abuse without your written permission except in very limited situations. Incidental Uses and Disclosures: Although we take safeguards to avoid this, it is possible that in the course of a lawful use or disclosure of your medical information, information is overheard or seen by someone other than the intended recipient of the information. Disclosures requiring your written authorization: Most uses and disclosures of psychotherapy notes, uses and disclosures of medical information for marketing purposes and disclosures that constitute the sale of medical information require your written authorization. Other uses and disclosures not covered by this Notice or the laws that apply to us will be made only with your written permission. You may, in most cases, revoke that permission, in writing, at any time. Note that we are unable to recover information that was previously disclosed with your permission. We cannot accept a revocation of your written permission when it was given as a condition of obtaining insurance coverage since other laws give the insurer the right to contest a claim under the insurance policy. If you refuse to give your written permission for release of information, we may not refuse to treat you unless 1) your written permission is required as a condition of participation in research related treatment, or 2) the only reason for the health care encounter is to create health information for release to a third party (ex. A pre-employment physical or OSHA mandated testing for your employer.)
Your Rights Regarding Your Health Information
You may exercise the following rights by contacting the facility where you received your services.
Right to Inspect and Copy: You have the right to inspect and obtain a copy (for a fee) of the information we maintain on you in your medical records, billing records and other records used to make decisions about your care. Your request must be in writing. You have the right to obtain an electronic copy of your electronically maintained medical records if those records are readily producible in the electronic form or format you request. We will encrypt electronic information provided to you (requiring that you use a password to access the information) unless you direct us not to use encryption. We may deny your request to inspect and copy your information in certain limited circumstances. You may request review of a denial. Right to Correct or Update Your Information: If you believe that your health records are incorrect or incomplete, you may request that we amend the records. You have the right to request an amendment for as long as we keep your information. Your request must be in writing. We will deny your request if 1) you do not provide a reason for the requested changes, or 2) the information was not created or maintained by us, or 3) the information is not within the records you are permitted to inspect and copy, or 4) the information in your records is accurate and complete. Any corrections we accept will be included in your record. Right to a List of Certain Disclosures: We are required to keep a list of certain (but not all) disclosures we make of your health information and you are entitled to a copy of that list. Your request must be in writing. You must state the time period for which you want the list of disclosures, but the time period cannot be longer than the preceding six years. The first list you request within a 12-month period will be free. However, if you request additional lists during this period, we will charge you for the costs of providing the list. Right to Request Restrictions: You have the right to request that we limit the use or disclosure of your health information for treatment, payment or health care operations. You have the right to request that we limit the information we disclose to your family, friends or others involved in your care or payment for care. Your request for restriction must be in writing. For any services 2 for which you paid out-of-pocket in full, we will honor your request to not disclose information about those services to your health plan, provided that such disclosure is not necessary for your treatment. In all other circumstances, we are not required to agree to your request for restriction nor provide a reason for our denial. We will not accept restriction on information when release is required or permitted by law or when we do not have the technical means to enforce a restriction. We cannot restrict information disclosed prior to your request for restriction. If we accept your request for restriction, we will comply with the request unless the information is needed to provide you emergency treatment. If we later reverse our decision to accept a restriction, you will be notified in writing. Right to Request Alternative Delivery of Information: You have the right to request that we communicate with you about health matters via alternative means or at alternative locations. For example, you may request that we only telephone you at work or that we mail your records to you or to a person designated by you at a location other than your home. Any request for alternative delivery of information must be made in writing and must specify how or where you wish to be contacted. We will accommodate requests that we can reasonably meet. Right to a Paper Copy of this Notice: You may obtain an additional paper copy of this Notice upon request.
Changes to This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. The Notice will contain on the first page, in the top right-hand corner, the effective date of the Notice. You may also obtain a copy of any revised Notice upon request.
Complaints:
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
TO FILE A COMPLAINT, PLEASE CONTACT:
Privacy Officer
Senior Scripts
739 Goddard Avenue Chesterfield, MO 63005
Phone: (636) 534 – 6800
Email: privacyofficer@seniorscripts.biz
Questions regarding this Notice may be directed to the Senior Scripts Privacy Officer at the address listed above.