• 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, submit a written request to the Contact Office listed at the end of this Notice.
  
• Request restrictions on certain uses and disclosures of PHI. You may request additional restrictions on our use and disclosure of PHI by sending a written request to the Contact Office listed at the end of this Notice. We are not required
  to agree to any such requested restriction or restrictions.
  
• Inspect and obtain a copy of PHI. You have the right to access and copy PHI contained in a designated record set for as long as we maintain the PHI. The "designated record set" usually will include prescription and billing records. To inspect or copy PHI, you must complete a request form at the pharmacy where you received service.
  
  We may charge you a fee for the costs of copying, mailing or other supplies that are necessary to respond to your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed in some cases.
  

• Request an amendment of PHI. If you feel that PHI we maintain 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 Contact Office listed at the end of this Notice.
  
  In addition, 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 submit a statement of disagreement with the decision and we will provide you with a rebuttal to your statement if we prepare one.
  

• Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI on or after April 14, 2003, for most purposes other than treatment, payment or health care operations. The accounting will exclude disclosures:
  

1. We have made directly to you;
2. To friends or family members involved in your care;
3. For notification purposes;
4. Incident to a use or disclosure otherwise permitted or required by law;
5. Pursuant to a valid authorization provided by you;
6. As part of a limited data set in accordance with law; or
7. That occurred prior to April 14, 2003.

The right to receive an accounting is subject to certain other exceptions, restrictions and limitations. To request an accounting, you must submit your request in writing to the Contact Office listed at the end of this Notice.

Your request must specify the time period for the disclosures we have made during the period commencing no sooner than the later of 6 years from the date on which you request the accounting or April 14, 2003. We will provide the first accounting you request within a 12 month period to you free of charge, but we may charge you 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.

• Request communications of PHI by alternative means or at alternative locations. For instance, you may request to receive communications of PHI from us only in writing or at a different location or post office box. To request confidential communication of PHI about you, you must submit your request in writing to the Contact Office listed at the end of this Notice.
  
  Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests.
  
  

Examples of How We May Use and Disclose PHI

The following categories describe and provide examples of different ways that we use and disclose PHI about you when, in our professional judgment, it is in your best interest, when the information is requested by the Indiana Board of Pharmacy or by a law enforcement officer charged with enforcement of laws pertaining to drugs or devices or the practice of pharmacy, or when the disclosure is essential to our business operations.

For treatment. Examples: Information obtained by the pharmacist will be used to dispense prescription medications to you or to coordinate or manage health care with a health care provider involved in your care or to consult with a health care provider relating to your treatment. This would include contacting and communicating with any health care professionals (or their representatives) involved in your care as we deem appropriate. We will also document in your record information related to the medications dispensed to you and services provided to you.

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 responsibility. We will collect from you or a third party payor the amount due for prescription medications dispensed to you. The information on or accompanying the communication may include information that identifies you, as well as the prescriptions you are taking.

For health care operations. Example: We may use or disclose information in your health record to monitor the performance of the pharmacists providing treatment to you or to detect and prevent fraud and abuse by appropriate methods or for compliance programs. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

We also may use or disclose PHI for the following purposes:

Business associates. There are some services provided by us through contracts with business associates. Examples include billing, claims processing and administration and data analysis. When these services are contracted for, we may disclose PHI to our business associates so that they can perform the job we have asked them to do and collect from you or your third-party payor for services rendered. To protect PHI, the business associate must appropriately safeguard the PHI as part of our contract with the business associate.

Communications with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to your representative involved in your care (i.e., a family member, other relative, close personal friend or neighbor or any person you identify) PHI that is relevant to your care, assistance in matters pertaining to your care or therapy and to that person's involvement in your care. We may also disclose PHI to such person that is relevant to payment related to your care.

Personal communications: We may contact you to provide refill reminders or information about treatment alternatives 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 its agents 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 to the extent authorized by and to the extent necessary to comply with laws relating to worker's compensation or other 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.

As required by law: We must disclose PHI when required to do so by law.

Health oversight activities: We may disclose PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs and compliance with civil rights laws.

Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI in response to a court or administrative order. We may also disclose PHI 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.

We are permitted to use or disclose PHI for the following purposes:

Research: We may disclose PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

Coroners, medical examiners and funeral directors: We may release PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.

Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of facilitating organ, eye or tissue donation and transplantation.

Notification: We may use or disclose PHI to notify or assist in notifying a family member, personal representative or another person responsible for your care, your location and general condition.

Correctional institution: If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents PHI necessary for your health and the health and safety of others.

To avert a serious threat to health or safety: We may use and disclose PHI when necessary to prevent or lessen 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 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 to authorized federal officials for the conduct of intelligence, counterintelligence and other national security activities authorized by law.

Protective services for the President and others: We may disclose PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Victims of abuse, neglect or domestic violence: We may disclose PHI to a governmental 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 or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.

Other Uses and Disclosures of PHI

We will obtain your separate written authorization before we use or disclose PHI for purposes other than those described in this Notice or as otherwise permitted or required by law in the event that we need to make such a use or disclosure. You may revoke this authorization at any time by submitting such revocation in writing to the Contact Office listed at the end of this Notice. Upon receipt of the written revocation, we will stop using or disclosing PHI, except to the extent that we have already taken action in reliance on the authorization.

For More Information or to Report a Problem

If you have questions or would like additional information about our privacy practices, you may contact us as follows at the contact office listed below. If you believe your privacy rights have been violated, you can file a complaint with us by writing to or calling us at the contact office listed below or with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.

The information for contacting the Contact Office is:

Marsh Drugs, LLC
9800 Crosspoint Boulevard
Indianapolis, Indiana 46256-3350
Attn.: Pharmacy Documents Official
Telephone Number: (317) 594-2406
Effective Date: This Notice is effective as of April 14, 2003.