NOTICE OF PRIVACY PRACTICES

Cottage Pharmacy and Surgical  respects the privacy and confidentiality of your personal health information. This Notice of Privacy Practices applies to all information and records related to your care that Cottage Pharmacy and Surgical has received or created. This Notice informs you about the possible uses and disclosures of your personal medical/health information. It also describes your rights and our obligations regarding your personal health information.

YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OR DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION

We will use and disclose personal health information (other than as described in the Notice or required by law) only when we obtain your written Authorization. You may revoke your Authorization to use or disclose personal health information, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose your personal health information for the purposes specified in that Authorization except where we have already taken actions in reliance on your Authorization.

YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION

Right to Request Restrictions:  You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment or health care operations. You also have the right to restrict the personal health information we may disclose about you to a family member, friend or other person who is involved with your care or payment for your care.

We are not required to agree to your requested restriction (except that while you are competent you may restrict disclosures to family members or friends). If we do not agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.

Right of Access to Personal Health Information:  You have the right to inspect and obtain a copy of your medical or billing records or other written information that may be used to make decisions about your care, subject to some limited exceptions. We may charge a reasonable fee for our costs in copying and mailing your requested information.

We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to personal health information, in some cases you will have a right to request review of the denial. This review would be performed by a licensed health care professional designated by an entity who did not participate in the decision to deny.

Right to Request Amendment:  You have the right to request that we amend any personal health information maintained by us for as long as the information is kept by Cottage Pharmacy and Surgical. Your request must be made in writing and must state the reason for the requested amendment.

We may deny your request for amendment if the information:

• Was not created by Cottage Pharmacy and Surgical, unless the originator of the information is no longer available to act on your request;
• Is not part of the personal health information maintained by Cottage Pharmacy and Surgical;
• Is not part of the information to which you have a right to access;
• Is already accurate and complete, as determined by Cottage Pharmacy and Surgical.

If we deny your request for amendment, we will give you a written denial, including the reasons for the denial and the right to submit a written statement disagreeing with the denial.