Ingles Pharmacy Notice of Privacy Practices

Ingles Pharmacy Notice of Privacy Practices
Effective Date: April 14, 2003

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 of Privacy Practices (the “Notice”) describes the privacy practices of Ingles Pharmacy that is owned by Ingles Markets Inc. This group of pharmacy locations treats itself as a single entity for purposes of using and disclosing health information about you.

Protected Health Information ("PHI") is information that may identify you and that relates to your health, medical conditions and prescriptions. Ingles Pharmacy is required by law to protect the privacy of your health information and to provide you with this Notice explaining our legal duties and privacy practices regarding your health information. Ingles Pharmacy is required to follow the terms of this Notice or any change to it that is in effect. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. If we do so, the updated Notice will be posted on our website and will be available at our facilities and locations where you receive health care products and services from us. Upon request, we will provide any revised Notice to you.

How We May Use and Disclose Your PHI
Below are examples of how federal law permits use or disclosure of your PHI for these purposes without your permission; however, not every permissible use or disclosure will be listed in this Notice. Note that some types of PHI, such as HIV information, genetic information, alcohol and/or substance abuse records, and mental health records may be subject to special confidentiality protections under applicable state or federal law and we will abide by these special protections. If you would like additional information about special state law protections, you may contact the Privacy Office or visit www.ingles-markets.com.

I. Uses and Disclosures of PHI 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 PHI for treatment, payment and health care operations without your prior authorization as follows:

Treatment. We may use and disclose your PHI to provide and coordinate the treatment, medications and services you receive. For example, we may disclose PHI to pharmacists, doctors, nurses, technicians and other personnel involved in your health care. We may also disclose your PHI with other third parties, such as hospitals, other pharmacies and other health care facilities and agencies to facilitate the provision of health care services, medications, equipment and supplies you may need.

Payment. We may use and disclose your PHI in order to obtain payment for the health care products and services that we provide to you and for other payment activities related to the services that we provide. For example, we may contact your insurer, payor, or other agent and share your PHI with that entity to determine whether it will pay for your prescription and the payment amount. We may also contact you about a payment or balance due for prescriptions dispensed to you at Ingles Pharmacy. We may also disclose your PHI to other health care providers or HIPAA covered entities who may need it for their payment activities.

Health Care Operations. We may use and disclose your PHI to monitor the effectiveness and quality of our health care services, to provide customer services to you and to resolve complaints. For example, we may use your PHI as part of our efforts to continually improve the quality and effectiveness of the health care products and services we provide. We may also analyze PHI to improve the quality and efficiency of health care, for example, to assess and improve outcomes for health care conditions. We may also disclose your PHI to other HIPAA covered entities that have provided services to you so that they can improve the quality and effectiveness of the health care services that they provide. We may use your PHI to create de-identified data, which is stripped of your identifiable data and no longer identifies you.

We may also use and disclose your PHI without your prior authorization for the following purposes:
Business Associates. We may contract with third parties to perform certain services for us. These third party service providers, referred to as Business Associates, are required by contract and law to protect your PHI and only use and disclose it as necessary to perform their services for us.

Individuals Involved in Your Care or Payment for Your Care. In these cases, you have both the right and choice to tell us to disclose to a family member, other relative, close personal friend, or any other person you choose to identify, PHI directly relevant to that person’s involvement in your care or payment related to your care. However, if we can reasonably infer that you agree, we may provide prescriptions and related information to your representative on your behalf if we believe it is in your best interest.

Parents or Legal Guardians. If you are a minor, we may release your PHI to your parents or legal guardians when we are permitted or required under federal and applicable state law.

Worker’s Compensation. To the extent necessary to comply with law, we may disclose your PHI to worker’s compensation or other similar programs established by law.

Public Health Activities. We may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including the U.S. Food and Drug Administration. These activities may include the following: disclosures to report reactions to medications or other products; disclosures to notify individuals of recalls, exposure to a disease, or risk for contracting or spreading a disease or condition.

Law Enforcement. We may disclose your PHI for law enforcement purposes as required or permitted by law – for example, in response to a subpoena, court order, summons, or similar process for law enforcement purposes.

Abuse or Neglect. If you have been a victim of abuse, neglect, or domestic violence, we may disclose your Protected Health Information to the government agency authorized to receive such information.

As Required by Law. We will disclose your PHI when required to do so by federal, state or local law.
Health Oversight Activities. We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with federal, state or local laws.

United States Department of Health and Human Services: Under federal law, we are required to disclose your PHI to the Secretary of U.S. Department of Health and Human Services to determine if we are in compliance with federal laws and regulations regarding the privacy of health information.

Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discover request, or other lawful process.

Although we may not engage in the following activities, under federal or applicable state law, we are allowed to use or disclose your PHI without your permission for these purposes: 

Research. Under certain circumstances, we may use your PHI to conduct research and we may disclose your PHI to researchers as authorized by law. For example, we may use or disclose your PHI as part of a research study when the research has been approved by an institutional review board or privacy 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 disclose your PHI to coroners, medical examiners, or funeral directors so that they can carry out their duties. This may be necessary, for example, to identify a deceased person or determine the cause of death. 

Organ or Tissue Procurement Organizations. Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Notification. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, regarding your location and general condition if we believe it is in your best interest.

Disaster Relief. We may use and disclose your PHI to organizations for purposes of disaster relief efforts.

Fundraising. As permitted by applicable law, we may contact you to provide you with information about our fundraising programs. You have the right to “opt out” of receiving these communications and such fundraising materials will explain how you may request to opt out of future communications if you do not want us to contact you further for fundraising efforts.

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 other individuals.

To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to 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 if certain conditions are met.

National Security, Intelligence Activities, and Protective Services for the President and Others. We may release PHI about you to authorized federal officials for intelligence, counterintelligence, protection of the President, other authorized persons or foreign heads of state, and other national security activities authorized by law.

II. Uses and Disclosures of PHI that Require Your Prior Authorization
Specific Uses or Disclosures Requiring Authorization. We will obtain your written authorization for the use or disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI, except in limited circumstances where applicable law allows such uses or disclosure without your authorization.

Other Uses and Disclosures. We will obtain your written authorization before using or disclosing your PHI for purposes other than those described in this Notice or otherwise permitted by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.

Your Health Information Rights:
Obtain a paper copy of the Notice upon request. You may request a copy of our current Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. You may obtain a paper copy at the site where you obtain health care services from us or by contacting the Privacy Office.

Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of your PHI by sending a written request to the Privacy Office. We are not required to agree to the restrictions, except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, is not otherwise required by law, and the PHI pertains solely to a health care item or service for which you, or a person on your behalf, has paid in full.

Inspect and obtain a copy of PHI. With a few exceptions, you have the right to timely access and obtain a copy of the PHI that we maintain about you within 30 days. If we maintain an electronic health record containing your PHI, you have the right to request to obtain the PHI in an electronic format. To inspect or obtain a copy of your PHI, you must send a written request to the Privacy Office. You may ask us to send a copy of your PHI to other individuals or entities that you designate. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed.

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. To request an amendment, you must send a written request to the Privacy Office. You must include a reason that supports your request. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it.

Receive an accounting of disclosures of PHI. With the exception of certain disclosures, you have a right to receive a list of the disclosures we have made of your PHI, in the six years prior to the date of your request, to entities or individuals other than you. To request an accounting, you must submit a request in writing to the Privacy Office. Your request must specify a time period.

Request communications of PHI by alternative means or at alternative locations. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For instance, you may request that we contact you at a different residence or post office box, or via e-mail or other electronic means. Please note if you choose to receive communications from us via e-mail or other electronic means, those may not be a secure means of communication and your PHI that may be contained in our e-mails to you will not be encrypted. This means that there is risk that your PHI in the e-mails may be intercepted and read by, or disclosed to, unauthorized third parties. To request confidential communication of your PHI, you must submit a request in writing to the Privacy Office. Your request must tell us how or where you would like to be contacted. We will accommodate all reasonable requests. However, if we are unable to contact you using the ways or locations you have requested, we may contact you using the information we have.

Notification of a Breach. You have a right to be notified following a breach of your unsecured PHI, and we will notify you in accordance with applicable law.

Where to obtain forms for submitting written requests. You may obtain forms for submitting written requests by contacting the Privacy Officer at Ingles Markets Inc., Attn: Privacy Officer, 2913 US Hwy 70W, Black Mountain, North Carolina 28711 or toll-free by telephone at (800) 635-5066.

For More Information or to Report a Problem
If you have questions or would like additional information about Ingles Pharmacy’s privacy practices, you may contact our Privacy Officer at Ingles Markets Inc., Attn: Privacy Officer, 2913 US Hwy 70W, Black Mountain, North Carolina 28711 or toll-free by telephone at (800) 635-5066. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services.
There will be no retaliation for filing a complaint.
Effective Date This Notice is effective as of July 1, 2017.


Changes to Notice of Privacy Practices
We reserve the right to make changes to this Notice and to make the revised Notice effective for health information we already have about you and any information we may receive in the future. Any revised Notice will be posted in the Ingles Pharmacy [or on the website at www.ingles-markets.com]. Upon request, we will provide a revised Notice to you. We are required to follow the terms of the Notice that is currently in effect.

Complaints
If you believe your privacy rights have been violated, you can file a complaint with the Pharmacy Privacy Officer at Ingles Markets, Inc., P.O. Box 6676, Asheville, NC 28816, Attn: Pharmacy Privacy Officer. You may also file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation for filing a complaint.

Contact Information
You may submit your requests or questions to the Pharmacy or Pharmacy Privacy Officer at:

Ingles Markets, Inc.
Attn: Pharmacy Privacy Officer
P.O. Box 6676
Asheville, NC 28816

or FAX to 828-669-3685 or 1-800-635-5066