Patient Privacy Notice
THIS NOTICE DESCRIBES HOW MEDICAL AND HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
SelectRx is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide you with notice of our legal duties and privacy practices with respect to PHI. References to “SelectRx,” “we,” “us,” and “our” include SelectRx and the members of its affiliated covered entity. An affiliated covered entity is a group of organizations under common ownership or control who designate themselves as a single affiliated covered entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). SelectRx, its employees, workforce members and members of the SelectRx affiliated covered entity who are involved in providing and coordinating health care are all bound to follow the terms of this Notice of Privacy Practices (“Notice”). The members of the SelectRx affiliated covered entity will share PHI with each other for the treatment, payment and health care operations of the affiliated covered entity and as permitted by HIPAA and this Notice.
PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care products and services to you or payment for such services. This Notice describes how we may use and disclose PHI about you, as well as how you obtain access to such PHI. This Notice also describes your rights with respect to your PHI. We are required by HIPAA to provide this Notice to you.
SelectRx 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
The following categories describe different ways that we use and disclose your PHI. We have provided you with examples in certain categories; 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.
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, pharmacy benefit manager or other health care payer to determine whether it will pay for health care products and services you need and to determine the amount of your co-payment, deductible or co-insurance. We may contact you about a payment or balance due on your account. 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 for our health care operations. Health care operations are activities necessary for us to operate our health care businesses. For example, we may use your PHI to monitor the performance of the staff and pharmacists providing treatment to you. 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.
Business Associates
We may contract with third parties to perform certain services for us, such as billing services or consulting services. These third party service providers, referred to as Business Associates, may need to access your PHI to perform services for us. They are required by contract and law to protect your PHI and only use and disclose it as necessary to perform their services for us.
To Communicate with Individuals Involved in Your Care or Payment for Your Care
We may disclose to a family member, other relative, close personal friend, or any other person you identify, PHI directly relevant to that person’s involvement in your care or payment related to your care. Additionally, we may disclose PHI to your “personal representative.” If a person has the authority by law to make health care decisions for you, we will generally regard that person as your “personal representative” and treat him or her the same way we would treat you with respect to your PHI.
Food and Drug Administration (“FDA”)
We may disclose to persons under the jurisdiction of the FDA, 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
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
We may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability, including the FDA. In certain circumstances, we may also report work-related illnesses and injuries to employers for workplace safety purposes.
Law Enforcement
We may disclose your PHI for law enforcement purposes as required or permitted by law for example, in response to a subpoena or court order, in response to a request from law enforcement, and to report limited information in certain circumstances.
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 civil rights laws.
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. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to first tell you about the request or to obtain an order protecting the information requested.
Research
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 release your PHI to coroners or medical examiners so that they can carry out their duties.
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.
Disaster Relief
We may use and disclose your PHI to organizations for purposes of disaster relief 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. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
National Security, Intelligence Activities, and Protective Services for the President and Others
We may release PHI about you to federal officials for intelligence, counterintelligence, protection of the President, and other national security activities authorized by law.
Victims of Abuse or Neglect
We may disclose PHI about you to a government authority if we reasonably believe you are a victim of abuse or neglect. 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.
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 access and obtain a copy of the PHI that we maintain about you. 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.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
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 SelectRx Privacy Office, 6800 W. 115th Street, Suite 2511, Overland Park, KS 66211 or toll-free by telephone at 833-247-0468.
For More Information or to Report a Problem
If you have questions or would like additional information about SelectRx privacy practices, you may contact our Privacy Officer at SelectRx, 6800 W. 115th Street, Suite 2511, Overland Park, KS 66211 or toll-free by telephone at 833-247-0468. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
Effective Date
This Notice is effective as of May 19, 2022.
Patient Privacy Web Access
This Patient Privacy notice can be accessed online at selectrx.com/patient-privacy
Patient Rights & Responsibilities
SelectRx recognizes that patients have the right to:
Considerate and respectful care from your pharmacists and other healthcare professionals.
Receive care that is free from discrimination and respectful of your dignity, personal beliefs, values, and individuality.
Participate in decisions about your health care and be involved in creating and updating your plan of care. Please ask questions if you don’t understand.
Speak with a health professional who can answer questions about your medication and treatment, and except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to treatment and medication and the risks involved. This includes receiving effective counseling and education from your pharmacists that empowers you to take an active role in your health condition and treatment decisions.
Know with whom you are speaking. You may ask any staff member his or her name and job title. You can also request to speak with the staff member’s supervisor.
Understand SelectRx is dedicated to protecting the privacy of our patients. Your personal health information will be kept safe and only shared with the patient management program as allowed by law. In certain circumstances, information may be shared in order to provide care or for billing purposes. We will also provide you with our Notice of Privacy Practices, at the start of care, to help you better understand how your protected health information (PHI) may be used and disclosed.
Call SelectRx with any privacy matters and ask for the Privacy Officer.
Expect that your personal data, including all contact information, is not released by pharmacists, pharmacies or insurance companies to another party to be used in soliciting the purchase of goods or services, whether or not the solicitation is related to your care.
Receive complete and accurate information from your pharmacist regarding the reason for your treatment and/or drug therapy, the proper use and storage of prescribed medications and the possible adverse side effects and interactions with other drugs, supplements or foods.
Make non-emergency decisions regarding your plan of care before and during treatment, as well as refuse any recommended treatment, therapy or plan of care after being informed of the consequences of refusing treatment, therapy or plan of care.
Expect that all prescribed medications you receive are safe, accurately dosed, effective and in usable condition.
Be advised if a medication has been recalled at the consumer level.
The patient has the right to be informed of pharmacy policies and practices that relate to patient care, treatment and responsibilities. Voice your grievances/complaints regarding treatment of care, lack of respect or to recommend changes in policy, personnel, or care/service without restraint, interference, coercion, discrimination, or reprisal, and have your grievances/complaints investigated.
Call SelectRx with grievances/complaints about your medication and ask for the Compliance Officer or Pharmacist-in-Charge.
Receive, in advance of care/services being provided, explanations of charges for medications including the extent to which payment may be expected from Medicare, Medicaid, or any other third party payer, charges for which you may be responsible, and an explanation of all forms you are requested to sign.
Be advised of any change in SelectRx’s plan of service before the change is made.
Receive information in a manner, format and/or language that you understand.
Have family members, as appropriate and as allowed by law, and with your authorization or the authorization of your personal representation, be involved in your care and treatment, and/or service decisions affecting you.
Be advised on the agency’s policies and procedures regarding the disclosure of clinical records.
Be fully informed of your responsibilities.
SelectRx recognizes that patients have the responsibility to:
Give accurate clinical and contact information and to notify the pharmacy of changes in this information.
Adhere to the plan of treatment or service established by your physician or healthcare provider.
Ask questions about your medications and treatment and/or services, or to have clarified any instructions provided by an SelectRx representative.
Communicate any information, concerns and/or questions related to perceived risks in your services, and unexpected changes in your condition.
Treat SelectRx personnel with respect and dignity without discrimination as to color, religion, sex, creed, or national or ethnic origin.
Care for and safely use medications, supplies and/or equipment, according to instructions provided, for the purpose they were prescribed and only for/on the individual for whom they were prescribed.
Notify SelectRx of any changes in your physical condition, physician’s prescription or insurance coverage.
Notify SelectRx immediately of any address or telephone changes whether temporary or permanent.
Pay all charges upon receipt of prescribed drugs.
Payment Policy
To avoid disruption in service, the best method is to authorize monthly auto-debit. Check, money order or credit cards are acceptable forms of payment. If for any reason you owe a balance, the balance will need to be paid before your next refill unless you have established an approved payment plan.
Terms and Conditions of Service
By signing up for our service, the patient acknowledges and agrees to the following:
To implement the SelectRx program and automatically refill my prescriptions every month,
To accept a monthly outreach call from SelectRx representative to discuss any information regarding prescriptions,
To play an active role in my prescription & medical management and ensure pharmacy is notified of doctor visits, hospital or urgent care visits, medication changes or additions or any changes in health status,
That SelectRx is not non-child resistant and should be stored in a safe place out of the reach of children,
To grant authorization to SelectRx to contact my current pharmacy provider and transfer prescriptions,
To grant authorization to SelectRx to contact my doctor(s) to obtain authorization for new prescriptions and exchange relevant health information with my doctor(s),
To be available for scheduled deliveries (in the event I, or designated individual, am not available or am non-compliant with scheduled deliveries a $20.00 re-delivery fee will be charged),
That due to industry constraints surrounding timely prescription deliveries, the preferred method of payment is via major credit card (VISA/MASTER-CARD/DISCOVER); that cards are processed the same day Rx orders are processed and shipped; that personal checks are accepted, though payments must be received and cleared prior to any medications being shipped or delivered,
That I received the Notice of Privacy Practices and that SelectRx and all affiliated covered entities can use and disclose my protected health information in accordance with HIPAA,
That SelectRx may leave my medication box with another person (neighbor, family member, etc.).
That SelectRx has the following cancellation policy: Only a patient or Authorized individual on record can cancel pharmacy services. We will act upon a formal request to transfer medications only if it comes from the patient directly, their doctor, pharmacy, or the Authorized individual on record. If a formal transfer request occurs from a doctor or pharmacy before receiving a cancellation of pharmacy services by the patient or Authorized individual on record, we will attempt to reach out to confirm the cancellation and transfer request. If we are unsuccessful in making contact with the patient or Authorized individual on record we will continue service until receiving a cancellation request directly from the patient or Authorized individual on record.