Effective Date: April 14, 2003 

Revision Date: September 25, 2005 

 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. 

Triangle Compounding 

We understand that your medical information is personal. We are committed to protecting your medical information. Triangle Compounding is required by law to maintain the privacy of your protected health information (“PHI”), to follow the terms of this Notice, and to give you this Notice of our legal duties and privacy practices concerning your health information. We must follow the terms of the current Notice. 

 How Triangle Compounding Pharmacy May Use or Disclose Your Health Information 

  • For Treatment. We may use your PHI to dispense prescriptions to you. We may disclose your PHI to treating physicians, pharmacists and other persons who are involved in dispensing your prescription. 
  • For Payment. We may use and disclose your PHI so that your pharmacy services may be billed to, and payment collected from you, your insurance company or a third party. 
  • For Health Care Operations. We may use and disclose your PHI for pharmacy operations, which include activities necessary to run the Pharmacy, and to make sure that you receive quality customer service. 
  • For Prescription Refill Reminders and Health-Related Products and Services. We may use or disclose your PHI for prescription refill reminders, to tell you about health-related products or services, or to recommend possible treatment alternatives that may be of interest to you. 
  • Individuals Involved in Your Care or Payment for Your Care. We may disclose your PHI to a family member or friend who is involved in your medical care or payment for your care, provided you agree to this disclosure, or we give you an opportunity to object to the disclosure. If you are unavailable or are unable to object, we will use our best judgment to decide whether this disclosure is in your best interests. 
  • As Required by Law. We will disclose your PHI when required to do so by federal, state or local law. 
  • 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. Any disclosure, however, would only be to someone able to help prevent the threat. 
  • Public Health Risks. We may disclose your PHI for public health activities, such as those aimed at preventing or controlling disease, preventing injury, reporting reactions to medications or problems with products, and reporting the abuse or neglect of children, elders and dependent adults. 
  • For Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities, which are necessary for the government to monitor the health care system, include audits, investigations, inspections and licensure. 
  • Lawsuits and Disputes. If you are involved in a lawsuit or 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 by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice), or to obtain an order protecting the information requested. 
  • Specialized Government Functions. We may disclose your PHI (1) if you are a member of the armed forces, as required by military command authorities; (2) if you are an inmate, or in custody, to a correctional institution or law enforcement official; (3) in response to a request from law enforcement, under certain conditions; (4) for national security reasons authorized by law; and (5) to authorized federal officials to protect the President, other authorized persons, or foreign heads of state. 
  • Workers’ Compensation. We may disclose your health information for workers’ compensation or similar programs. 
  • Organ and Tissue Donation. We may also disclose your PHI to organ procurement or similar organizations for purposes of donation or transplant. 
  • Coroners and Funeral Directors. We may release your PHI to a coroner or medical examiner, for example, to determine a person’s cause of death. We may also disclose your PHI to funeral directors consistent with applicable law to enable them to carry out their duties. 
  • Personal Representatives. We may disclose your PHI to a person legally authorized to act on your behalf, such as a parent, legal guardian, administrator or executor of your estate, or other individual authorized under applicable law. 

Other Uses and Disclosures of Your Health Information. 

Except as described in this Notice, we will not use or disclose your PHI without your written authorization. If you do give us authorization to use or disclose your PHI, you may cancel your authorization in writing at any time. If you cancel your authorization, this will stop any further use or disclosure for the purposes covered by your authorization, except where we have already acted on your permission. 

You Have the Following Rights With Respect to Your Health Information in Our Records 

  • You may request restrictions on the use or disclosure of your PHI for treatment, payment or health care operations, or when using or disclosing your PHI to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we agree, we will comply with your request except in certain emergency situations or as required by law. 
  • You may inspect and copy your pharmacy records, with certain exceptions. Usually, this includes prescription and billing records. We may charge you for the costs of your request. We may deny your request in some circumstances, in which case, you may request that the denial be reviewed. 
  • You may request that we amend your health information if it is incorrect or incomplete. You must provide a reason that supports your request. We may deny your request if the health information is accurate and complete, or is not part of the health information kept by or for Triangle Compounding Pharmacy. If we deny your request, you have the right to submit a statement of disagreement regarding any item in your record you believe is incomplete or incorrect. If you request this, it will become part of your medical record. We will attach it to your records and include it when we make a disclosure of the item or statement you believe to be incomplete or incorrect. 
  • You may request an accounting of disclosures of your PHI. This is a list of the disclosures made of your health information, other than for treatment, payment or health care operations, and other exceptions allowed by law. Your request must specify a time period, which may not be longer than six years and may not include dates before April 14, 2003. 
  • You may request that we contact you in a certain way or at a certain location. For example, you may request we contact you only at work or at a different residence or post office box. Your written request must state how or where you wish to be contacted. We will grant all reasonable requests. 

If you would like to exercise any of these rights, contact the pharmacy to get the appropriate form, or submit a written request to Triangle Compounding Pharmacy Stores, Inc., 3700 Regency Parkway, Suite 140, Cary, NC 27518. A paper copy of this Notice may be obtained from Triangle Compounding Pharmacy upon request, or downloaded here. 

Changes to this Notice of Privacy Practices 

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI we already have about you and any information we receive in the future. We will post a copy of the current Notice in the pharmacy. If we change our Notice, you may obtain a copy of the revised Notice by visiting our Web site at www.trianglecompounding.com or upon request. 

For More Information or to Report a Problem 

If you have questions about this Notice, contact Triangle Compounding Pharmacy, 3700 Regency Parkway, Suite 140, Cary, NC 27518. If you believe your privacy rights have been violated, you may file a written complaint, and there will be no retaliation, with the Compliance Officer at the above address, or with the Secretary of the Department of Health and Human Services, Office of Civil Rights. 

HIPAA STATEMENT 

IMPORTANT NOTICE TO OUR PATIENTS 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule takes effect on April 14, 2003 in an effort to protect the confidentiality of an individual’s protected health information (PHI). “PHI” is defined as individually identifiable health information contained in the record set maintained for each patient. This law was designed specifically to protect health information transmitted in an electronic form by a health plan, health care clearinghouse, hospital, pharmacist or doctor in connection with a transaction covered by HIPAA (e.g., electronic submission of prescription information for online adjudication, electronic submission of claims for reimbursement). 

Ways That We May Use and Disclose Your PHI 

  1. We may use and disclose your PHI as necessary to maintain a patient profile on you, which may include information about you, your medical condition, medications and prescription devices that you use, any allergies that you may have and any other applicable information.
  2. We may use and disclose your PHI among our staff as necessary, in dispensing prescription medicines and related products and services.
  3. We may discuss with your physician, dentist or other healthcare provider your treatment and in doing so we may use and disclose your PHI.
  4. We may communicate with you concerning your health and treatment and in doing so we may use and disclose your PHI. For example, we routinely monitor your medications for appropriateness and take other steps to help you use your medication properly and ensure that your treatment is effect (e.g, we may contact you to remind you to obtain your refill).
  5. We may use and disclose your PHI to your caregivers in our discussions with them about your treatment.
  6. If you are a minor, we may disclose your PHI to a parent or legal guardian.
  7. We may disclose certain PHI to those individuals that assist us in conducting the services that we provide to your during the course of your treatment. If you choose to have the medications that we prepare for you delivered to you, we may disclose as necessary certain information (e.g., your home address), to the delivery service companies that we use. 

Thank you for the privilege of being your pharmacy and we look forward to continuing to be of service to you.