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.

As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, MyBrand-Rx, LLC has created this Notice of Privacy Practices (Notice).  This Notice describes our privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected Health Information (PHI).  Your PHI is information about you, or that could be used to identify you, as it relates to your past and present physical and mental health care services. The HIPAA regulations require that we protect the privacy of your PHI that we have received or created.

We will abide by the terms presented within this Notice.  For any uses or disclosures that are not listed below, the pharmacy will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at any time, as explained in more detail below.
We reserve the right to change our privacy practices and this Notice.  Revisions to the Notice will be posted on this website under "Privacy Policy" and, upon your request, provided to you in paper format.

The following is an accounting of the ways that we are permitted, by law, to use and disclose your PHI.

Uses and disclosures of PHI for Treatment:  We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care.

Uses and disclosures of PHI for Payment: We will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.

Uses and disclosures of PHI for Health Care Operations:  We may use the minimum necessary amount of your PHI to conduct quality assessments, improvement activities, and evaluate our workforce and that of our partner pharmacies.

The following is an accounting of additional ways in which we are permitted or required to use or disclose PHI about you without your written authorization.  All uses and disclosures will be to the minimum necessary amount of your PHI.  Many of these uses and disclosures will never be made by us; however, we are required by law to notify you of them as a health care provider.

Uses and disclosures as required by law:  We are required to use or disclose PHI about you as required and as limited by law.

Uses and disclosure for Public Health Activities:  We may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability.  This includes the FDA so that it may monitor any adverse effects of drugs, foods, nutritional supplements and other products as required by law.

Uses and disclosure about victims of abuse, neglect or domestic violence: We may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence.

Uses and disclosures for health oversight activities: We may use or disclose PHI about you to a health oversight agency for oversight activities which may include audits, investigations, inspections as necessary for licensure, compliance with civil laws, or other activities the health oversight agency is authorized by law to conduct.

Disclosures for judicial and administrative proceedings: The pharmacy may disclose PHI about you in the course of any judicial or administrative proceedings, provided that proper documentation is presented to us.

Disclosures for law enforcement purposes: We may disclose PHI about you to law enforcement officials for authorized purposes as required by law or in response to a court order or subpoena.

Uses and disclosures about the deceased: We may disclose PHI about a deceased, or prior to, and in reasonable anticipation of an individual’s death, to coroners, medical examiners, and funeral directors.

Uses and disclosures for cadaveric organ, eye or tissue donation purposes:  We may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.

Uses and disclosures for research purposes:  We may use and disclose PHI about you for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board.  Otherwise, we will request a signed authorization by the individual for all other research purposes.

Uses and disclosures to avert a serious threat to health or safety:  We may use or disclose PHI about you, if it believed in good faith, and is consistent with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.

Disclosure for workers’ compensation:  We may disclose PHI about you as authorized by and to the extent necessary to comply with workers’ compensation laws or programs established by law.

Disclosures for disaster relief purposes:  We may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts. 

Disclosures to business associates:  We may disclose PHI about you to our business associates for services that they may provide to or for us to assist us to provide quality health care.  To ensure the privacy of your PHI, we require all business associates to apply appropriate safeguards to any PHI they receive or create.

We may contact you for the following purposes:

Refill reminders:  We may contact you to remind you of your prescription upon such time they are ready to be refilled.

Information about treatment alternatives:  We may contact you to notify you of alternative treatments and/or products.

Health related benefits or services:  We may use your PHI to notify you of benefits and services that we provide.

Fundraising:  If we participate in a fundraising activity, we may use demographic PHI to send you a fundraising packet, or we may disclose demographic PHI about you to a business associate or an institutionally related foundation to send you a fundraising packet.  No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization.

We will obtain a written authorization from you for all other uses and disclosures of PHI, and we will only use or disclose pursuant to such an authorization.  In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact us at either of the phone numbers listed below to obtain a Request for Restriction of Uses and Disclosures.

The following are a list of your rights in respect to your PHI.

Request restrictions on certain uses and disclosures of your PHI:  You have the right to request additional restrictions of our uses and disclosures of your PHI; however, we are not required to accommodate a request.  If you wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from us and return the completed form to us at either of the addresses listed below. 

The right to have your PHI communicated to you by alternate means or locations:  You have the right to request that we communicate confidentially with you using an address or phone number other than your residence.  However, state and federal laws require us to have an accurate address and home phone number in case of emergencies. We will consider all reasonable requests.  If you wish to request a change in your communicating address and/or phone number, please obtain a form, Request for Alternative Arrangements for Confidential Communication, from us and return the completed form to us. 

The right to inspect and/or obtain a copy your PHI:  You have the right to request access and/or obtain a copy of your PHI that is contained in our facility for the duration that we maintain PHI about you.  If you wish to inspect or obtain a copy of your PHI, please obtain a form, Request for Access to Records, from us and return the completed form to us.  There may be a reasonable cost-based charge for photocopying documents.  You will be notified in advance of incurring such charges, if any.

The right to amend your PHI:  You have the right to request an amendment of the PHI we maintain about you, if you feel that the PHI we have maintained about you is incorrect or otherwise incomplete.  Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review.  You may also ask the Secretary, United States Department of Health and Human Services (“HHS”), or their appropriate designee, to review such a denial.  If you wish to amend your PHI files, please obtain a form, Request for Amendment to PHI, from us and return the completed form to us. 

The right to receive an accounting of disclosures of your PHI:  You have the right to receive an accounting of certain disclosures of your PHI made by us. If you wish to receive an accounting of disclosures of your PHI, please obtain a form, Request for Accounting of Disclosures, from us and return the completed form to us.   You should be aware, however, that such an accounting excludes uses and disclosures made for treatment, payment, or health care operations purposes.

The right to receive additional copies of our Notice of Privacy Practices:  You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically.  If you wish to receive a paper copy of this request, please ask a our workforce member and they will provide you with a copy.

We reserve the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The revised Notice will be available, upon request, to all individuals.  We will also post the revised version of the Notice on this website, under "Privacy Policy".

If you believe your privacy rights have been violated, you may file a complaint with us and/or to the Secretary of HHS, or his designee.  If you wish to file a complaint with us, please contact us at the address or phone number listed below.  If you wish to file a complaint with the Secretary, please write to:

The U.S. Department of Health and Human Services
Office of the Inspector General
200 Independence Ave, S.W.
Washington, D.C. 20201

We will not take any adverse action against you as a result of your filing of a complaint.

If you have any questions on our privacy practices or for clarification on anything contained within the Notice, please contact us at:

MYBRAND-RX, LLC
P.O BOX 452
LAFAYETTE HILL, PA 19444
888-850-5545
MyBrand-Rx
Notice of Privacy Practices
Effective September 1, 2011
















How the Pharmacy May Use and
 Disclose Your PHI





































































Other Uses and Disclosures
















For All Other Uses and Disclosures





Your Health Information Rights











































Revisions to the Notice of Privacy
Practices



Complaints











Contact Information
Copyright 2014 MyBrand-Rx, LLC
Privacy Policy
HOMEABOUT USPATIENTSPROVIDERSE-PRESCRIBECONTACT US

PRIVACY POLICY

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.

As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, MyBrand-Rx, LLC (the Company) has created this Notice of Privacy Practices (Notice). This Notice describes the Company's privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected Health Information (PHI). Your PHI is information about you, or that could be used to identify you, as it relates to your past and present physical and mental health care services. The HIPAA regulations require that the Company protect the privacy of your PHI that the Company has received or created.

This Company will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below, the Company will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at any time, as explained in more detail below.
The Company reserves the right to change the Company’s privacy practices and this Notice. Revisions to the Notice will be posted on this website under "Privacy Policy" and, upon your request, provided to you in paper format.

The following is an accounting of the ways that the Company is permitted, by law, to use and disclose your PHI.

Uses and disclosures of PHI for Treatment: We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care.

Uses and disclosures of PHI for Payment: The Company will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.

Uses and disclosures of PHI for Health Care Operations: The Company may use the minimum necessary amount of your PHI to conduct quality assessments, improvement activities, and evaluate the Company workforce.

The following is an accounting of additional ways in which the Company is permitted or required to use or disclose PHI about you without your written authorization. All uses and disclosures will be to the minimum necessary amount of your PHI. Many of these uses and disclosures will never be made by the Company; however, we are required by law to notify you of them as a health care provider.

Uses and disclosures as required by law: The Company is required to use or disclose PHI about you as required and as limited by law.

Uses and disclosure for Public Health Activities: The Company may use or disclose PHI about you to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability. This includes the FDA so that it may monitor any adverse effects of drugs, foods, nutritional supplements and other products as required by law.

Uses and disclosure about victims of abuse, neglect or domestic violence: The Company may use or disclose PHI about you to a government authority if it is reasonably believed you are a victim of abuse, neglect or domestic violence.

Uses and disclosures for health oversight activities: The Company may use or disclose PHI about you to a health oversight agency for oversight activities which may include audits, investigations, inspections as necessary for licensure, compliance with civil laws, or other activities the health oversight agency is authorized by law to conduct.

Disclosures for judicial and administrative proceedings: The Company may disclose PHI about you in the course of any judicial or administrative proceedings, provided that proper documentation is presented to the Company.

Disclosures for law enforcement purposes: The Company may disclose PHI about you to law enforcement officials for authorized purposes as required by law or in response to a court order or subpoena.

Uses and disclosures about the deceased: The Company may disclose PHI about a deceased, or prior to, and in reasonable anticipation of an individual’s death, to coroners, medical examiners, and funeral directors.

Uses and disclosures for cadaveric organ, eye or tissue donation purposes: The Company may use and disclose PHI for the purpose of procurement, banking, or transplantation of cadaveric organs, eyes, or tissues for donation purposes.

Uses and disclosures for research purposes: The Company may use and disclose PHI about you for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board. Otherwise, the Company will request a signed authorization by the individual for all other research purposes.

Uses and disclosures to avert a serious threat to health or safety: The Company may use or disclose PHI about you, if it believed in good faith, and is consistent with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.

Disclosure for workers’ compensation: The Company may disclose PHI about you as authorized by and to the extent necessary to comply with workers’ compensation laws or programs established by law.

Disclosures for disaster relief purposes: The Company may disclose PHI about you as authorized by law to a public or private entity to assist in disaster relief efforts. 

Disclosures to business associates: The Company may disclose PHI about you to the Company’s business associates for services that they may provide to or for the Company to assist the Company to provide quality health care. To ensure the privacy of your PHI, we require all business associates to apply appropriate safeguards to any PHI they receive or create.

The Company may contact you for the following purposes:

Refill reminders: The Company may contact you to remind you of your prescription upon such time they are ready to be refilled.

Information about treatment alternatives: The Company may contact you to notify you of alternative treatments and/or products.

Health related benefits or services: The Company may use your PHI to notify you of benefits and services the Company provides.

Fundraising: If the Company participates in a fundraising activity, the Company may use demographic PHI to send you a fundraising packet, or the Company may disclose demographic PHI about you to its business associate or an institutionally related foundation to send you a fundraising packet. No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization.

The Company will obtain a written authorization from you for all other uses and disclosures of PHI, and the Company will only use or disclose pursuant to such an authorization. In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact us at either of the phone numbers listed below to obtain a Request for Restriction of Uses and Disclosures.

The following are a list of your rights in respect to your PHI.

Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of the Company’s uses and disclosures of your PHI; however, the Company is not required to accommodate a request. If you wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from the Company and return the completed form to the Company at either of the addresses listed below. 

The right to have your PHI communicated to you by alternate means or locations: You have the right to request that the Company communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require the Company to have an accurate address and home phone number in case of emergencies. The Company will consider all reasonable requests. If you wish to request a change in your communicating address and/or phone number, please obtain a form, Request for Alternative Arrangements for Confidential Communication, from the Company and return the completed form to the Company. 

The right to inspect and/or obtain a copy your PHI: You have the right to request access and/or obtain a copy of your PHI that is contained in the Company for the duration the Company maintains PHI about you. If you wish to inspect or obtain a copy of your PHI, please obtain a form, Request for Access to Records, from the Company and return the completed form to the Company. There may be a reasonable cost-based charge for photocopying documents. You will be notified in advance of incurring such charges, if any.

The right to amend your PHI: You have the right to request an amendment of the PHI the Company maintains about you, if you feel that the PHI the Company has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment. If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services (“HHS”), or their appropriate designee, to review such a denial. If you wish to amend your PHI files, please obtain a form, Request for Amendment to PHI, from the Company and return the completed form to the Company. 

The right to receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by the Company. If you wish to receive an accounting of disclosures of your PHI, please obtain a form, Request for Accounting of Disclosures, from the Company and return the completed form to the Company. You should be aware, however, that such an accounting excludes uses and disclosures made for treatment, payment, or health care operations purposes.

The right to receive additional copies of the Company’s Notice of Privacy Practices: You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically. If you wish to receive a paper copy of this request, please ask a Company workforce member and they will provide you with a copy.

The Company reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The revised Notice will be available, upon request, to all individuals. The Company will also post the revised version of the Notice on this website, under "Privacy Policy".

If you believe your privacy rights have been violated, you may file a complaint with the Company and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with the Company, please contact us at the address or phone number listed below. If you wish to file a complaint with the Secretary, please write to:

The U.S. Department of Health and Human Services
Office of the Inspector General
200 Independence Ave, S.W.
Washington, D.C. 20201

The Company will not take any adverse action against you as a result of your filing of a complaint.

If you have any questions on the Company’s privacy practices or for clarification on anything contained within the Notice, please contact us at:

ARROW PHARMACY HOLDINGS, LLC
461 COOKE STREET
FARMINGTON, CT 06032
888-850-5545