Privacy Notice MediSort Medication Consultants, P.A. Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Explanation of Forms Medisort Medication Consultants, P.A. is required to maintain the privacy of Protected Health Information (“PHI”) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that which relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you. Medisort Medication Consultants, P.A. ("MMC") is required by law to keep PHI about you private and to give you this Notice. MMC must abide by this Notice; however, MMC reserves the right to amend this Notice and make such change applicable to all medical information maintained by MMC. Upon request, we will provide any revised Notice to you. Effective Date This Notice is effective as of June 12, 2006 until revised by MMC. Your Health Information Rights You have the following rights with respect to PHI about you: Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. You may obtain a paper copy by calling 614-538-0887. Request a restriction on certain uses and disclosures of PHI. You have the right to request restrictions on the use and disclosure of medical information about you; however, MMC will only be bound by the restrictions if MMC notifies you that it agrees with them. Inspect and obtain a copy of PHI. You have the right to see and receive a copy of PHI about you kept by MMC under most circumstances. Request an amendment of PHI. You have the right to have MMC amend its records of information about you. MMC may refuse to amend information that is accurate, that was created by someone else, or is not disclosable to you. Receive an accounting of disclosures of PHI. You have the right to see a list of disclosures of PHI about you by MMC which includes the purposes and recipients of the information. Request communications of PHI by alternative means or at alternative locations. You have the right to have MMC use only confidential means of communicating with you about medical information. This means you may request that we contact you about medical matters only in writing or at a different residence or post office box. Examples of How We May Use and Disclose PHI The following are descriptions and examples of ways we use and disclose PHI. We will use PHI for treatment. Information obtained by an MMC pharmacist will be used to assess and monitor your prescription and non-prescription medications. We may also share this information with your physician as needed to coordinate your care. We will use PHI for payment. MMC may disclose PHI about you when health plans or insurers, Medicare, Medicaid, or other payors require the information before paying for your health care service. We will use PHI for health care operations. MMC may use PHI about you when it hires new staff whose training requires information about the medical needs of our patients. We are likely to use or disclose PHI for the following purposes. As required by law: We must disclose PHI about you when required to do so by law. You will be notified, as required by law, of any such uses or disclosures. Public Health: We may disclose PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to another government agency that is collaborating with the public health authority. Health oversight activities: We may disclose PHI about you to an oversight agency for activities including audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights. Food and Drug Administration (FDA): We may disclose to the FDA, or 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. Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal, in certain conditions in response to a subpoena, discovery request or other lawful process. Law Enforcement: We may disclose PHI about you for law enforcement purposes to a law enforcement official as required by law, court order, warrant, or administrative request. Worker’s Compensation: We may disclose your PHI as authorized to comply with worker’s compensation laws and other similar legally established programs. Communication with individuals involved in your care or payment for your care: We may communicate with other health professionals such as physicians or therapists, consistent with applicable law, disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to that person’s involvement in your care or payment related to your care if your MCC pharmacist, in his or her professional judgment, determines that it is in your best interest. Business associates: We may for certain services provided by us through contracts with business associates disclose PHI about data aggregation services relating to health care operations. When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do. To protect PHI about you, we require our business associates to appropriately safeguard the PHI. We are permitted to use or disclose PHI about you when required to do so by law. Research: We my disclose PHI about you to researchers when their research has been approved by an institutional review 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 PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person, determine the cause of death or other duties as authorized by law. We may also disclose PHI to funeral directors, consistent with applicable law, to carry out their duties. Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others. Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as a social service or protective agency, if we reasonably believe, in our professional judgment, you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information (1) to the extent required by law, (2) if you agree to the disclosure, or (3) if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you. Military and veterans: If you are a member of the armed forces, we may disclose PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority. Other Uses and Disclosures of PHI Medisort Medication Consultants, P.A.will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. For More Information or to Report a Problem If you have question or would like additional information about MMC’s privacy practices, you may call 305-758-3477. If you believe your privacy rights have been violated, you can file a complaint with the MMC or with the Secretary of Health and Human Services. There will be no retaliation for filling a complaint.