Privacy Notice 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. EFFECTIVE DATE OF NOTICE: 04/14/2003 To Our Valued Customers: GSPOPS wants all its customers to know we respect your privacy and do everything we can to keep your personal information confidential. Under applicable law, we are required to protect the privacy of your individual health information (information we refer to in this notice as "Protected Health Information"). We are also required to provide you with this Notice regarding our policies and procedures regarding your Protected Health Information and to abide by the terms of this notice, as it may be updated from time to time. This notice provides you with information of how we will go about protecting your information and your privacy rights. Occasionally, this information may be updated or revised. Use and disclosure of Protected Healthcare Information may be used for treatment, payment, and healthcare purposes. We may use your Protected Healthcare Information for the purpose of treatment, dispensing medication, to provide and manage your healthcare. Other instances, such as consultation and other services, may require healthcare providers to use and disclose relevant information regarding your healthcare. Use and disclosure of relevant protected information may also be used for payment purposes, for reimbursement, for providing healthcare, or for billing purposes. The plan sponsor may employ benefit managers and claims administrators who may use this information. Your Protected Health Information may be also used to verify benefits. The use of the disclosure of relevant protected information may also be used for healthcare operations purposes, such use and disclosure will take place in a number of ways, including for quality assessment and improvement; provider review and training; underwriting activities; legal services and auditing functions; fraud and abuse detection and compliance programs; reviews and compliance activities; and planning, development, management and administration. Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided. Also it can be used to conduct peer review of the services or conduct of a medical care institution. We store some of your Protected Health Information in electronic computer files. We backup our electronic records periodically, and employ other precautions to safeguard the integrity of your Protected Health Information. In spite of these precautions it is possible, but unlikely, that a computer crash or other technological failure could cause the loss of data. In addition reasonable safeguards are employed to protect your Protected Health Information stored on electronic media. In addition, we may contact you to provide refill reminders, health screenings, wellness events, inoculations, vaccinations or information about treatment alternatives or other health-related benefits and services that may be of interest to you. In addition, we may disclose your health information to the plan sponsor or business associate. We may use and disclose your Protected Health Information, without your authorization when GSPOPS needs to contact a physician or physician’s staff, or other covered entity, and is permitted or required to do so without individual written authorization. We may use and disclose your Protected Health Information if we are contacted by a pharmacy who states they have your request and consent to transfer Protected Health Information to them. From time to time we may employ the services of business associates who may assist us in one or more tasks and who may use, change or create Protected Health Information. Business associates are required to comply with all the privacy regulations on your behalf. We may disclose Protected Health Information about you without your authorization to comply with workers compensation laws, as required by law enforcement, legal proceedings, public health requirements, health oversight activities and as required by law. If you apply for and receive benefits from federal and state health care programs, such as Medicare or Medicaid, your PHI may be disclosed to the agency granting those benefits. Lawsuits and other legal disputes may involve your PHI that we possess. In the event that you are involved in a lawsuit or other legal proceeding, whether as a plaintiff or a defendant, and without regard to the basis for the lawsuit, such as medical malpractice or divorce, we will disclose your PHI when required to comply with a court order. Other uses and disclosures will be made only with your written authorization, and you may revoke your authorization by notifying us as described below. You may ask us to restrict uses and disclosures of your Protected Health Information to carry out treatment, payment, or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care. However, we are not required to agree to your request. You have the right to request the following with respect to your Protected Health Information: (i) inspection and copying; (ii) amendment or correction; (iii) an accounting of the disclosures of this information by us (we are not required to account to you for disclosures made for treatment, payment, operations, disclosures to you, disclosures to your care givers, for notifications or as otherwise excluded by law. If we are not able to agree to your requested change, we will notify you in writing as to why we are not able to agree. You then have the right to submit to us a written statement of disagreement, to which we may elect to further respond in writing to you.); and (iv) the right to receive a paper copy of this notice upon request. We may require you to pay for this request to cover our costs of copying, labor and postage. The period of time for which we are required to provide the accounting is the six-year period immediately prior to the date of your request for the accounting but no earlier than April 14, 2003; however, your request for an accounting can be for a shorter period of time. In addition, you may request, and we must accommodate the request, if reasonable, to receive communications of Protected Health Information by alternative means or at alternative locations. If we are unable to provide our records to you, we will provide you a written explanation of why we are not able to provide the records. Depending on the reason, you may request for us to reconsider. You must reasonably describe in your written request the information you seek. You must include the reason you are making this request and we may deny your request; however, if we deny your request we must advise you of the reasons for the denial and advise you of your right to file a statement of rebuttal. To make this request please contact, in writing: Garden State Pharmacy Owners Provider Services Corporation P.O.Box 4190 Hamilton, NJ 08610 (609)439-0860 We may use your name to reference your prescriptions and pharmaceutical care services. You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this Notice and the disclosure of Protected Health Information as outlined herein. This information may be disclosed by us to other persons who ask for you or your prescriptions by name. You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative orally or in writing of your restriction or prohibition. We are not required to honor those requests. We are able to provide treatment services to you even if you object to sign the acknowledgment of the receipt of this Notice or if we decide not to honor a request regarding the information in this document. In the event of an emergency or your incapacity, we will do in our reasonable judgement what is consistent with your known preference, and what we determine to be in your best interest. We will inform you of any such uses or disclosures if uses and disclosures would require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable. We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care. In addition we may use or disclose the Protected Health Information to notify, identify, or locate a member of your family, your personal representative, another person responsible for care, or certain disaster relief agencies of your location, general condition, or death. If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do in our judgement what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare. We will also use our judgment and experience regarding your best interest in allowing people to pick-up filled prescriptions, or other similar forms of Protected Health Information. We may disclose Protected Health Information to a certificate holder or policy holder, to inform them or the status on an insurance transaction. We reserve the right to change the terms of this Notice and to make new Notice provisions effective for all Protected Health Information we maintain. You may receive a copy of this Notice by contacting us as outlined below. If you believe that your privacy rights have been violated, you may complain to us at the location described below or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201. You will not be retaliated against for filing a complaint. You may contact us for further information at: Garden State Pharmacy Owners Provider Services Corporation P.O.BOX 4190 Hamilton, NJ 08610 (609)439-0860 Back to Top