Our Duties
RX Box Pharmacy is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI. We are required to abide by the terms of the notice currently in effect.
How We May Use and Disclose Your Health Information
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. For example, we may share information with your prescribing physician or other healthcare providers involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services we provide. For example, we may share information with your health insurance company to obtain reimbursement for prescriptions.
Health Care Operations
We may use and disclose your PHI for our health care operations, including quality assessment, training, licensing, and business management activities necessary to run our pharmacy.
As Required by Law
We will disclose your PHI when required to do so by federal, state, or local law, including to public health authorities, law enforcement, or in response to a court order or subpoena.
Business Associates
We may share your PHI with third-party "business associates" that perform services on our behalf, such as billing companies or IT providers. We require these associates to protect your information under a written agreement.
Serious Threats to Health or Safety
We may use or disclose your PHI when necessary to prevent a serious and imminent threat to your health or safety or the health or safety of the public.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that we maintain. We may charge a reasonable fee for copies. To request access, contact us in writing.
Right to Amend
If you believe your PHI is incorrect or incomplete, you may request an amendment. We may deny your request under certain circumstances and will explain the reason in writing.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI. This does not include disclosures for treatment, payment, or health care operations.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI. We are not required to agree to your request except in limited circumstances required by law.
Right to Confidential Communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location (e.g., only by mail to a specific address).
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Right to Opt Out of Fundraising
We may contact you for fundraising purposes. You have the right to opt out of receiving such communications.
How to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
To file a complaint with us, contact our Privacy Officer at the address or phone number below. To file a complaint with HHS, visit www.hhs.gov/ocr/privacy/hipaa/complaints.
Changes to This Notice
We reserve the right to change this notice and to make the revised notice effective for health information we already have about you as well as any information we receive in the future. We will post the current notice in our pharmacy and on our website. You may request a copy of the current notice at any time.
Contact Our Privacy Officer
- RX Box Pharmacy · 2821 Glenwood Ave, Rockford, IL 61101
- (815) 904-6951·Fax: (877) 502-2250
- [email protected]