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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.
MAIL-MEDS CLINICAL PHARMACY
JTJ MEDICAL SUPPLY, INC Doing Business As MAIL-MEDS CLINICAL PHARMACY AND BLISS RX
NOTICE OF PRIVACY PRACTICES
As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, JTJ Medical Supply, Inc. has created this Notice of Privacy Practices (Notice). This Notice describes JTJ Medical Supply, Inc.’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 JTJ Medical Supply, Inc. protect the privacy of your PHI that JTJ Medical Supply, Inc. has received or created.
JTJ Medical Supply, Inc. will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below, JTJ Medical Supply, Inc. 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. Individually identifiable health information is used only for the purposes necessary for conducting the business of JTJ Medical Supply, Inc., including evaluation activities. JTJ Medical Supply, Inc. reserves the right to change JTJ Medical Supply, Inc.’s privacy practices and this Notice.
HOW MAIL-MEDS CLINICAL PHARMACY MAY USE AND DISCLOSE YOUR PHI
The following is an accounting of the ways that JTJ Medical Supply, Inc. is permitted, by law, to use and disclose your PHI.
The following is an accounting of additional ways in which JTJ Medical Supply, Inc. is permitted or required to use or disclose PHI about you without your written authorization.
OTHER USES AND DISCLOSURES
JTJ Medical Supply, Inc. may contact you for the following purposes:
FOR ALL OTHER USES AND DISCLOSURES
JTJ Medical Supply, Inc. will obtain a written authorization from you for all other uses and disclosures of PHI, and JTJ Medical Supply, Inc. 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 our Privacy Officer to obtain a Request for Restriction of Uses and Disclosures.
YOUR HEALTH INFORMATION RIGHTS
The following are a list of your rights in respect to your PHI. Please contact the our Privacy Officer for more information about the below.
The Right to request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of JTJ Medical Supply, Inc.’s uses and disclosures of your PHI; however, we are not required to agree to your request, and we may say “no” if it would affect your care. The right to choose to pay for a prescription or service in full out of pocket and restrict disclosure of PHI to a health plan for payment. We will say “yes” unless the law requires us to share the information.
The right to have your PHI communicated to you by alternate means or locations: You have the right to request that JTJ Medical Supply, Inc. communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require JTJ Medical Supply, Inc. to have an accurate address and home phone number in case of emergencies. JTJ Medical Supply, Inc. will consider all reasonable requests.
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 JTJ Medical Supply, Inc. for the duration JTJ Medical Supply, Inc. maintains PHI about you. 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 JTJ Medical Supply, Inc. maintains about you, if you feel that the PHI JTJ Medical Supply, Inc. 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.
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 JTJ Medical Supply, Inc.
The right to receive additional copies of JTJ Medical Supply, Inc.’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.
FLORIDA STATE SPECIFIC PROVISIONS
Disclosure – Pharmacy Records
We will not disclose your pharmacy records without your written authorization, except to:
b. your legal representative;
c. the Department of Health pursuant to existing law;
d. in the event that you are incapacitated or unable to request your records yourself;
e. in any civil or criminal proceeding, upon the issuance of a subpoena from a court of competent jurisdiction and proper
notice to you or your legal representative, by the party seeking the records, and
f. as otherwise authorized by state law.
If you have any questions on JTJ Medical Supply, Inc.’s privacy practices or for clarification on anything contained within the Notice, please contact:
JTJ Medical Supply, Inc
DBA Mail-Meds Clinical Pharmacy and Bliss Rx
ATT: Privacy Officer
2692 Oak Ridge Court
Fort Myers, FL 33901
REVISIONS TO THE NOTICE OF PRIVACY PRACTICES
JTJ Medical Supply, Inc. 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. JTJ Medical Supply, Inc. will also post the revised version of the Notice in JTJ Medical Supply, Inc.
If you believe your privacy rights have been violated, you may file a complaint with JTJ Medical Supply, Inc. and/or to the Secretary of HHS, or his designee. If you wish to file a complaint with JTJ Medical Supply, Inc., please contact our Privacy Officer, Privacy Officer. If you wish to file a complaint with the Secretary, please write to:
Region IV ‐ Atlanta
(Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee)
Roosevelt Freeman, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Sam Nunn Atlanta Federal Center, Suite 16T70
61 Forsyth Street, S.W.
Atlanta, GA 30303‐8909
Voice Phone (800) 368‐1019
FAX (404) 562‐7881
TDD (800) 537‐7697
JTJ Medical Supply, Inc. will not take any adverse action against you as a result of your filing of a complaint.