HIPAA Notice of Privacy Practices

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.

When this Notice of Privacy Practices ("Notice") refers to "we" or "us," it is referring to OPTMZ, LLC and all the pharmacists who provide health care services and the employees of our pharmacy. We are required by law to maintain the privacy of your protected health information ("PHI"), to follow the terms of the Notice currently in effect, to give you this Notice setting forth our legal duties and privacy practices concerning your PHI, and to notify affected individuals following a breach of unsecured PHI. This Notice describes how we may use and disclose your PHI. It also explains the rights you have with respect to your PHI and certain obligations we must abide by in accordance with the law. We reserve the right to amend this Notice. If we make any material revisions, we will post a copy of the revised Notice in the pharmacy, on our website, and will offer you a copy.

I. Use and Disclosure of Your PHI

We will use and disclose your PHI for treatment, payment, and health care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization, which you may revoke at any time by providing written notice.

A. Treatment

We may use and disclose your PHI in order to provide you with prescription and supply services, and may disclose your PHI to other pharmacists, pharmacy technicians, and health care providers involved in your care. You will receive an individual notice and have the opportunity to opt out of any subsidized treatment communications.

B. Payment

We will use and disclose your PHI in order to obtain payment for the health care services we provide to you. We may also need to disclose your PHI to receive prior approval from your health plan or to determine whether your health plan will cover a certain prescription or service.

C. Health Care Operations

We may use and disclose your PHI in connection with the management of our pharmacy — including quality assessment and improvement, internal compliance audits, and performance evaluations — and for our business management and general administrative activities.

D. Prescription Refill Reminders, Treatment Alternatives, or Health-Related Benefits

We may use and disclose your PHI to remind you about prescription refills, tell you about treatment options or alternatives, or inform you about health-related benefits or services that may be of interest to you.

E. Family Members, Relatives, or Close Friends

Unless you object, we may disclose your PHI to your family members, relatives, close personal friends, or any other persons identified by you as being involved in your care or payment for your care. If you are not present to agree or object, we may exercise our professional judgment to determine whether the disclosure is in your best interest, and will only disclose the PHI relevant to your treatment or payment.

F. Other Permitted and Required Uses and Disclosures

We may use your PHI without obtaining your authorization, and without offering you the opportunity to agree or object, as permitted by law — including:

• as required by law;
• to a public health authority authorized by law to collect or receive such information, including for disease prevention/control, reporting deaths, adverse-event reporting, communicable disease notification, and reporting of abuse or neglect;
• to a health oversight agency for oversight activities authorized by law, including audits, inspections, and civil, administrative, or criminal investigations or proceedings;
• for judicial or administrative proceedings in response to a subpoena, court order, or discovery request, but only with appropriate efforts to inform you or obtain protective orders;
• to law enforcement to report certain injuries, comply with court orders or warrants, identify a suspect, fugitive, missing person, or victim, or to report a crime;
• to coroners or medical examiners as authorized by law;
• to funeral directors as necessary to carry out their duties;
• to organ procurement organizations or similar entities to facilitate donation and transplantation;
• for research purposes, provided certain approvals and assurances are in place;
• to avert a serious threat to health or safety, where disclosure is to a person reasonably able to prevent or lessen the threat;
• for military and veterans activities (including foreign military personnel) and benefits eligibility;
• for national security and intelligence activities;
• for protection of the President and other authorized persons or foreign heads of state;
• to a correctional institution or law enforcement custodian if you are an inmate or under custody; and
• to the extent necessary to comply with laws relating to workers' compensation and work-related injuries.

II. Your Rights as Our Patient

A. Right to Request Restrictions

You may request restrictions or limitations on how we use and/or disclose your PHI; however, we do not have to agree (except for transactions you paid for in full out-of-pocket). Your written request must specify what use/disclosure to restrict or limit, what information is covered, and to whom the restriction applies.

B. Right to Confidential Communications

You have the right to receive confidential communications by alternative means or locations (for example, receiving prescription-related communications at an address other than your home). Please submit such requests in writing to the Privacy Officer. We will accommodate all reasonable requests.

C. Right to Access

You have the right to access, inspect, and obtain a copy of your PHI, including electronic PHI, subject to certain HIPAA exemptions. We may charge a reasonable, cost-based fee for copy costs and postage. If we deny access, you may request that the denial be reviewed and, if access is ultimately denied, you are entitled to a written explanation.

D. Right to an Accounting of Disclosures

You have the right to receive an accounting of disclosures of your PHI for a period of up to six (6) years prior to the date you request it. One request annually is free of charge; we may charge a reasonable, cost-based fee for additional requests in the same twelve-month period.

E. Right to Request Amendments

If you believe we have PHI about you that is incorrect or incomplete, you may make a written request stating the reasons for any requested amendment. We may deny the request if, for example, the PHI was not created by us or is already accurate and complete. You may file a written statement of disagreement, and we have the right to rebut it.

F. Right to a Paper Copy

You have the right at any time to obtain a paper copy of this Notice, even if you received it electronically. Send your request to the Privacy Officer at the address below.

G. Right to Opt Out of Fundraising

You have the right to opt out of fundraising; your PHI will not be used for fundraising purposes or sold without your prior authorization.

III. Additional Information / Questions or Complaints

If you need additional information about this Notice or wish to exercise any of your rights, please contact the Privacy Officer at:

If you believe your privacy rights have been violated, you may file a complaint without retaliation with the Privacy Officer of the pharmacy or with: