Notice of Privacy Practices; Compassionate Distributors, Inc.
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.
COMPASSIONATE DISTRIBUTORS, INC. NOTICE OF PRIVACY PRACTICES
Compassionate Distributors, Inc. is committed to maintaining the privacy of your protected health information (PHI) that is provided to us. This document specifies our privacy practices, including how we use and/or disclose your PHI in compliance with the Standards for Privacy of Individually Identifiable Health Information, issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (the "HIPAA Privacy Standards"). As a covered entity, we are required to protect and maintain the privacy of all of your health information, to provide you with notice of our legal duties and privacy practices regarding PHI, and to abide by the terms of this Notice. This Notice describes our efforts to maintain your trust by following the standards for patient privacy and confidentiality set forth in the HIPAA Privacy Standards.
Your Personal Health Information
In order to provide you with medical cannabis, we request confirmation from your healthcare provider concerning your medical condition. The HIPAA Privacy Standards require us to protect any of this health information that will identify you, such as your name, Social Security Number, telephone number, address, etc. We protect this information regardless of the form in which we receive it (e.g., oral, written, or recorded in other media).
Examples of Allowable Uses or Disclosures of Your Personal Health Information
The HIPAA Privacy Standards allow healthcare entities to receive and disclose your information without obtaining your authorization, for treatment, payment, and healthcare operations purposes. Each of these purposes is explained below.
Treatment: When we receive a request by you or a referring physician for approval to become our patient, it may contain your name, age, and other identifiable information. The disclosure of this information to us is considered treatment, as is our disclosure of your status as our patient to your healthcare provider.
Payment: We may legitimately use and disclose your health information for payment purposes, for example, sending your information to a billing service to file claims for us with health plans or other payors, in the event that someone else is paying for your medicine or health plans actually start approving payment for such treatment.
Healthcare Operations: We may disclose your information as part of our internal operations to maintain the high quality of our distribution services. We may use or disclose protected health information, for instance, to assure quality, accreditation and certification, licensing, or credentialing activities.
Legitimate Use and Disclosure When Required by Law
The HIPAA Privacy Standards specify certain other circumstances where we may legally use or disclose protected health information without your authorization; these situations generally are for public health and safety, legal, and judicial purposes.
Public health: As required by law, we may disclose your health information to public health or legal authorities and other entities charged with preventing or controlling disease, injury, or disability. We may also disclose health information for health oversight activities.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to product defects or may post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers compensation: We may disclose health information to the extent authorized by, and necessary to comply with, laws relating to workers compensation or other similar programs established by law.
Judicial proceedings: We may disclose health information to courts or administrative agencies in response to a court order, or a discovery request. In the case of the latter, we will not disclose the information unless we are satisfied that you have been given notice of the request and have not objected, or the party seeking the information obtains an order protecting the information from further disclosure.
In All Other Situations We Use and Disclose Your Personal Information only with Your Authorization
Except as otherwise permitted or required, we do not use or disclose your personal health information without your written authorization and then we use or disclose it only in a manner consistent with the terms of that authorization. You may revoke the authorization to use or disclose any PHI at any time, by writing to the contact person listed in this Notice, unless we have already acted under that authorization.
Your Rights With Respect to Your Personal Health Information
Under the HIPAA Privacy Standards, you have certain rights with respect to your PHI. You may contact us in the following manner: Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355. to request actions to be taken concerning these rights.
Right To Inspect and Copy Personal Health Information: You have the right to request a copy your personal information as we have received it. To do so, write to Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355.
Right To Receive Personal Health Information via Confidential Communications: Upon request from you, we can send you your personal information in a confidential manner. You may contact us in the following manner to request that we communicate with you in a confidential manner: Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355.
Right To Receive this Notice of Privacy Practices: You can request and receive a free copy of this Notice of Privacy Practices in printed or electronic form by writing or calling the contact person listed in this Notice; Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355..
Right To Request Restrictions On Use Or Disclosure: You can request restrictions on certain uses and disclosures of your personal health information; we are not required to agree with the request. If we do agree, we will not violate that restriction except in certain emergency situations. To request restrictions, contact Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355.
Right To Amend Personal Health Information: You can request that we amend your personal health information or your clinical record. The HIPAA Privacy Standards provide that we can deny the request for amendment under certain specified circumstances. If we do deny your request to amend, we will explain why to you, and explain your rights to seek review of that decision, if required under the HIPAA Privacy Standards.
Right To Receive An Accounting Of Disclosures of Personal Health Information: You can get a written accounting of all of our disclosures of your personal health information not directly related to treatment, payment, healthcare operations, or disclosed based on a signed authorization or for other legitimate purposes as stated above. You may request that Compassionate Distributors, Inc. provide an accounting of all disclosures of your test results, if you wish. To do so, contact Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355.
Right to Complain: We are committed to complying with the privacy practices described in this Notice of Privacy Practices. If you believe that we have violated any of them, you may file a complaint with us and/or with the Department of Health and Human Services, Office of Civil Rights. To file a complaint with us, please send a letter to Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355.. Compassionate Distributors, Inc. will not retaliate in any way if you file a complaint with the Office of Civil Rights or with us.
Amendments to this Privacy Practices
We can revise or amend this Notice of Privacy Practices at any time and make the revisions effective for all personal information we receive and maintain, including any we created or received before the effective date of the revision or amendment.
Access to Our Notice of Privacy Practices
You may request a copy of our current Notice of Privacy Practices, by writing to Mandy Denson, c/o Compassionate Distributors, Inc., P.O. Box 1828, Ruidoso, New Mexico 88355..
Contacting Us Regarding our Privacy Practices
If you have any questions about our privacy practices or your personal health information, please contact us. Send questions, requests, or complaints to:
Compassionate Distributors, Inc.
P.O. Box 1828
Ruidoso, NM 88355
Effective Date of Notice: May 1, 2010
I acknowledge I received a copy of this notice on _____ day of ____________, 20_____.
If you have any questions regarding the privacy of your health information at Compassionate Distributors, Inc. you may contact our Privacy Officer at:
P.O. Box 1828
Ruidoso, NM 88355
For more information about HIPPA, visit the HIPPA website.