Privacy Statement
As you know, Privacy statements are long and inclusive. Kinney Drugs wants you to know that your information is
absolutely private and we will never release your information to outside parties.
KINNEY DRUGS
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.
Kinney Drugs is required by law to maintain the privacy of Protected Health Information ("PHI") and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services. This Notice of Privacy Practices ("Notice") describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you.
Kinney Drugs is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. We will provide any revised Notice to you upon request.
Your Health Information Rights
You have the following rights with respect to PHI about you:
Obtain a paper copy of the Notice upon request.
You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still
entitled to a paper copy. To obtain a paper copy, contact
Kinney Drugs, 520 East Main St., Gouverneur, NY 13642 or call (315-287-3600)
and leave your name and address, or request a copy at any Kinney Drugs.
Request a restriction on certain uses and disclosures of PHI.
You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request
to Kinney Drugs, 520 East Main St., Gouverneur, NY 13642, Attn: Privacy Officer. We are not required to agree to those restrictions.
Inspect and obtain a copy of PHI.
You have the right to access and copy PHI about you contained in a designated record set for as long as we maintain the PHI.
The designated record set usually will include prescription and billing records. To inspect or copy PHI about you, you must
send a written request to Kinney Drugs, 520 East Main St., Gouverneur, NY 13642, Attn: Privacy Officer. We may charge you a fee
for the costs of copying, mailing, and supplies that are necessary to fulfill your request. We may deny your request to inspect
and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI.
If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an
amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to Kinney Drugs, 520 East
Main St., Gouverneur, NY 13642, Attn: Privacy Officer. You must include a reason that supports your request. In certain cases,
we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of
disagreement with the decision and we may give a rebuttal to your statement.
Receive an accounting of disclosures of PHI.
You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most
purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as
disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care,
and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions,
restrictions, and limitations. To request an accounting, you must submit a request in writing to Kinney Drugs,
520 East Main St., Gouverneur, NY 13642, Attn: Privacy Officer. Your request must specify the time period, but may not be
longer than six years. The first accounting you request within a 12 month period will be provided free of charge, but you may
be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to
withdraw or modify your request at that time.
Request communications of PHI by alternative means or at
alternative locations. For instance, you may request that we contact you about pharmacy matters only in writing or
at a different residence or post office box. To request confidential communications of PHI about you, you must submit a
request in writing to Kinney Drugs, 520 East Main St., Gouverneur, NY 13642, Attn: Privacy Officer. Your request must state
how or where you would like to be contacted. We will accommodate all reasonable requests.
Examples of How We May Use and Disclose PHI
The following are descriptions and examples of ways we use and disclose PHI:
Treatment.
For example, we will use PHI to dispense prescription medications to you, which will include pharmacists and other persons
involved in the dispensing function. We will document in your record information related to the medications dispensed to you
and services provided to you. We also may contact you to provide refill reminders or information about treatment alternatives
or other health-related benefits and services that may be of interest to you.
Payment.
For example, we will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription
and the amount of your co-payment. We will bill you or a third-party payer for the cost of prescription medications dispensed
to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions
you are taking.
Health care operations.
For example, we may use information in your health record to monitor the performance of the pharmacists providing treatment
to you. This information will be used in an effort to continually improve the quality and effectiveness of the health
care and service we provide.
We also are permitted to use or disclose your PHI for the following purposes. However, we may never have reason
to make some of these disclosures.
Business associates:
There are some services provided by us through contracts with third parties, which are known as "business associates."
When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform
the job we have asked them to do and, if applicable, bill you or your third-party payer for services rendered.
To protect PHI about you, we require the business associate to appropriately safeguard the PHI.
Communication with individuals involved in your care or payment for your care:
Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative,
close personal friend or any person you identify, PHI relevant to that person's involvement in your care or payment related
to your care. For example, we may allow a friend or family member to pick up a prescription on your behalf.
Food and Drug Administration (FDA):
We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs,
foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs,
or replacement.
Worker's compensation:
We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker's
compensation or similar programs established by law.
Public health:
As required or permitted by law, we may disclose PHI about you to public health or legal authorities charged with
preventing or controlling disease, injury, or disability.
Law enforcement:
We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena
or other legal process.
As required by law:
We must disclose PHI about you when required to do so by law.
Health oversight activities:
We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include
audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care
system, government programs, and compliance with civil rights laws.
Judicial and administrative proceedings:
If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order.
We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else
involved in the dispute, but only if efforts have been made to notify you about the request or to obtain an order protecting
the requested PHI.
Research:
We may disclose PHI about you to researchers when their research has been approved by an institutional review
board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, medical examiners, and funeral directors:
We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased
person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to
carry out their duties.
Organ or tissue procurement organizations:
Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged
in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Fund-raising:
We may use or disclose your PHI for fund-raising activities.
Notification:
We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another
person responsible for your care, your location, and your general condition.
Correctional institution:
If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when
necessary for your health or the health and safety of others.
To avert a serious threat to health or safety:
We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health
and safety of the public or another person.
Military and veterans:
If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may
also release PHI about foreign military personnel to the appropriate military authority.
National security and intelligence activities:
We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national
security activities authorized by law.
Protective services for the President and others:
We may disclose PHI about you to authorized federal official so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special investigations.
Victims of abuse, neglect, or domestic violence:
We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we
reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information
to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it
is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive
the report represents that it is necessary and will not be used against you.
Incidental Disclosures at the Drive-Thru Window
We make reasonable efforts to avoid any inadvertent oral disclosure of your protected health information. However, in some locations we offer customers the convenience of picking up their prescriptions at a drive-thru window where a conversation with the pharmacy could be overheard by a passerby. If you are concerned about the possibility of someone overhearing your drive-thru communications, we recommend that you obtain your prescriptions from the pharmacy counter inside the store.
Other Uses and Disclosures of PHI
We will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided
for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt
of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken
action in reliance on the authorization.
Our New York pharmacies will not access a common electronic file or database used to maintain required personally identifiable dispensing information except upon your, or your agent's, express request.
Minors
If you are a minor who has lawfully provided consent for treatment and you would like the pharmacy, to the extent permitted
by your state's laws, to treat you as an adult for purposes of access to and disclosure of records related to such treatment,
please notify the pharmacist.
For More Information or to Report a Problem
If you have questions or would like additional information about Kinney Drugs' privacy practices, you may contact the
Privacy Officer at Kinney Drugs, 520 East Main St. Gouverneur, NY 13642 or call 315-287-3600. If you believe your privacy
rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services.
There will be no retaliation for filing a complaint.
Effective Date
This Notice (Version 1) is effective as of April 14, 2003.












