Notice of Privacy Practices

Effective as of: 3/1/2015

This notice describes how protected health information about you may be used and disclosed and how you can access this information. Please review this notice carefully.

This Notice is being directed to all patients of PersonifilRx, LLC (PersonifilRx) as well as those individuals and/or entities acting on their behalf. The current Notice may be found on our website, with paper copies available upon request and at no charge to you.

Privacy Responsibility

This Notice describes how we may collect, use and disclose your protected health information and your rights concerning your protected health information. “Protected health information” is information about you, including demographic information collected from you, that can reasonably be used to identify you and that relates to your past, present, or future physical condition, the provision of health care to you or the payment for that care.

Protected health information in this Notice includes information about you that appears on enrollment materials, prescription and pharmacy records, claims submitted and/or received on your behalf, and other records received and/or generated in writing, in person, by telephone, or electronically (such as your name, address, telephone number, and other demographic data).

PersonifilRx is committed to:

  • Protecting the privacy of any protected health information created or received about you and notifying you if there is a breach of your unsecured protected health information.
  • Providing you with this Notice to explain our privacy policies.
  • Using and sharing protected health information as outlined in this Notice.
  • Notifying you when information within this Notice changes.

Uses and Disclosures of Your Protected Health Information

Uses and Disclosures for Payment, Health Care Operations and Treatment. We use and disclose protected health information in a number of different ways in connection with the payment of your health care, our health care operations, and your treatment. The following are only a few examples of the types of uses and disclosures of your protected health information that we are permitted to make without your authorization.

Payment:

We will use and disclose your protected health information for purposes of payment. These uses and disclosures include, but are not limited to: the determination of eligibility; claims payment and/or the filing of insurance claims; utilization review and management; coordination of care, benefits and other services; and responding to complaints, appeals and external review requests.

Health Care Operations:

Protected health information may be used or disclosed in order to perform necessary business activities in relation to your benefits and services received. These activities include, but are not limited to: quality improvement surveys and studies; performance measurement and outcomes assessments; operation of preventive health, early detection and disease and case management and coordination of care programs, including information about treatment alternatives, therapies, health care providers, settings of care or other health-related services, such as medication therapy management (MTM) activities; risk management and audit services; data and information systems management; customer service; and administrative management.

Treatment:

Protected health information may be used or disclosed in order to make sure that you are receiving the medical treatment and services needed as well as to suggest health-related services that may be of benefit to you. We may disclose your protected health information to health care providers (doctors, dentists, chiropractors, pharmacies, hospitals, and other caregivers) who request it in connection with your medical treatment. We may also use and/or disclose your protected health information to health care providers in connection with preventive health, early detection and disease and case management programs.

In connection with Payment, Health Care Operations, and Treatment, we may collect the following types of information about you:

  • Information we receive directly or indirectly from you, your insurer, and/or third parties through applications, surveys, medical/prescription records, or other forms (e.g., name, address, social security number, date of birth, marital status, dependent information, prescription information, insurance information and medical history).
  • Information about your relationships and transactions with us and others (e.g., medical history, eligibility information, and payment information ).

Affiliates and Business Associates

We may share your protected health information with affiliates and third party business associates that perform various activities for us or on our behalf. Whenever such arrangement involves the use or disclosure of your protected health information, we will have a written contract that contains terms designed to protect the privacy of your protected health information in accordance with applicable Federal and State law.

Plan Administrative Functions

We may disclose protected health information to the plan sponsor to permit the plan sponsor to perform administrative functions. Please see your plan sponsor for a full explanation of the limited uses and disclosures that the plan sponsor may make of your protected health information in providing plan administrative functions for your group health plan, if applicable.

Use and Disclosure After the Completion of Services

We do not immediately destroy protected health information when individuals terminate their relationship with us. The information is necessary and used for many of the purposes described above and is in many cases subject to legal retention requirements. However, the policies and procedures that protect this information against inappropriate use and disclosure apply regardless of whether you are currently receiving services from us, subject to applicable law.

Applicability of More Stringent State Law

Some of the uses and disclosures described in this notice may be limited in certain cases by applicable State laws that are more stringent than Federal laws, including disclosures related to substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.

Other Permitted or Required Uses and Disclosures of Protected Health Information

We may use or disclose your protected health information in the following additional situations without your authorization:

Others Involved in Your Healthcare:

Unless you object, we may disclose to a member of your family, a relative, or any other person that you identify, the protected health information directly relevant to that person’s involvement in your health care, particularly in the event of an emergency. If you are present for such a disclosure, we will either seek your verbal agreement to the disclosure or provide you an opportunity to object to it. We may also make such disclosures to the persons described above in situations where you are not present or you are unable to agree or object to the disclosure, if we determine that the disclosure is in your best interest. We may also disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Unless we are given an alternative address, we will mail information containing protected health information to you at the address that we have on record for you.

Informing You:

Your protected health information may be used to let you know about services that are offered by PersonifilRx, its affiliates, and/or other health care providers. This may include contacting you for refill reminders, follow-up care surveys, informing you of treatment alternatives or providing you with information about health-related benefits and services, subject to the other limitations in this Notice.

As Required by Law:

Your protected health information may be used or disclosed to the extent that we are required to do so by law.

Legal Proceedings:

We may disclose your protected health information in the course of any legal proceeding, in response to an order of a court or administrative tribunal and, in certain cases, in response to a subpoena, discovery request or other lawful processes.

Law Enforcement:

We may disclose your protected health information under limited circumstances to law enforcement officials. For example, disclosures may be made in response to a warrant or subpoena or for the purpose of identifying or locating a suspect, witness or missing persons, or to provide information concerning victims of crimes.

Public Health:

Your protected health information may be reported to a public health agency to help prevent or control disease, injury, disability, infection exposure, child abuse, or family violence. In addition, disclosures may be made as required to the Food and Drug Administration to report adverse events or product defects, track products, enable product recalls, make repairs or replacements, or conduct product surveillance.

Abuse or Neglect:

We may make disclosures to government authorities concerning actual, alleged, or suspected abuse, neglect or domestic violence, in accordance with applicable law.

Health Oversight Activities:

Your protected health information may be used by or disclosed to a governmental agency authorized to oversee the health care system or government programs or its contractors. Examples include: licensing and inspecting of medical facilities and audits or other proceedings related to the oversight of the health care system.

Coroners, Medical Examiners, or Funeral Directors:

Protected health information may be used or disclosed to a medical examiner, coroner, or funeral director as needed to carry out duties authorized by law. For example, medical information may be necessary to identify a deceased person.

For Organ Donations:

If you are an organ donor, information may be given to the organization that locates organs for the purpose of an organ transplantation or donation.

Worker’s Compensation:

Your protected health information may be used or disclosed to the extent required by worker’s compensation laws.

Public Safety:

Your protected health information may be used or disclosed in order to prevent or lessen a serious threat to your health or safety, to another person, or the general public.

Military Activity and National Security:

If you are a veteran, your protected health information may be used or disclosed as required by veteran administration authorities. It also may be disclosed to Armed Forces personnel under certain circumstances and to authorized federal officials for the conduct of national security and intelligence activities.

Court Orders/Correctional Institutions:

Your protected health information may be disclosed in order to comply with court orders and other hearings. If you are an inmate in a correctional facility, your information may be disclosed for the provision of health care to you or the health and safety of you or others.

De-Identified Information

We may use or disclose information without your consent to the extent it has been redacted so as not to identify you individually. This includes the sharing of de-identified, aggregate information with affiliates and third parties.

Uses and Disclosures of Protected Health Information with Your Authorization

Your authorization is usually necessary to allow us to use or disclose your protected health information for certain marketing activities, including Treatment or Health Care Operations communications where we receive financial remuneration from a third party to communicate this information to you. We also do not sell your protected health information, nor will do we use or disclose your information for fundraising or other similar activities, except as permitted by law. Other uses and disclosures of protected health information will be made only with your written authorization, unless otherwise permitted or required by law.

You may revoke your authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization. Please see the Notice for contact information for this type of request.

Your Protected Health Information Rights

The following are additional rights you have in relation to your protected health information:

Right to Review or Copy Your Protected Health Information:

You have the right to review or copy records used to make decisions about your services. This right to review and/or copy does not include information needed for civil, criminal, administrative actions and proceedings, or psychotherapy notes, to the extent PersonifilRx has this information.

Right to Correct Information You Believe to be Incorrect or Incomplete:

You have the right to ask us to amend our records. All requests for amendments must be in writing. In certain cases, we may deny your request, as we may not have created the original information. All denials will be made in writing and will indicate how you can respond if you disagree.

Right to Request a List of Who Was Given Your Information and Why:

You have the right to have us provide you with a list of times when we have disclosed your protected health information for any purpose other than treatment, payment, or health care operations, national security purposes, or for any listing already provided to you. All requests must be in writing. We will require you to provide us with the specific information we need to fulfill your request, with specific dates required. This requirement applies for six years from the date of the disclosure. If you request a list more than once in a 12-month period, we may charge you certain actual costs in relation to your request.

Right to Request Restrictions:

You have the right to request restrictions on the way we use or disclose your protected health information for treatment, payment, or health care operations; however, we are not required to agree to these restrictions, unless that restriction is regarding disclosure of health information to your health plan and: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the health information pertains solely to a health care item or service for which you or another person (other than your health plan) paid for in full. If we agree to the restriction, we will comply with your request unless the information is needed to provide emergency treatment to you.

Right to Confidential Communications:

You have the right to reasonable requests to communicate with you about your protected health information by alternative means or to alternative locations. Your request will be evaluated and you will be notified if it can be done.

Right to Contact Information:

You may exercise any of the rights described above by contacting PersonifilRx at the phone and address listed in this Notice. All requests for review, restrictions, corrections and/or disclosures must be made in writing.

Changes to Privacy Practices

This notice may be changed or amended at any time. The changes are effective for all protected health information that we maintain. PersonifilRx will make available a new Notice of Privacy Practices whenever policy changes are made. The Notice may be accessed on our website at: www.personifilrx.com or you may request a paper copy.

For Questions, Concerns, and/or Complaints

If you are concerned about this Notice of Privacy Practices, wish to file a complaint, or wish to contact us to exercise your privacy rights, please contact PersonifilRx, LLC at (715) 852-5790 or (844) 780-2909 (toll-free). Or you may write to the following:

  • PersonifilRx, LLC
  • Attn: Compliance Officer
  • 800 Wisconsin St
  • Suite 18-101
  • Eau Claire, WI 54703-3588
  • English – For help to translate or understand this, please call 1-844-780-2909.
  • Spanish – Si necesita ayuda para traducir o entender este texto, por favor llame al teléfono 1-844-780-2909.
  • Russian – Если вам не всё понятно в этом документе, позвоните по телефону 1-844-780-2909.
  • Hmong – Yog xav tau kev pab txhais cov ntaub ntawv no kom koj totaub, hu rau 1-844-780-2909.
  • Somali – Si laguu siiyo kaalmo xagga tarjumaadda ama si aad u fahamtid, fadlanwac 1-844-780-2909.
  • TDD/TTY – 1-800-947-3529
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