Understanding Your Medical Record and Your Health Information

Each time your prescription is filled by Southern Star Pharmacy or one of its affiliates (together affiliated covered entity), information about you is recorded in your medical record. Typically, this record consists of your pharmacy patient profile, diagnosis, laboratory results pertaining to medications, prescription information, and future care plans, and billing
information. Understanding your health information and how it is used helps to ensure that it is accurate, and that it is used and disclosed appropriately.

Your Health Information Privacy Rights

Although your medical record is the property of Southern Star Pharmacy, the information belongs to you. You have legal rights regarding your health information, which is described below. To exercise any of these rights, a written request with supporting reasons, must be submitted to the pharmacy manager. Requests that do not follow these guidelines may be denied. Your legal rights include a:

• Right to Access – With some exceptions, you have the right to review and copy your health information. We may charge a fee for the cost of copying, mailing, or other supplies associated with your request.

• Right to Amend – You have the right to request an amendment of your health information when it is incorrect or incomplete. This right exists as long as we keep this information.

• Right to an Accounting of Disclosures – You have the right to obtain a listing of those to whom we disclosed your health information. This right applies to disclosures other than those made for treatment, payment, health care operations; and those you specifically authorized. You can request an accounting for up to 6 years prior to the date of the request. The first request in a 12-month period is provided at no cost to you. There may be a charge for subsequent requests within the same 12-month period.

• Right to Request Restrictions – You have the right to request restrictions on the use or disclosing of your health information. We will use our best efforts to comply with all approved requests except when the information is needed to provide emergency treatment. We will provide you with a written explanation for denied requests or when we revoke a previously agreed to restriction.

• Right to Request Alternate Communications –You have the right to specify that communication with you be conducted in a particular manner or be directed to a certain location. We will attempt to accommodate all reasonable requests.

• Right to a Paper Copy of this Notice – You may request a paper copy of this Notice at any time.

• Right to Require Written Authorization – Any uses or disclosures of your health information, other than those described below will be made only with your advance written authorization, which you may grant or revoke at any time.

Use and Disclosure of Your Health Information

Federal privacy laws allow Southern Star Pharmacy to use and disclose your health information for the following reasons or to the following entities:

• Treatment – Members of Southern Star Pharmacy workforce (including pharmacists, pharmacy technicians) may use your health information to treat and care for you. We may disclose your health information to providers not affiliated with
Southern Star pharmacy to facilitate the care they provide you. For example, we may disclose your health information to the nursing facility where you are located, in order for them to administer the prescribed medication.

• Payment – Members of Southern Star Pharmacy workforce may use your heath information to request payment, for the treatment we provide. For example, we may disclose your health information to your health insurance plan, to a third party, worker’s compensation plan, or directly to you to request payment for the medications we provide.

• Health Care Operations – Members of Southern Star Pharmacy workforce may use your health information for health care operations of the pharmacy. Examples of these activities are: review our services, determine effectiveness of new treatments, evaluate our performance, provide training to our staff, or to identify future services offerings and those no longer needed.

• Patient Communication - We may contact you to provide alternative drug therapies, and other health services that may be of interest.

• Business Associates – We may disclose your information to service providers with whom we have contracted to provide a service on our behalf. We must have written assurances in place, before disclosing your information to our Business Associates.

• Research – All research studies require internal approval before your health information is disclosed. We will obtain your authorization if the researcher requires access to information that identifies you.

• Lawsuits, Disputes, Law Enforcement – We may disclose your information in response to a court or administrative order, subpoena, warrant, summons, or discovery request.

• Funeral Directors, Coroners, Medical Examiners – We may disclose your health information in order for these individuals to carry out their duties.

• Food and Drug Administration (FDA), Public Health Agencies, Health Oversight Agencies – We may disclose your information to: report adverse events with food, drugs, medical devices, dietary supplements, other products and product recalls; report births, deaths, child abuse, neglect, domestic violence; prevent or control disease, injury, disability; notify people possibly exposed to a disease or maybe spreading a disease; authorized organ donations; or as required by law.

• Correctional Institution – We may disclose your information when you are an inmate or under custody so the correctional institution can provide you health care, to protect your health and safety and that of others.

• Military Authorities – We may disclose your information when you are a member or veteran of the military.

Our Responsibilities

It is our responsibility to:
• Provide reasonable safeguards in order to protect the privacy of your health information;
• Use or disclose the minimum amount of information required to reasonably provide necessary services;
• Provide this Notice to you (upon your request) regarding our legal duties and privacy practices with respect to your health information;
• Post the current Notice in the pharmacy, as well as on our website; and
• Abide by the terms of this Notice.

We reserve the right to change our practices and to make the new provisions effective for all health information we maintain.
This Notice will specify the effective date on the first page.

State Law Requirements

Some states have adopted more stringent restrictions on the use or disclosure of your health information than those described above. If the Southern Star Pharmacy is located in such a state, these additional requirements will be included as an attachment to this Notice.

Southern Star Pharmacy Privacy Contact

If you have questions, or to exercise your rights, please contact the Southern Star Pharmacy Manager who is the Privacy Contact at the Southern Star pharmacy. If you believe your privacy rights have been violated, you may file a complaint with the pharmacy manager or you may file a complaint through our corporate compliance department at (844-290-7034). Additionally, you may file a written complaint with the Secretary of the Department of Health and Human Services. No retaliation will occur based on your filing a complaint.

Written information about this prescription has been provided for you. Please read this information before you take the medication. If you have questions concerning this prescription, a pharmacist is available during normal business hours to answer these questions at (972) 677-7891 or toll free at (844) 290-7034.

"Do not flush unused medications or pour down a sink or drain."

Complaints concerning the practice of pharmacy may be filed with the Texas State board of Pharmacy at: William P. Hobby Building 333 Guadalupe Street Ste 3-600 Austin, TX 78701. Phone: 512-305-8000
Thank you for using Southern Star Pharmacy.


Se ha proporcionado información escrita sobre esta receta para usted. Por favor, lea esta información antes de tomar el medicamento. Si tiene preguntas sobre esta receta, un farmacéutico estará disponible durante las horas hábiles normales para
responder a estas preguntas al (972) 677-7891 or toll free at (844) 290-7034.

No lave los medicamentos sin usar o vierta un fregadero o desagüe.

Las quejas referentes a la práctica de la farmacia pueden ser archivadas con el tablero del estado de Texas de la farmacia en William P. Hobby Building 333 Guadalupe Street Ste 3-600 Austin, TX 78701. Phone: 512-305-8000

Gracias, Southern Star Pharmacia

Privacy Policy