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.
The Department of Health and Human Services (HHS) Health Insurance Portability and Accountability Act (HIPAA) was passed to promote standardization and efficiency within the healthcare industry. It created what is known as Protected Health Information (PHI), which is any healthcare information that may specifically identify you, including demographic information, information about your past, present, or future medical conditions, including physical and mental health, or any treatment or related healthcare services. Avella Specialty Pharmacy, Inc. (Avella) would like to make you aware of your rights and our responsibilities, as identified by HIPAA.
CLICK TO DOWNLOAD THE HIPAA AUTHORIZATION FOR DISCLOSURE FORM
Uses and Disclosures
Avella may use your PHI in the preparation of your order. This may include prescription and over-the-counter medication, as well as medical devices and educational programs. We may use your information to contact you, your representative, your physician, or your third party payor (i.e. insurance company) to prepare your order or provide services.
We collect information from you or your representative in order to accurately and beneficially provide you with care. None of your information is ever sold, either during or after your treatment with Avella. Occasionally, we may contact you, your representative, your healthcare provider, or your third party payor to suggest treatment options, offer reminders of therapy, find alternatives for care, or to resolve payment issues. Your physician may be contacted in order for us to clarify or discuss treatment, as well as ask for refills and changes, per your request. Your third party payor may be contacted to determine coverage or eligibility, discuss payment or reimbursement, or to gather additional information in an attempt to submit claims.
Any communication necessary to provide and maintain our high standard of care would be carried out as needed; however, it would always be executed within the limits of HIPAA and constrained to the release or collection of the minimum amount of information.
Business Associates (i.e. insurance companies, pharmacy benefits managers, etc.) of Avella may have access to your PHI from time to time. These companies are either covered by the laws of HIPAA or have agreed to abide by these laws through Business Associate Contracts they have signed with us. We will hold all entities with which we do business to the standards of our privacy practices and HIPAA laws. Any company wavering from these policies will be given notice of their shortcomings with an opportunity to correct their mistakes. Associations will be severed with associates who are unable to continually maintain these privacy standards.
Be assured that at all time, Avella will release or collect only the minimum amount of information necessary to accomplish its objective. We apply the most stringent standard of law, whether state or federal, to the protection of your PHI.
Orders may be placed, altered, and picked-up, and PHI may be given to or changed by someone other than yourself, with your permission. For current patients, Avella would apply historical standards to your care. For instance, if a spouse or caregiver has regularly attended to your orders and PHI, this would be considered the standard. To ensure seamless service, please request a HIPAA Authorization form from Avella, or download one on Avella’s web site at: http://avella.com/About-Us/Privacy-Practices.aspx.
Information may be disclosed without your consent in certain circumstances, as required by law. These include requests from the Department of Health and Human Services, state departments of insurance, law enforcement agencies, and court orders, as well as other public health, military, and judicial agencies. We will comply with all requests by authorized agencies, but will only release the information necessary to fulfill the request, as required by law. In these instances, you would be notified of any such disclosures, in accordance with the law.
It is required that a written release be obtained by Avella in order to use or disclose any PHI not otherwise described in this notice. Additionally, the following requires an authorization by patient: uses and disclosures of PHI for marketing purposes, any reference to genetic information and disclosures that constitute a sale of PHI. You may revoke this authorization at any time with a written request.
A request for access to your information may be made to our Privacy Officer during business hours. Avella has up to 30 days to make your Protected Health Information available to you, and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request.
You have the right to request that any information in your record which you believe to be incorrect or incomplete be corrected or added to, once complete and accurate information is verified. You may make an amendment to your PHI at any time, although this amendment may or may not influence the content or release of your information, but it will be kept as a permanent part of your record. You may request that any correspondence with regard to your PHI be delivered to you by means other than in person. A written request must be received, acknowledging the fact that you would possibly endanger yourself or your information, before such information is delivered by alternative means. Your PHI is protected for 50 years after your death; after that, it is no longer considered PHI.
If your Protected Health Information is maintained in an electronic format, you have the right to request an electronic copy of your record sent to you or transmitted to another individual or entity, as long as it has been authorized by you in writing. We will make every effort to provide access to your Protected Health Information in the format you request. If the Protected Health Information is not readily producible in the format you request, your record will be provided in either our standard electronic format or hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
You may request that your information not be shared with certain individuals, such as family members, Business Associates or other HIPAA Covered Entities, such as third party payors, pharmacy benefits managers, or physicians. You also have the right to restrict disclosure of information to health plans if the services were paid in full by you. You may request a list of all disclosures of your health information that we have made to others. We do not routinely monitor these disclosures, with some exceptions as required by law, but will accommodate the request to the best of our ability. Avella will consider all of the above requests, but we are not legally required to fulfill them.
You have the right to be notified upon a breach of any of your unsecured Protected Health Information, and a notice will be mailed to you if this should occur.
Avella has a legal duty to protect the privacy of your information, to provide and make available our Notice of Privacy Practices and legal duties, including updates and revisions, and to abide by the terms of this notice.
Should you disagree with a decision that has been made with regard to your records, or believe that your rights have been violated, you may contact our Privacy Officer, listed below. Also, you may contact your state’s Board of Pharmacy. Finally, you have the right to file a complaint with the Secretary of the Department of Health and Human Services. In accordance with Federal Regulation 160.306, your complaint must be filed in writing within 180 days of the violation, unless good cause is found to waive this time limit. The complaint must list the entity thought to be in violation and the subject of the violation, as well as describe the standards, requirements, or specifications believed to have been violated. Avella will not retaliate against any person who files a complaint.
Requests and Information
We are dedicated to protecting your privacy. This Notice of Privacy Practices may be updated and revised over time. To submit requests for records or disclosures, to correct or add information or restrictions to your record, or to receive more details about HIPAA and Avella’s privacy practices, please contact our Privacy Officer by telephone at (480) 248-2555 or by mail at:
Avella Specialty Pharmacy
Attn: Privacy Officer
1606 W. Whispering Wind Dr.
Phoenix, AZ 85085