AEQUITA PHARMACY 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.

Aequita Pharmacy is a compounding pharmacy which respects your privacy. We will not give out your personal health information (PHI) to others unless you tell us to, or unless the law allows or requires us to do so. PHI is any information that identifies you and relates to your health care or payment for your health care.

We are required by law to keep your PHI private, to give you this Notice, and to follow the terms of this Notice. We have the right to change our practices and to make the changes effective for all PHI that we maintain. If we make changes to this Notice, you will see the updated version on our website. It is also posted at the pharmacy.

For more information about our privacy practices, or for additional copies of this Notice, please contact us at the pharmacy.

I. USING AND RELEASING PROTECTED HEALTH INFORMATION

A. Without Your Written Permission. We may use and share your health information without your written permission for the following reasons:

  1. Treatment: We may communicate with your medical provider(s) for purposes of your treatment. This will help any such providers stay informed about your care and also help ensure that all treatment you receive is appropriate.
  2. Payment: If not directly billed to you, we may use or disclose PHI to determine coverage for your medical care or to request payment from your health insurance plan, or for other reasons related to billing, claims management, and reimbursement. Information shared for these reasons may include your diagnoses and medications received from the pharmacy.
  3. Health Care Operations: We may use and share PHI for our health care operations, such as quality improvement activities, training programs, accreditation, certification, licensing or credentialing activities. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff.
  4. Required or Permitted by Law: We may share PHI when we are required or permitted to do so by law. For example, we may disclose PHI to proper authorities if we believe that you are a possible victim of abuse, neglect, or domestic violence. We may also share PHI if necessary to stop a serious threat to the health or safety of you or others. Other reasons we may disclose information could include: public health activities; requests from state or federal agencies; law enforcement; court order or other lawful process; approved research; workers’ compensation claims; military or national security agencies, coroners, medical examiners, and correctional institutions.

B. Contacting You. By providing Aequita Pharmacy any cell number to contact you, or by utilizing our general email to contact the pharmacy, or otherwise providing us with an email to contact you, you authorize Aequita Pharmacy to use those same means (cell phone and email) to reach out to you regarding your care and to discuss your care, including leaving you a voice message regarding your care, all in unencrypted manner.

C. Marketing Communications: Sale of PHI. We must have your written permission before using or sharing PHI for marketing or the sale of PHI, consistent with the related definitions and exceptions set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Other Uses and Disclosures. Any uses and disclosures besides those described in this Notice will only be made with your written permission. You may revoke any permission you choose to provide at any time by providing us with a written request, except to the extent we have already taken action in reliance on your permission.

II. YOUR INDIVIDUAL RIGHTS

A. Right to Inspect and Copy. You may request to see your PHI in records maintained by the pharmacy to inspect and/or request copies of the records. All requests to view records must be made in writing. Under limited circumstances, we may deny access to your records. We may charge a fee for the cost of copying and sending records you request.

B. Right to Alternative Communications. We will accommodate reasonable written requests by you to receive PHI by alternative means of communication or at alternative locations.

C. Right to Request Restrictions. You have the right to request limitations regarding PHI we use or share for treatment, payment, or health care operations. You must request limitations in writing addressed to the pharmacy. Please be advised that we are not required to agree to any limitations you request, unless your request is to limit disclosing PHI to a health plan for payment or health care operations and that PHI directly relates to a health care item or service that you or another person or entity on your behalf paid in full, and the disclosure is not otherwise required by law.

D. Right to Accounting of Disclosures. You may request in writing an accounting of disclosures of PHI made by us in the last six years, subject to certain restrictions and limitations.

E. Right to Request Amendment: You have the right to request that we amend your PHI. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.

F. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice by submitting a request to the pharmacy for fulfillment.

G. Right to Receive Notification of a Breach. We are required to notify you if we discover a breach of your PHI, according to requirements under federal law.

H. Questions and Complaints. If you have questions about your privacy rights, or are concerned that we have violated your privacy rights, you may contact us by phone or in writing at the pharmacy. You may also file a written complaint with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint with the Director or with our office.

I. Contact Information.

Aequita Pharmacy, LLC

12825 NE 126th Pl. Kirkland, WA 98034

Phone: 425-224-2330 Toll free: 844-282-1430

Email: info@aequitapharmacy.com

Privacy Officer: Nathan Kenney, PharmD, RPh

III. EFFECTIVE DATE

A. Effective Date. This Notice is effective on March 8, 2024 (v1).