Union Center Pharmacy, Inc.       2324 Eastlake Ave E, Suite 405      Seattle, WA 98102      206-441-9174

This NOTICE Describes How Medical Information about You may be Used & Disclosed, & How You Can Gain Access to This Information. Please review it carefully. EFFECTIVE DATE: April 14, 2003, Uses & Disclosures of Protected Health Information:

1.Under applicable law, we are required to protect the privacy of your individual health information, also called PHI: Protected Health Information.  We are also required to provide you with this Notice regarding our policies & procedures regarding your PHI & to abide by the terms of this notice, as it may be updated from time to time.  We are permitted to make certain types of uses & disclosures under applicable law for treatment, payment, & healthcare operations purposes.  We may obtain information to dispense prescriptions & for the documentation of pertinent information in your records that may assist us in managing your medication therapy or your overall health.  For treatment purposes, such use & disclosure will take place in providing, coordinating, or managing healthcare & its related services by one or more of your providers, such as when your pharmacist consults with your physician or a specialist regarding your medications, treatment or condition.

For payment purposes, such use & disclosure will take place to obtain or provide reimbursement for providing pharmaceutical care services, such as when your case is reviewed to ensure that appropriate care was rendered.  For reimbursement purposes, your PHI may be disclosed to one or several intermediaries employed by your plan sponsor including but not limited to insurers, pharmacy benefits managers, claims administrators & computer switching companies.

For healthcare operations purposes, such use & disclosure will take place in a number of ways, including for quality assessment & improvement; provider review & training; underwriting activities; reviews & compliance activities; & planning, development, management & administration. Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided.

We store some of your PHI in electronic computer files.  We backup our electronic records daily & employ other precautions to safeguard the integrity of your PHI.  In spite of these precautions it is possible but unlikely that a computer crash or other technological failure could cause the loss of data.  In addition reasonable safeguards are employed to protect your PHI stored on electronic media.

In addition, we may contact you to provide refill reminders, health screenings, wellness events, inoculation, vaccinations or information about treatment alternatives or other health-related benefits & services that may be of interest to you.  Also, we may disclose your health information to your plan sponsor. 

We may use & disclose your PHI without your authorization when the pharmacy needs to contact a physician or physician’s staff & is permitted or required to do so without individual written authorization.  We may use & disclose your PHI if we are contacted by another pharmacy who states they have your request & consent to transfer pharmacy records to them.

We may employ the services of business associates who may assist us in one or more tasks & who may use, change or create PHI.  Business associates are required to comply with all the privacy regulations on your behalf.

We may disclose PHI about you without your authorization to comply with workers compensation laws, as required by law, legal proceedings, public health requirements, health oversight activities & as required by law.  Other uses & disclosures will be made via your written authorization.  2. You may ask us to restrict uses & disclosures of your PHI to carry out treatment, payment, or healthcare operations, or to restrict uses & disclosures to family, relatives, friends, or other persons identified by you who are involved in your care or payment for your care.  However, we are not required to agree to your request.  3. You have the right to request the following regarding your PHI:  a. inspection & copying; b. amendment or correction; c. an accounting of the disclosures of this information by us (we are not required to account to you disclosures made for treatment, payment, operations, to your care givers, or as otherwise excluded by law); & d. the right to receive a copy of this notice upon request.  We may require you to pay for this request to cover our costs.

In addition, you may request, & we must accommodate the request, if reasonable, to receive communications of PHI by alternative means or locations.  To make this request please contact, in writing:

Privacy Officer, Kelley-Ross Pharmacy, 616 Olive Way, Seattle, WA, 98101

4. We may use your name to reference your prescription & pharmaceutical care services.  You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this Notice & the disclosure of PHI as outlined herein.  We may disclose this information to other persons who ask for you or your prescriptions by name.  You may restrict or prohibit these uses & disclosures by notifying a pharmacy representative orally or in writing of your restriction or prohibition.  We are not required to honor those requests.  We are able to provide treatment services to you even if you object to sign the acknowledgment of the receipt of this Notice or if we decide not to honor a request regarding the information in this document.  In the event of an emergency or your incapacity, we will do in our reasonable judgment what is consistent with your known preference, & what we determine to be in your best interest.  We will inform you of any such uses or disclosures if uses & disclosures would require your signed authorization under such circumstances & give you an opportunity to object as soon as practicable.  5. We may disclose to family, relative, friend, or to any other person identified by you, PHI that is directly relevant to the person’s involvement with your care or payment related to your care.  We may also use or disclose the PHI to notify, identify, or locate a member of your family, your personal representative, another person responsible for care, or certain disaster relief agencies of your location, general condition, or death.  If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do in our judgment what is in your best interest regarding such disclosure & will disclose only the information that is directly relevant to the person’s involvement with your healthcare.  We will also use our judgment & experience regarding your best interest in allowing people to pickup filled prescriptions, or other forms of PHI. 

6. We reserve the right to change the terms of the Notice & to make new Notice provisions effective for all PHI we maintain.  You may receive a copy upon request. 7. If you believe that your privacy rights have been violated, you may complain to us via the contact listed in #3 above, or to the Secretary of the Dept. of Health & Human Services, Hubert H. Humphrey Building, 200 Independence Ave SW, Washington, DC   20201.  You will not be retaliated against for filing a complaint. 

You may contact us for further information at any of the above listed pharmacies.