HIPAA Notice of Privacy Practices

Health Mart Pharmacy, located at 15817 C W Hadan Dr, Bennington, Nebraska 68007, is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

We use and disclose health information about you for the following purposes:

Treatment: We may use your health information to provide you with pharmacy services, including dispensing medications, checking for drug interactions, and consulting with your healthcare providers.

Payment: We may use and disclose your health information to bill and receive payment from your health insurance plan or other payers.

Healthcare Operations: We may use and disclose your health information for our internal operations, including quality assessment, training, and compliance activities.

As Required by Law: We will disclose your health information when required by federal, state, or local law.

We may also use or disclose your health information for the following purposes without your authorization:

• To public health authorities to prevent or control disease
• To report suspected child abuse or neglect
• To the FDA regarding adverse events or product recalls
• To law enforcement in limited circumstances
• To avert a serious threat to health or safety
• For workers' compensation as authorized by law

For any purpose not described above, we will ask for your written authorization before using or disclosing your health information. You may revoke your authorization at any time in writing, except where we have already acted in reliance on it.

You have the following rights regarding your protected health information:

Right to Inspect and Copy: You have the right to inspect and receive a copy of your health information that we maintain in a designated record set.

Right to Amend: If you believe that health information we have about you is incorrect or incomplete, you may ask us to amend it.

Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your health information.

Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your health information.

Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time.

We reserve the right to change this notice and to make the revised notice effective for health information we already have about you as well as any information we receive in the future. We will post the current notice in our pharmacy. You may request a copy of any revised notice by contacting us.

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact:

Health Mart Pharmacy – Bennington
15817 C W Hadan Dr
Bennington, NE 68007
Phone: (402) 932-5556
Email: [email protected]

You will not be retaliated against for filing a complaint.