Notice of Privacy Practices

This notice describes how medical/medication information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or given out by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for health care providers that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.

We may use and disclose your medical records only for each of the following purposes: treatment, payment and health care operations.

  • Treatment: We may obtain information to dispense prescriptions and for the documentation of pertinent information in your records that may assist us in managing your medication therapy or your overall health. We may share this information with your other health care providers. An example would be when we call your doctor to OK refills or for prescription clarification and fill your prescription.
  • Payment means such activities as obtaining reimbursement for services, confirming insurance coverage, billing or collection activities, and utilization review. An example of this would be transmitting a claim for your prescription to your insurance company for payment or calling your insurance company for information to bill your claim.
  • Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost management analysis, and customer service. An example would be an internal quality assessment review.

Therefore, we will not disclose your prescription orders or the contents thereof, except to:

  • You, or another pharmacist acting on your behalf;
  • The licensed practitioner who issued the prescription;
  • The licensed practitioner who is currently treating you
  • Other providers within related health care entities when necessary for your current treatment
  • A member, inspector, or investigator of the board or any federal, state, county, or municipal officer whose duty it is to enforce the laws of this state or the United States relating to drugs and who is engaged in a specific investigation involving a designated person or drug;
  • An agency of government charged with the responsibility of providing medical care for you;
  • An insurance carrier or attorney on receipt of written authorization signed by you or your legal representative, authorizing the release of such information; and
  • Any person duly authorized by a court order.
  • To a Provider in a medical emergency when the provider is unable to obtain your consent due to your condition or the nature of the medical emergency;

We may also create and distribute de-identified health information by removing all references to individually identifiable information.

We may contact you to discuss compliance or provide you with medication information, or with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to our privacy officer:

  • The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
  • The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or alternative locations.
  • The right to inspect and copy your protected health information.
  • The right to amend you protected health information.
  • The right to receive an accounting of disclosures of protected health information.
  • The right to obtain a paper copy of this notice from us upon request

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

This notice is effective as of April 1, 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from Goodrich Pharmacy.

You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of Goodrich Pharmacy. We will not retaliate against you for filing a complaint.

Please contact us for more information
Steve Simenson. Privacy Officer
Goodrich Pharmacy
100 Monroe Street
Anoka, Minnesota 5530

For more information about HIPAA or to file a complaint:

The US Department of Health and Human Services
Office of Civil Rights
200 Independence Ave SW
Washington, D.C. 20201
Toll Free: 1-877-696-6775


This policy took effect April 14th, 2003