NEXGEN COMPOUNDING & RESEARCH LABORATORIES, LLC 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.
Pharmacies are required by federal and state laws to maintain the privacy of “Protected Health Information” (PHI) and to provide you with notice about your rights and our legal duties and privacy practices with respect to your PHI. We must abide by the terms of this Notice while it is in effect. Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that may be more stringent than the federal standards. This Notice is effective as of November 17, 2015.
PHI is information about you, including demographic information, which can be reasonably used to identify you and which relates to your past, present, or future physical or mental health or condition, the provision of related health care services to you or the payment for that care. This Notice tells you about the ways in which pharmacies may collect, use, and disclose your PHI to carry out treatment, payment or health care operations and for other specified purposes permitted or required by law. Your rights concerning you PHI are also disclosed in this Notice.
HOW PHARMACIES MAY USE AND DISCLOSE YOUR PHI: We may use and disclose your PHI without your authorization for purposes of payment and health care operations or treatment.
Payment: We use and disclose your PHI in order to process claims and seek reimbursement for your health expenses covered by an insurer or plan.
Health Care Operations and Treatment: We use and disclose your PHI in order to perform our administrative activities, including data management. We may use and disclose your PHI to assist your health care providers (Example: doctors, dentists, hospitals, pharmacies) in your diagnosis and treatment.
OTHER DISCLOSURES OF YOUR PHI PERMITTED OR REQUIRED BY LAW:
Public Health Activities. Pharmacies may disclose about you, with some limitations, to public health agencies for reasons of preventing or controlling disease and enabling product recalls, repairs, or replacements.
Communication with Certain Individual Involved in Your Care or Payment. Pharmacies my disclose to any person you identify as relevant to their involvement in your care or related payments.
As required by Military Command Authorities. Pharmacies may disclose PHI about foreign military personnel to the appropriate agencies.
Correctional Institutions. If you are or become and inmate of a correctional institution, pharmacies may disclose when necessary to protect your personal or public health.
Victims of Abuse, Neglect, or Domestic Violence. Pharmacies may disclose to government agencies if there is reasonable proof you are a victim of abuse, neglect, or domestic violence.
Health Oversight Activities. Pharmacies may disclose to government oversight agencies as authorized by law, including audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system and compliance with laws and regulations.
Judicial and Administrative Proceedings. Pharmacies may disclose in response to a court order, administrative order, subpoena, discovery request, or other lawful process.
Coroners, Medical Examiners, Funeral Directors, or Organ Donation.
Research. Pharmacies may disclose about you provided that research is approved by an institutional review board and certain measures have been taken to protect your privacy.
Special Government Functions. Pharmacies may disclose to authorized federal officials for national security or intelligence activities.
OTHER DISCLOSURES OF YOUR PHI AS PERMITTED BY YOUR WRITTEN AUTHORIZATION: Other uses or disclosures of you PHI will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization at any time in writing, except to the extent the pharmacy has already taken action on the information disclosed.
YOUR RIGHTS REGARDING YOUR PHI:
YOU HAVE THE RIGHT TO ACCESS YOUR PHI, with some limited exceptions. These records include prescription, billing and claims information, and case or medical management records. To inspect or copy your PHI, you must request in writing. The pharmacy may charge you and administrative fee for the costs of copying, mailing, and supplies necessary to fulfill your request. If you are denied access due to certain limited circumstances, you may request that the denial be reviewed.
YOU HAVE THE RIGHT TO AMEND YOUR PHI, if the PHI maintained by the pharmacy is incorrect or incomplete. Your request must be made in writing and must include the reason you are seeking a change. The pharmacy may deny your request if you ask the pharmacy to amend information that was not created by the pharmacy or you ask the pharmacy to amend a record that is accurate and complete. If the pharmacy denies your request to amend, it must notify you in writing.
YOU HAVE THE RIGHT TO AN ACCOUNTING OF DISCLOSURES OR YOUR PHI MADE BY THE PHARMACY, with the exception of disclosures related to your treatment, billing or receipt of payment, health care operations, or disclosures made to your or with your authorization. Your request must be made in writing and must include the reason you are seeking an accounting and must state the time period for which you want the accounting. This time period may not be longer than 6 years. We may charge for an accounting and you will be informed of the cost in advance and you may choose to withdraw or modify your request at that time.
YOU HAVE THE RIGHT TO REQUEST RESTRICTIONS ON THE USE AND DISCLOSURE OF YOUR PHI unless the information is needed for an emergency or required by law. Your request must be made in writing and must state 1) what information you wish to limit; 2)whether you want to limit how we use or disclose your information; 3) to whom you wish the restrictions to apply. We may not agree to your request.
YOU HAVE THE RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS. You may request that the pharmacy will use a certain method to communicate with you about your PHI or that the pharmacy send pharmacy-related information to a certain location if the communication could endanger you. Your request must be made in writing and must specify how or where you wish to be contacted and must state how the usual way of communicating could endanger you. The pharmacy will accommodate reasonable requests.
YOU HAVE THE RIGHT TO RECEIVE A PAPER COPY OF THIS NOTICE.
HEALTH INFORMATION SECURITY: Pharmacy employees must follow the pharmacy’s security practices which limit access to customer health information. PHI information will be accessible only to those employees who need it to perform their job responsibilities. In addition, the pharmacies must maintain physical, administrative, and technical security measures to safeguard your PHI.
CHANGES TO THIS NOTICE: We reserve the right to change the terms of this Notice at any time, effective for PHI the pharmacy may already have about you as well as any information the pharmacy receives in the future. The pharmacy will provide you with a copy of the new Notice whenever a material change is made to the privacy practices described in this Notice.
COMPLAINTS OR WRITTEN REQUESTS: If you believe your rights to privacy of your PHI have been violated, you may file a complaint with the pharmacy. The complaint must be in writing. Requests for access to your PHI; amending of your PHI; accounting of PHI disclosures made by the pharmacy; restrictions on the use and disclosure of your PHI; and use of a certain method of communication from the pharmacy must be made in writing and delivered to the pharmacy.
STATE SPECIFIC PRIVACY POLICIES:
ALABAMA We will not disclose your personal health records to anyone without your authorization, except where it is in your best interest or where the law requires the disclosure.
ARIZONA: We will not disclose any confidential communicable disease related information unless the subject of that information has authorized us in writing to do so or unless state or federal law authorizes or requires the disclosure.
CONNECTICUT: We will not sell your individually identifiable medical record information. We will not disclose information about pharmaceutical services rendered to you to third parties without your consent, except to the following persons: (a) the prescribing practitioner or a pharmacist or another prescribing practitioner presently treating you when deemed medically appropriate; (b) a nurse who is acting as an agent for a prescribing practitioner that is presently treating you or a nurse providing care to you in a hospital; (c) third party payors who pay claims for pharmaceutical services rendered to you or who have a formal agreement or contract to audit any records or information in connection with such claims; (d) any governmental agency with statutory authority to review or obtain such information; (e) any individual, the state or federal government or any agency thereof or court pursuant to a subpoena; and (f) any individual, corporation, partnership or other legal entity which has a written agreement with the pharmacy to access the pharmacy’s database provided the information accessed is limited to data which does not identify specific individuals.
FLORIDA: We will not disclose your pharmacy records without your written authorization, except to: (a) you; (b) your legal representative; (c) the Department of Health pursuant to existing law; (d) in the event that you are incapacitated or unable to request your records, your spouse; and (e) in any civil or criminal proceeding, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice to you or your legal representative, by the party seeking the records.
GEORGIA: Unless authorized by you, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities: (a) the prescriber, or other licensed health care practitioners caring for you; (b) another licensed pharmacist for purposes of transferring a prescription or as part of a patient’s drug utilization review, or other patient counseling requirements; (c) the Board of Pharmacy, or its representative; or (d) any law enforcement personnel duly authorized to receive such information. We may also disclose your confidential information without your consent pursuant to a subpoena issued and signed by an authorized government official or a court order issued and signed by a judge of an appropriate court. We will not disclose AIDS confidential information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
HAWAII We will not disclose any HIV/AIDS/ARC-related information, except in situations where the subject of the information has provided us with prior written consent allowing the release or where we are authorized or required by state or federal law to make the disclosure.
IOWA: We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
IDAHO: We will not release your identifiable prescription information to anyone other than you or your designee, unless requested by any of the following persons or entities: (a) the Board of Pharmacy, or its representatives, acting in their official capacity; (b) the practitioner, or the practitioner’s designee, who issued your prescription; (c) other licensed health care professionals who are responsible for the your care; (d) agents of the Department of Health and Welfare when acting in their official capacity with reference to issues related to the practice of pharmacy; (e) agents of any board whose practitioners have prescriptive authority, when the board is enforcing laws governing that practitioner; (f) an agency of government charged with the responsibility for providing medical care for you; (g) the federal Food and Drug Administration, for purposes relating to monitoring of adverse drug events in compliance with the requirements of federal law, rules or regulations adopted by the FDA; and (h) the authorized insurance benefit provider or health plan that provides your health care coverage or pharmacy benefits.
INDIANA: We will disclose your confidential information only when it is in your best interests, when the information is requested by the Board of Pharmacy or its representatives or by a law enforcement officer charged with the enforcement of laws pertaining to drugs or devices or the practice of pharmacy, or when disclosure is essential to our business operations.
KENTUCKY: We will only use your information to provide pharmacy care. We will not disclose your patient information or the nature of professional services rendered to you without your express consent or without a court order, except to the following authorized persons: (a) members, inspectors, or agents of the Board of Pharmacy; (b) you, your agent, or another pharmacist acting on your behalf; (c) another person, upon your request; (d) licensed health care personnel who are responsible for your care; (e) certain state government agents charged with enforcing the controlled substances laws; (f) federal, state, or municipal government officers who are investigating a specific person regarding drug charges; and (g) a government agency that may be providing medical care to you, upon that agency’s written request for information.
MAINE: We will not disclose your health care information for fundraising purposes or to coroners or funeral directors, without your authorization. We will only disclose patient identifiable communicable disease information to Department of Human Services for adult or child protection purposes or to other public health officials, agents or agencies or to officials of a school where a child is enrolled, for public health purposes. In a public health emergency, as declared by the state health officer, we may also release your information to private health care providers and agencies for the purpose of preventing further disease transmission.
MICHIGAN Unless authorized by you, we will not disclose your prescription or equivalent record on file, except to the following persons: (a) you, or another pharmacist acting on your behalf; (b) the authorized prescribed who issued the prescription, or a licensed health professional who is currently treating you; (c) an agency or agent of government responsible for the enforcement of laws relating to drugs and devices; or (d) a person authorized by a court order. We will not disclose AIDS-related information about an individual except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
MINNESOTA: We will not disclose your prescription orders or the contents thereof, except to: (a) you, your agent, or another pharmacist acting on your behalf or your agent’s behalf; (b) the licensed practitioner who issued the prescription; (c) the licensed practitioner who is currently treating you; (d) 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; (e) an agency of government charged with the responsibility of providing medical care for you; (f) an insurance carrier or attorney on receipt of written authorization signed by you or your legal representative, authorizing the release of such information; and (g) any person duly authorized by a court order. Unless we have obtained your oral or written consent, we will not disclose the nature of pharmaceutical services rendered to you, except as follows: (a) pursuant to an order or direction of a court; (b) to other pharmacies; (c) to you; or (d) drug therapy information to your physician.
MISSOURI: Unless specifically authorized by you, we will not release your pharmacy records to anyone other than: (a) you or any other person authorized by you to receive the information; (b) the authorized prescriber who issued the prescription order, or a licensed health professional who is currently treating you; (c) in response to lawful requests from a court or grand jury; (d) a person authorized by a court order; (e) to transfer medical or prescription information between pharmacists as provided by law; or (f) government agencies acting within the scope of their statutory authority. We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
MONTANA: We will not disclose information concerning persons infected, or reasonably suspected to be infected with a sexually transmitted disease, except to: (a) personnel of the Department of Public Health and Human Services; (b) a physician who has obtained the written consent of the person whose record is requested; or (c) a local health officer.
NEW HAMPSHIRE: We will not use, release, or sell your identifiable medical information for the purpose of sales or marketing of services or products unless you have provided us with a written authorization permitting such activity. We will only disclose your professional records if: (a) we have obtained your permission to do so; (b) it is an emergency situation and it is in your best interest for us to disclose the information; or (c) the law requires us to disclose the information.
NEW MEXICO: Unless we receive a written consent from you, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities: (a) pursuant to the order or direction of a court; (b) to the prescriber or other licensed practitioner caring for you; (c) to another licensed pharmacist where it is in your best interest; (d) to the Board of Pharmacy or its representative or to such other persons or governmental agencies duly authorized by law to receive such information; (e) to transfer a prescription to another pharmacy as required by the provisions of patient counseling; (f) to provide a copy of a nonrefillable prescription to you; (g) to provide drug therapy information to physicians or other authorized prescribers for their patients; or (h) as required by the provisions of the patient counseling regulations.
NEW YORK: We may not give a patient a copy of a prescription for a controlled substance, and for copies of other types of prescriptions, we must indicate that the copy is for informational purposes only.
NEVADA We will not disclose the contents of your prescriptions or disclose any copies of your prescriptions, other than to you, except to: (a) the practitioner who issued the prescription; (b) the practitioner who is currently treating you; (c) a member, inspector or investigator of the Board of Pharmacy, an inspector of the FDA, or an agent of the investigation division of the department of public safety; (d) an agency of state government charged with the responsibility of providing medical care for you; (e) an insurance carrier, on receipt of your written authorization or your legal guardian authorizing the release of information; (f) any person authorized by an order of a district court; (g) a member, inspector, or investigator of a professional licensing board that licenses the practitioner who orders the prescriptions filled at the pharmacy; and (h) other registered pharmacists for the limited purpose of and to the extent necessary for the exchange of information regarding persons suspected of misusing prescriptions to obtain excessive amounts of drugs or failing to use a drug in conformity with the directions for its use, or taking a drug in combination with other drugs in a manner that could result in injury to that person. We will not disclose any personal information about an individual who has, or is suspected of having, a communicable disease, without the individual’s written consent, except as follows: (a) for statistical purposes, as long as the identity of the person is not discernible from the information disclosed; (b) in a prosecution for a violation or a proceeding for an injunction brought pursuant to the communicable disease laws; (c) neglect of a child or elderly person; (d) to any person who has a medical need to know the information for his own protection or for in reporting the actual or suspected abuse or the well-being of a patient or dependent person, as determined by the health authority in accordance with regulations of the state board of health; (e) pursuant to specified statutes that require the reporting of certain test results; (f) if the disclosure is made to the department of human resources and the person about whom the disclosure is made has been diagnosed as having AIDS or an illness related to HIV and is a recipient of or an applicant for Medicaid; (g) to a fireman, police officer or person providing emergency medical services if the board has determined that the information relates to a communicable disease significantly related to that occupation and the information is disclosed in the manner prescribed by the state board of health; and (h) if the disclosure is authorized or required by specific statute.
NORTH CAROLINA: We will not disclose or provide a copy of your prescription orders on file, except to: (a) you; (b) your parent or guardian or other person acting in loco parentis if you are a minor and have not lawfully consented to the treatment of the condition for which the prescription was issued; (c) the licensed practitioner who issued the prescription or who is treating you; (d) a pharmacist who is providing pharmacy services to you; (e) anyone who presents a written authorization for the release of pharmacy information signed by you or your legal representative; (f) any person authorized by subpoena, court order or statute; (g) any firm, company, association, partnership, business trust, or corporation who by law or by contract is responsible for providing or paying for medical care for you; (h) any member or designated employee of the Board of Pharmacy; (i) the executor, administrator or spouse of a deceased patient; (j) Board-approved researchers, if there are adequate safeguards to protect the confidential information; and (k) the person who owns the pharmacy or his licensed agent.
NORTH DAKOTA: We will not disclose the nature of the services we provide to you to anyone other than you, without first obtaining your oral or written consent, except that we may disclose such information: (a) to other pharmacies; (b) to your physician; or (c) as ordered or directed by a court.
OHIO: Unless we have obtained your written consent, we will only disclose your pharmacy records to: (a) you; (b) the prescriber who issued the prescription or medication order (c) certified/licensed health care personnel who are responsible for your care; (d) a member, inspector, agent, or investigator of the state board of pharmacy or any federal, state, county, or municipal officer whose duty 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; (e) an agent of the state medical board when enforcing the statutes governing physicians and limited practitioners; (f) an agency of government charged with the responsibility of providing medical care for you, upon a written request by an authorized representative of the agency requesting such information; (g) an agent of a medical insurance company who provides prescription insurance coverage to you, upon authorization and proof of insurance by you or proof of payment by the insurance company for those medications whose information is requested; (h) an agent who contracts with the pharmacy as a “business associate” in accordance with the regulations promulgated by the secretary of the United States department of health and human services pursuant to the federal standards for privacy of individually identifiable health information; or (i) in emergency situations, when it is in your best interest.
OKLAHOMA: We will not divulge the nature of your problems or ailments or any confidence you have entrusted to the pharmacist in his professional capacity, except in response to legal requirements or where its in your best interest. We will not disclose information which identifies any person who has or may have a communicable or venereal disease, unless authorized by the individual or as otherwise permitted under state law. Whenever possible, we will de-identify such information prior to disclosure.
PENNSYLVANIA: We will not disclose any HIV-related information, except in situations where the subject of the information has provided us with a written consent allowing the release or where we are authorized or required by state or federal law to make the disclosure.
RHODE ISLAND: We will only disclose your prescription information to our agents and persons directly involved in your care. We will not disclose your confidential health care information without your consent, except in certain limited situations, as permitted under R.I. Gen. Laws § 5-37.3-4(b). Such situations may include: (a) to medical personnel who believe in good faith that the information is necessary for diagnosis or treatment in a medical or dental emergency; (b) to qualified personnel for the purpose of conducting scientific research, management audits, financial audits, program evaluations, actuarial, insurance underwriting, or similar studies, provided that personnel shall not identify, directly or indirectly, any individual patient in any report of that research, audit, or evaluation, or otherwise disclose patient identities in any manner; (c) to appropriate law enforcement personnel, or to a person if the health care provider believes that person or his or her family to be in danger from a patient; or to appropriate law enforcement personnel if the patient has or is attempting to obtain narcotic drugs from the health care provider illegally; (d) to the state medical examiner in the event of a fatality that comes under his or her jurisdiction; or e) to the attorneys for a health care provider whenever that provider considers that release of information to be necessary in order to receive adequate legal representation; (e) to a grand jury or to a court of competent jurisdiction pursuant to a subpoena or subpoena duces tecum when that information is required for the investigation or prosecution of criminal wrongdoing by a health care provider relating to his or her or its provisions of health care services and that information is unavailable from any other source; provided, that any information so obtained is not admissible in any criminal proceeding against the patient to whom that information pertains; (f) to the state board of elections pursuant to a subpoena or subpoena duces tecum when that information is required to determine the eligibility of a person to vote by mail ballot and/or the legitimacy of a certification by a physician attesting to a voter’s illness or disability; or (g) to the foster parent or parents pertaining to the disclosure of health care records of children in the custody of the foster parent or parents; provided, that the foster parent or parents receive appropriate training and have ongoing availability of supervisory assistance in the use of sensitive information that may be the source of distress to these children.
SOUTH CAROLINA We will not disclose your prescription drug information without first obtaining your consent, except in the following circumstances: (a) the lawful transmission of a prescription drug order in accordance with state and federal laws pertaining to the practice of pharmacy; (b) communications among licensed practitioners, pharmacists and other health care professionals who are providing or have provided services to you; (c) information gained as a result of a person requesting informational material from a prescription drug or device manufacturer or vendor; (d) information necessary to effect the recall of a defective drug or device or protect the health and welfare of an individual or the public; (e) information whereby the release is mandated by other state or federal laws, court order, or subpoena or regulations (e.g., accreditation or licensure requirements); (f) information necessary to adjudicate or process payment claims for health care, if the recipient makes no further use or disclosure of the information; (g) information voluntarily disclosed by you to entities outside of the provider-patient relationship; (h) information used in clinical research monitored by an institutional review board, with your written authorization; (i) information which does not identify you by name, or that is encoded so that identifying you by name or address is generally not possible, and that is used for epidemiological studies, research, statistical analysis, medical outcomes, or pharmacoeconomic research; (j) information transferred in connection with the sale of a business; (k) information necessary to disclose to third parties in order to perform quality assurance programs, medical records review, internal audits or similar programs, if the third party makes no other use or disclosure of the information; (l) information that may be revealed to a party who obtains a dispensed prescription on your behalf; or (m) information necessary in order for a health plan licensed by the South Carolina Department of Insurance to perform case management, utilization management, and disease management for individuals enrolled in the health plan, if the third party makes no other use or disclosure of the information. We will not disclose your information or the nature of professional pharmacy services rendered to you, without your express consent or the order or direction of a court, except to: (a) you, or your agent, or another pharmacist acting on your behalf; (b) the practitioner who issued the prescription drug order; (c) certified/licensed health care personnel who are responsible for your care; (d) an inspector, agent or investigator from the Board of Pharmacy or any federal, state, county, or municipal officer whose duty is to enforce the laws of South Carolina or the United States relating to drugs or devices and who is engaged in a specific investigation involving a designated person or drug; and (e) a government agency charged with the responsibility of providing medical care for you upon written request by an authorized representative of the agency requesting the information.
TENNESSEE: We will obtain your authorization before we disclose your patient records for any reason, except where: (a) the disclosure is in your best interest; (b) the law requires the disclosure; or (c) the disclosure is to an authorized prescriber or to communicate a prescription order where necessary to: i. carry out prospective drug use review as required by law; ii. assist prescribers in obtaining a comprehensive drug history on you; or iii. prevent abuse or misuse of a drug or device and the diversion of controlled substances. We will not disclose your name and address or other identifying information, except to: (a) a health or government authority pursuant to any reporting required by law; (b) an interested third-party payor for the purpose of utilization review, case management, peer reviews, or other administrative functions; or (c) in response to a subpoena issued by a court of competent jurisdiction. We will not sell your name and address or other identifying information for any purpose.
TEXAS: We will only release your confidential record to you, your agent, or to: (a) a practitioner or another pharmacist if, in the pharmacist’s professional judgment, the release is necessary to protect your health and well-being; (b) the pharmacy board or another state or federal agency authorized by law to receive the record; (c) a law enforcement agency engaged in investigation of a suspected violation of the controlled substances laws, or the Comprehensive Drug Abuse Prevent Control Act of 1970; (d) a person employed by a state agency that licenses a practitioner, if the person is performing the person’s official duties; or (e) an insurance carrier or other third party payor authorized by the patient to receive the information.
UTAH: We will not release or discuss information in your prescription or medication profile to anyone except: (a) you or your legal guardian or designee; (b) a lawfully authorized federal, state, or local drug enforcement officer; a third party payment program authorized by you; (c) another pharmacist, pharmacy intern, pharmacy technician, or prescribing practitioner providing services to you or to whom you have requested us transfer a prescription; and (d) your attorney, with a written authorization signed by: i. you before a notary public; ii. your parent or lawful guardian, if you are a minor; iii. your lawful guardian, if you are incompetent; or iv. your personal representative, in the case of deceased patients.
WASHINGTON: We will not disclose any information regarding an individual’s treatment for a sexually transmitted diseases, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure. Unless authorized by you, we will not disclose your health care information except in limited circumstances permitted by law. Such permitted disclosures may include: (a) To a person who the provider reasonably believes is providing health care to the patient; (b) To any other person who requires health care information for health care education, or to provide planning, quality assurance, peer review, or administrative, legal, financial, or actuarial services to the health care provider; or for assisting the health care provider in the delivery of health care and the health care provider reasonably believes that the person: i. Will not use or disclose the health care information for any other purpose; and ii. Will take appropriate steps to protect the health care information; (c) To any other health care provider reasonably believed to have previously provided health care to the patient, to the extent necessary to provide health care to the patient, unless the patient has instructed the health care provider in writing not to make the disclosure; (d) To any person if the health care provider reasonably believes that disclosure will avoid or minimize an imminent danger to the health or safety of the patient or any other individual, however there is no obligation under this chapter on the part of the provider to so disclose; (e) Oral, made to immediate family members of the patient, or any other individual with whom the patient is known to have a close personal relationship, if made in accordance with good medical or other professional practice, unless the patient has instructed the health care provider in writing not to make the disclosure; (f) To a health care provider who is the successor in interest to the health care provider maintaining the health care information; (g) To a person who obtains information for purposes of an audit, if that person agrees in writing to certain restrictions. (h) To an official of a penal or other custodial institution in which the patient is detained; or (i) To provide directory information, unless the patient has instructed the health care provider not to make the disclosure.
WEST VIRGINIA We will not disclose confidential information relating to an individual who is obtaining or has obtained treatment for a mental illness, without the individual’s written consent, except in the following circumstances: (a) with the signed, written consent of the individual or his legal guardian; (b) in certain proceedings involving involuntary examinations; (c) pursuant to a court order in which the court found the relevance of the information to outweigh the importance of maintaining the confidentiality of the information; (d) to protect against clear and substantial danger of imminent injury by the individual to himself or another; or (e) to staff of the mental health facility where the individual is being cared for or to other health professionals involved in treatment of the individual, for treatment or internal review purposes.
WISCONSIN: We will not disclose your prescription records to anyone other than you or someone authorized by you without first obtaining your written informed consent.
WYOMING: Unless we have received an authorization from you, we will only disclose your confidential information to: (a) you, or as you direct; (b) to those practitioners and other pharmacists where, in the pharmacist’s professional judgment such release is necessary for treatment or to protect your health and well being; (c) to such other persons or governmental agencies authorized by law to investigate controlled substance law violations; (d) a minor’s parent or guardian; (e) your third party payor; or (f) your agent.
NexGen Pharmaceuticals LLC
2005 FORT WORTH HWY, SUITE 100
WEATHERFORD, TX 76086
Effective Date: 8/12/2019