SHOPRITE PHARMACIES 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.
Protected Health Information (PHI) is information that may identify you and that relates to your
past, present or future physical or mental health or condition and related health-care services.
This Notice of Privacy Practices (Notice) describes your rights and how ShopRite Pharmacies may
use and disclose PHI to carry out treatment, payment or health-care operations and for other
purposes permitted or required by law.
ShopRite Pharmacies will not use or disclose PHI about you without your written permission,
except as described in this Notice. We are required by law to maintain the privacy of PHI and to
provide individuals with notice of our legal duties and privacy practices with respect to PHI.
We are also required to abide by the terms of this Notice of Privacy Practices. We may change our
practices and this Notice and make the new Notice effective for the PHI we maintain. If you request
it, we will provide you with any revised Notice.
Your Health Information Rights
You may obtain a paper copy of the Notice upon request, and you may request a copy
of the Notice at any time.
Even if you agreed to receive the Notice electronically, you are entitled to a paper copy.
For a copy, call 1-800-ShopRite (746-7748).
You may inspect and obtain a copy of your PHI, which usually includes prescription and billing
records, for as long as the ShopRite Pharmacies maintains the PHI.
To inspect or copy PHI about
you, send a written request to the Privacy Officer of your ShopRite Pharmacy. We may charge you
for copying, mailing and supplies needed to fulfill your request. We may deny your request in
certain circumstances, and you may ask to have the denial reviewed.
You may request a change to your PHI.
If you feel that PHI we maintain about you is incomplete or
incorrect, you may request an amendment to it for as long as we maintain the PHI. To request a
change, send a written request and a reason supporting the request to the Privacy Officer of your
ShopRite Pharmacy. If we deny your request, you may file a statement disagreeing with our decision,
and we may give a rebuttal to your statement.
You may request a restriction of your PHI.
This means that you may ask us not to use or disclose
any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also
request that any part of your PHI not be disclosed to family members or friends who may be involved
in your care or for notification purposes as described in this Notice of Privacy Practices. To
request a restriction, send a written request and the specific reason supporting the request to the
Privacy Officer of Your ShopRite Pharmacy. Your request must also list the individuals to whom you
want the restriction to apply. We are not required to agree to a requested restriction.
You may request a list of PHI disclosures we made about you after April 14, 2003, for purposes
other than treatment, payment, or health-care.
Some disclosures will not be included. Certain other
exceptions, restrictions, and limitations may also apply. To request a list, send a written request
to the Privacy Officer of your ShopRite Pharmacy. Specify the time period you need, but not longer
than six years. There is no charge for the first list requested within a 12-month period, but you
may be charged for the cost of providing additional lists. We will notify you of the cost, and
you may then withdraw or modify your request.
You may request communications of PHI by alternative means or at alternative locations. For
instance, you may ask that we contact you about medical matters only in writing or at a different
residence or post office box. To request confidential communication of PHI about you, send a
written request, including how or where you would like to be contacted, to the Privacy Officer of
your ShopRite Pharmacy. We will accommodate all reasonable requests.
How We May Use and Disclose PHI
For example, information obtained by the pharmacist will be used to dispense prescription
medications to you. We will include information in your record about the medications and
services you received.
For example, we will contact your insurer, pharmacy benefit manager or workers
compensation benefit manager to learn if it will pay for your prescription and what your copayment
is. We will bill you or a third-party payor for the cost of medications dispensed to you. The
information we send on or with the bill may include wording that identifies you and your
For health-care operations.
For example, we may use information in your health record to monitor the
performance of the pharmacists providing treatment to you, so we can improve the quality and
effectiveness of the service we provide. As necessary, we may share PHI with other healthcare
professionals for circumstances including, but not limited to, multiple prescribers or prescription
transfers between pharmacies.
To business associates:
Some services are provided by us through contracts with business associates.
We may disclose PHI about you to our business associates so they can perform their assigned job.
To protect your PHI, we require our business associates to sign legally binding agreements to
To individuals involved in your care or payment for your care:
Using their professional judgment,
health professionals such as pharmacists may disclose your PHI to a family member, relative,
friend, or any person identified by you, if these people need to know about your care, payment
related to your care, your location or condition.
For health-related communications:
We may send you refill reminders, information about treatment
alternatives or other health-related benefits and services that may interest you.
To the Food and Drug Administration (FDA):
We may disclose PHI about the effects of drugs, foods,
supplements, products and product defects, or other data that may show a need for product recalls,
repairs or replacement, or to prevent a serious threat to your health and safety or that of the
For workers’ compensation:
We may disclose PHI to comply with workers’ compensation or similar
For public health, disease control or to avert a serious threat to health or safety:
We may disclose PHI about you if needed to prevent a serious threat to your health and safety or the
health and safety of the public or another person.
To law enforcement officials and as required by law:
We may disclose PHI about you for law
enforcement purposes, in response to a subpoena or other legal process, when required to do so
by law or to comply with a discovery request or other lawful process related to a lawsuit or
We may disclose PHI about you to an oversight agency for legal activities
when needed for licensure or to monitor the health-care system, government programs and compliance
with civil rights laws.
We may disclose PHI about you to researchers if their research has been approved
by an institutional board that has reviewed the proposal and set out rules to ensure your privacy.
To coroners, medical examiners and funeral directors: We may release PHI about you to a coroner or
medical examiner if needed, for example, to identify a deceased person or determine cause of death,
or to funeral directors to fulfill their duties.
To organ or tissue procurement organizations:
Consistent with applicable law, we may disclose PHI
about you to groups that procure, bank, or transplant organs or tissues for donation and transplants.
We may contact you as part of a fundraising effort.
To a correctional institution:
If you are or become an inmate of a correctional institution, we may
disclose PHI to the institution or its agents when necessary for your health or the health and
safety of others.
To military authorities:
If you are in the armed forces or are a veteran, we may release PHI about
you as required by military command authorities. This applies also to foreign military personnel.
For national security, intelligence activities and presidential protection:
We may release PHI about
you to authorized federal officials for intelligence, counterintelligence, other national security
activities authorized by law and to provide protection to the President, other authorized persons or
foreign heads of state, or conduct special investigations.
For victims of abuse, neglect, or domestic violence:
We may disclose PHI about you to a government
agency if we reasonably believe you are a victim of abuse, neglect or domestic violence, but only
as required by law, if you agree to it, or we believe it necessary to prevent serious harm to you
or someone else.
Other Uses and Disclosures of PHI
ShopRite Pharmacies will obtain your written authorization before using or disclosing PHI about you
for reasons other than those listed or as permitted or required by law. You may revoke an
authorization in writing at any time. When we receive the revocation, we will stop using or disclosing
For More Information or to Report a Problem
For questions or more information, contact the Privacy Officer
at your ShopRite Pharmacy. If you
believe your privacy rights have been violated, you may file a complaint with the
Privacy Officer or
with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
This Notice is effective as of April 14, 2003