Notice of Privacy Practices

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

Protecting the privacy of information about your medical conditions and health is a responsibility Wilkinson Pharmacy takes very seriously. We understand that information about your health is personal, and it is important that we keep it confidential. We are committed to the practices and procedures we establish to protect the confidential nature of information about your health.

This notice describes the ways in which we may use and disclose information about your health to carry out treatment, payment and health care operations and for other purposes as permitted or required by law. It also describes your rights and our duties regarding the use and disclosure of health information.

Uses and Disclosure without Your Authorization
Your Private Healthcare Information (PHI) will be used in Treatment, Payment and Operations in providing you quality care. This quality care includes customer service, account maintenance, and information and correspondence concerning products that may be of interest or benefit to you. Any individual representing you as your health care agent is considered to have been given consent by you and will have access to your PHI.

• Treatment: Providing medication, equipment and related services to you to treat your health conditions.
• Payment: Generally, we will disclose information about your health to obtain reimbursement of incurred expenses for your medication, equipment and related services to you to treat your health conditions. This includes, but is not limited to conversations with other health care providers, insurance companies, and care partners attending to your expenses.
• Operations: Information about your healthcare will be disclosed as is necessary for our business to make sure you receive quality service. Wilkinson Pharmacy, Inc. will not sell your PHI to any individuals or outside marketing firms.
• Legal Requirements: PHI will be disclosed as required by law. An example of this includes disclosure to the Missouri Board of Pharmacy Inspector, the DEA, a court order, or other legally required disclosures.

Your Health Care Rights
All requests to exercise any of your rights outlined below must be received in writing, and addressed to:

ATTN: PRIVACY OFFICER
WILKINSON PHARMACY INC
PO BOX 365
NEVADA MO 64772-0365

As a patient you have the right to request a review of and inspect a copy of your health care information and certain disclosures of your PHI that may have been made. You may request to receive a review of any disclosures after April 14, 2003. Please note that the right to receive this information is subject to certain exceptions, restrictions and limitations. Additionally, a fee of up to $15.00 plus $.35 per page may apply as is outlined by Mo. Ann. Stat. 191.227 (West 2002).

• Disclosures: Any disclosure of PHI outside of treatment, payment and operations will be recorded in your patient history. As a patient you have the right to request a review of your PHI. This disclosure applies to disclosures for purposes outside of treatment, payment and operations; or disclosures as otherwise permitted or required by law.
• Restrictions: You have the right to restrict and/or request confidential communications, if you believe our normal communication channels would endanger you. Your request must include the reason for the restriction/confidentiality, and your proposed alternative forms of communication methods. All reasonable confidential communication and restriction requests will be reviewed and accommodated as is administratively feasible. If your request for either restriction or confidential communication is feasible, the Privacy Officer will notify you in writing within 60 days from the date of the approval of your request.
• Complaints: If you believe your PHI rights have been violated, you may file a complaint with the Privacy Office, and the Department of Health and Human Services. You will not be discriminated against for filing a complaint.
• Amendment: If you believe the PHI we have is incorrect or incomplete, you may request to amend the information; you must provide a reason that supports your request. We reserve the right to deny your request if it is administratively unfeasible to process.
• Copy of this notice: You have the right to request a copy of this notice at any time. Wilkinson Pharmacy, Inc. reserves the right to alter this notice. If the alteration of this notice creates a material change, you will receive an updated notice at your visit following the effective date of the change. This notice is being published and becomes effective April 14, 2003.