Privacy Statement:

HIPAA Notice of Privacy Practices for Personal Health Information

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

Dear FactorHealth Management, LLC™ and FCS Pharmacy, LLC™ Patients:

This is your Health Information Privacy Notice from the FactorHealth Management, LLC™ (FactorHealth™) and FCS Pharmacy, LLC™ (FCS™). Please read it carefully. FactorHealth™ and FCS™ strongly believe in protecting the confidentiality and security of information we collect about you. This notice refers to FactorHealth™ and FCS™ by using the terms "us," "we," or "our."

This notice describes how we protect the personal health information we have about you which relates to your FactorHealth™ and FCS™ services ("Personal Health Information"), and how we may use and disclose this information. Personal Health Information includes individually identifiable information which relates to your past, present, or future health, treatment, or payment for health care services. This notice also describes your rights with respect to the Personal Health Information and how you can exercise those rights.

We are required to provide this Notice to you by the Health Insurance Portability and Accountability Act ("HIPAA"). For additional information regarding our HIPAA Medical Information Privacy Policy or our general privacy policies, please see the privacy notices contained at our website, www.factorhealth.com. You may submit questions to us there or you may write us at ATTN: Privacy Officer, FactorHealth Management™, 7700 Congress Ave., Ste. 3109, Boca Raton, Florida 33487.

We are required by law to:

  • Maintain the privacy of your Personal Health Information;
  • Provide you notice of our legal duties and privacy practices with respect to your Personal Health Information; and
  • Follow the terms of this notice.

We protect your Personal Health Information from inappropriate use or disclosure. Our employees, and those of companies that help us service you, are required to comply with our requirements that protect the confidentiality of Personal Health Information. They may look at your Personal Health Information only when there is an appropriate reason to do so, such as to administer our products and services.

We will not disclose your Personal Health Information to any other company for their use in marketing their products to you. However, as described below, we will use and disclose Personal Health Information about you for business purposes related to your pharmacy services as well as comprehensive health management services. The main reasons for which we may use and may disclose your Personal Health Information are to evaluate and process any requests for services as well as coverage and claims for benefits.

The following describe these and other uses and disclosures together with some examples.

For Payment: We may use and disclose Personal Health Information to insurance carriers to coordinate benefits with respect to a particular claim. In addition, we may disclose Personal Health Information to a health plan or an administrator of an employee welfare plan for various payment related functions, such as eligibility determination, audit and review, or to assist you with your inquiries or disputes.

For Health Care Operations: We may also use and disclose Personal Health Information for our pharmacy and comprehensive health management services. These purposes include evaluating a request for pharmacy or comprehensive health management services, administering those products or services, and processing transactions requested by you. We may also disclose Personal Health Information to Affiliates and to business associates outside of FactorHealth Management™ and FCS Pharmacy, LLC™ if they need to receive Personal Health Information to provide a service to us and will agree to abide by specific HIPAA rules relating to the protection of processing companies, or companies that provide general administrative services. Personal Health Information may be disclosed for audit or claim review reasons. Personal Health Information may also be disclosed as part of a potential merger or acquisition involving our business in order to make an informed business decision regarding any such prospective transaction.

Where Required by Law or for Public Health Activities: We disclose Personal Health Information when required by federal, state, or local law. Examples of such mandatory disclosures include notifying state or local health authorities regarding particular communicable diseases, or providing Personal Health Information to a governmental agency or regulator with health care oversight responsibilities. We may also release Personal Health Information to a coroner or medical examiner to assist in identifying a deceased individual or to determine cause of death.

To Avert a Serious Health or Safety Threat: We may disclose Personal Health Information to avert a serious threat to someone's health or safety. We may also disclose Personal Health Information to federal, state, or local agencies engaged in disaster relief as well as to private disaster relief or disaster assistance agencies to allow such entities to carry out their responsibilities in specific disaster situations.

For Health-Related Benefit or Services: We may use Personal Health Information to provide you with information about products or services currently available to you and, in limited situations, about health-related products or services that may be of interest to you.

For Law Enforcement or Specific Government Functions: We may disclose Personal Health Information in response to a request by a law enforcement official made through a court order, subpoena, warrant, summons, or similar process. We may disclose Personal Health Information about you to federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

When Requested as Part of a Regulatory or Legal Processing: If you or your estate are involved in a lawsuit or a dispute, we may disclose Personal Health Information about you in response to a court or administrative order. We may disclose Personal Health Information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the Personal Health Information requested.

Other uses of Personal Health Information: Other uses and disclosures of Personal Health Information not covered by this notice and permitted by the laws that apply to us will be made only with your written authorization or that of your legal representative. If we are authorized to use or disclose Personal Health Information about you, you or your legally authorized representative may revoke that authorization, in writing, any time, except to the extent that we have taken action relying on authorization. You should understand that we will not be able to take back any disclosures we have already made with authorization.

Your Rights Regarding Personal Health Information We Maintain About You

The following are your various rights as a consumer under HIPAA concerning Personal Health Information. Should you have any questions about a specific right, please write to us at the location listed in our discussion of that right.

Right to Inspect and Copy Your Personal Health Information: In most cases, you have the right to inspect and obtain a copy of the Personal Health Information that we maintain about you. To inspect and copy Personal Health Information, you must submit your request in writing to ATTN: Privacy Officer, FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave. Ste. 3109, Boca Raton, Florida 33487. To receive a copy of your Personal Health Information, you may be charged a fee for the costs of copying, mailing, or other supplies associated with your request. However, certain types of Personal Health Information collected by us in connection with, or in reasonable anticipation of any claim or legal proceeding. In very limited circumstances we may deny your request to inspect and obtain a copy of your Personal Health Information. If we do, you may request that the denial be reviewed. The review will be conducted by an individual chosen by us who was not involved in the original decision to deny your request. We will comply with the outcome of that review.

Right to Amend Your Personal Health Information: If you believe that your Personal Health Information is incorrect or that an important part of it is missing, you have the right to ask us to amend your Personal Health Information while it is kept by us. You must make this request along with the reason for the request in writing, and submit it to ATTN: Privacy Officer, FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave., Ste. 3109, Boca Raton, Florida 33487. We may deny your request if it is not in writing or does not include a reason that supports the request. In addition, we may deny your request if you ask us to amend Personal Health Information that:

  • Is accurate and complete;
  • Was not created by us, unless the person or entity that created the Personal Health Information is no longer available to make the amendment;
  • Is not part of the Personal Health Information kept by or for us: or
  • Is not part of the Personal Health Information which you would be permitted to inspect and copy.

Right to a List of Disclosures: You have the right to request a list of disclosures we have made of Personal Health Information about you. This list will not include disclosures made for treatment, payment, health care operations, for purposes of national security, made to law enforcement or to corrections' personnel or made pursuant to your authorization or made directly to you. To request this list, you must submit your request in writing to ATTN: Privacy Officer, FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave., Ste. 3109, Boca Raton, Florida 33487. Your request must state the time period for which you want to receive a list of disclosures. The time period may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12 month period will be free. We may charge you for responding to any additional requests. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions: You have the right to request a restriction or limitation on Personal Health Information we use or disclose about you for treatment, payment, or health care operations, or that we disclose to someone who may be involved in your care or payment for your care, like a family member or friend. While we will consider your request, we are not required to agree to it. If we do agree to it, we will comply with your request. To request a restriction, you must make your request in writing to ATTN: Privacy Officer, FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave., Ste. 3109, Boca Raton, Florida 33487. In your request, you must tell us (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse or parent). We will not agree to restrictions on Personal Health Information uses or disclosures that are legally required, or which are necessary to administer our business.

Right to Request Confidential Communications: You have the right to request that we communicate with you about Personal Health Information in a certain way or at a certain location if you tell us that communication in another manner may endanger you. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to ATTN: Privacy Officer, FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave. Ste. 3109, Boca Raton, Florida 33487 and specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave., Ste. 3109, Boca Raton, Florida 33487. All complaints must be submitted in writing. You will not be penalized for filing a complaint. If you have questions as to how to file a complaint, please contact us toll free 1-800-589-6053 or 1-561-314-1690.

ADDITIONAL INFORMATION

Changes to This Notice: We reserve the right to change the terms of this notice at any time. We reserve the right to make revised or changed notice effective for Personal Health Information we already have about you as well as any Personal Health Information we receive in the future. The effective date of this notice and any revised or changed notice may be found on the last page, on the bottom right hand corner of the notice. You will receive a copy of any revised notice from FactorHealth Management™/FCS Pharmacy, LLC™ by mail or e-mail, but only if e-mail delivery is offered by FactorHealth Management™/FCS Pharmacy, LLC™ and you agree to such delivery.

Further Information: You may have additional rights under other applicable laws. For additional information regarding HIPAA Medical Information Privacy Policy or our general privacy policies, please contact us at www.factorhealth.com , (561) 314-1700 ext. 226, or write to us at ATTN: Privacy Officer, FactorHealth Management™/FCS Pharmacy, LLC™, 7700 Congress Ave., Ste 3109, Boca Raton, Florida 33487.