Privacy Policy
747 Herra St. Unit D
ElburnIL 60119
630-365-2372
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.
DATE OF NOTICE: JUNE 82013
Revised November 22018
2nd Revision March 272024
SECTION A: Uses and Disclosures of Protected Health Information
1.
Our companyShamrock RxInc. DBA Shamrock Specialty Rx is a pharmacy that provides medication and healthcare services. Under applicable lawwe are required to protect the privacy of your individual health information (information we refer to in this notice as “Protected Health Information” or “PHI”. We are also required to provide you with this Notice regarding our policies and procedures regarding your PHI and to abide by the terms of this noticeas it may be updated from time to time.
Personal information collected includes but is not limited tonamedate of birthallergiesaddressphone numberemail addressand payment information. Information may be collected in personvia faxphone callemailrefill app or SMS texting. SMS consent will not be shared with third parties.
We are permitted to make certain types of uses and disclosure under applicable law for treatmentpaymentand healthcare operations purposes. We may obtain information to dispense prescriptions and for the documentation of pertinent information of your record that may assist us in managing your medication therapy or your overall health. For treatment purposessuch use and disclosure will take place in providingcoordinationor managing healthcare and its related services by one or more of your providerssuch as when your pharmacist consults with your physician or a specialist regarding your medicationstreatment or condition.
For payment purposessuch use and disclosure will take place to obtain or provide reimbursement for providing pharmaceutical care servicessuch as when your case is reviewed to ensure that appropriate care was rendered.
For healthcare operations purposessuch use and disclosure will take place in a number of waysincluding for quality assessment and improvement; provider review and training; underwriting activities; review and compliance activities; and planningdevelopmentmanagement and administration. Your information could be used for exampleto assist in the evaluation of the quality of care that you were provided.
We store some of your PHI in electronic computer files. We backup our electronic records daily and employ other precautions to safeguard the integrity of your PHI. Despite these precautionsit is possible but unlikely that a computer crash or other technological failure could cause loss of data. In additionreasonable safeguards are employed to protect your PHI stored on electronic media.
In additionwe may contact you to provide refill remindershealth screeningswellness eventsinoculationsvaccinations or information about treatment alternatives of other health-related benefits and services that may be of interest to you. In additionwe may disclose your health information to your plan sponsor.
We may use and disclose your Protected Health Informationwithout your authorization when the pharmacy needs to contact a physician or physician’s staff as is permitted or required to do so without individual written authorization. We may use and disclose your PHI if we are contacted by another pharmacy who states they have your request and consent to transfer pharmacy records to them.
From time to time we may employ the services of business associates who may assist us in one or more tasks and who may usechange or create PHI. Business associates are required to comply with all the privacy regulations on your behalf.
We may disclose PHI about you without your authorization to comply with workers compensation lawsas required by law enforcementlegal proceedingspublic health requirementshealth oversight activities and as required by law.
Other uses and disclosures will be made only with your written authorization and you may revoke your authorization by notifying us as described in Section B.
2.
You may ask us to restrict uses and disclosures of your PHI to carry out treatmentpaymentor healthcare operationsor to restrict uses and disclosures to family membersrelativesfriendsor other persons identified by you who are involved in your care or payment for your care. Howeverwe are not required to agree to your request.
3.
You have the right to request the following with respect to your PHI: (i) inspection and copying; (ii) amendment of correction; (iii) and accounting of the disclosures of this information by us (we are not required to account to you for disclosures made for treatmentpaymentoperationsdisclosures to youdisclosures to your caregiversfor notifications or as otherwise excluded by law); and (iv) the right to receive a paper copy of this notice upon request. We may require you to pay for this request to cover our costs of copyinglabor and postage. In additionyou may requestand we must accommodate the requestif reasonableto receive communications of PHI by alternative means or at alternative location. To make this requestplease contactin writing:
Shamrock Specialty Rx
Cheryl O’SheaRPh
747 Herra St.Unit D
ElburnIL 60119
630-365-2372
4.
We may use your name to reference your prescriptions and pharmaceutical care services. Your may be required to sign a signature log form to acknowledge receipt of serviceto acknowledge receipt of Notice and disclosure of Protected Health Information as outlined herein. This information may be disclosed by us to other persons who ask for you or your prescriptions by name. You may restrict or prohibit these uses and disclosures by notifying a pharmacy representative orally or in writing of your restriction or prohibition. We are not required to honor those requests. We can provide treatment services to you even if you object to sign the acknowledgment of the receipt of this Notice or if we decide not to honor a request regarding the information in this document. In the event of an emergency or your incapacitywe will do in our reasonable judgement what is consistent with your known preferenceand what we determine to be in your best interest. We will inform you of any such uses of disclosures if uses and disclosures would require your signed authorization under such circumstances and give you an opportunity to object as soon as practicable.
5.
We may disclose to one of your family membersto a relativeto a close personal friendor to any other person identified by youPHI that is directly relevant to the person’s involvement with your care or payment related to your care. In additionwe may use or disclose that PHI to notifyidentifyor locate a member of your familyyour personal representativeanother person responsible for careor certain disaster relief agencies of your locationgeneral conditionor death. If you are incapacitatedthere is an emergencyor you object to this use or disclosurewe will do in our judgement what is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare. We will also use our judgement and experience regarding your best interest in allowing people to pick-up filled prescriptionsor other similar forms of PHI.
6.
We reserve the right to change the terms of this Notice and make new Notice provisions effective for all PHI we maintain. You may receive a copy of this Notice by contacting us as outlined in Section B or upon the receipt of pharmacy care services.
7.
If you believe that your privacy rights have been violatedyou may complain to us at the location described in Section B or to the Secretary of the Department of Health and Human ServicesHubert H Humphrey Building200 Independence Ave SWWashingtonDC 20201. You will not be retaliated against for filing a complaint.
SECTION B: CONTACTING US
You may contact us for further information at:
Shamrock Specialty Rx
Cheryl O’SheaRPh
747 Herra St.Unit D
ElburnIL 60119
630-365-2372