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If you are denied access to PHI about you, you may request that the denial be reviewed. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it.

You may request an amendment for as long as we maintain the PHI.

JOSEPH PHARMACY 216 WEST 72ND STREET NEW YORK, NY 10023 TEL (212) 875-1718 FAX (212) 875-0921 E-Mail: [email protected] 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.

COM 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. JOSEPH PHARMACY is required by law to maintain the privacy of Protected Health Information ('PHI') and to provide individuals with notice of our legal duties and privacy practices with respect to PHI.

We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain.

To obtain a paper copy, contact the Privacy Officer at (212) 875-1718 or e-mail request to [email protected] *Request a restriction on certain uses and disclosures of PHI.

To request an amendment, you must send a written request to the Privacy Officer or e-mail it to: [email protected] In addition, you must include a reason that supports your request.

In certain cases, we may deny your request for an amendment.

To request confidential communication of PHI about you, you must submit a request in writing to the Privacy Officer or e-mail it to [email protected] Your request must state how or where you would like to be contacted. Example of How We May Use and Disclose PHI The following categories describe and provide examples of different ways we use and disclose PHI about you. Example: Information obtained by the pharmacist will be used to dispense prescription medications to you.

We will document in your record information related to the medications dispensed to you and services provided to you. Example: We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your co-payment.




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