DELAUNE’S PHARMACY AND HOME MEDICAL
308 NORTH LEWIS ST.
New Iberia, LA 70563

Notice of Privacy Practices

This notice describes how medical information about you, our patient, may be used and disclosed or discussed and how you can get access to this information.

Please review it carefully.

If you have any questions about this Notice, please contact our privacy coordinator, Mr. Carol Melancon at 337-364-7671 or at 308 North Lewis St., New Iberia, LA 70563.

This Notice of Privacy Practices describes how Delaune’s, its employees, staff, office personnel and/or auditors and consultants may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” is information about you that may identify you and that relates to your past, present, or future physical mental health or condition and related health care services.

We at Delaune’s are required to abide by the terms of this Notice of Privacy Practices. We may change the terms or language of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time as well as the information we obtain in the future. Upon your request, we will provide you with any revised Notice of Privacy Practices by:

• accessing our website at www.Delaune's1.com
• calling the office and requesting that a revised copy be sent to you in the mail
• requesting on at the time of your next visit or appointment

Understanding Your Health Record/Information

Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

• basis for planning your care and treatment
• means of communication among the many health professionals who contribute to your care
• legal documents describing the care you received
• means by which you or a third-party can verify that services billed were actually provided as a tool in educating health professionals
• source of data for medical research
• source of information for public health officials charged with improving the health of the nation
• source of data for facility planning and marketing
• a tool with which we can assess and continually work to improve the care we render as the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

• ensure its accuracy
• better understand who, what, when, where, and why others may access your health information
• make more informed decisions when authorizing disclosure to others

Your Health Information Rights

Although your health information is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

• request a restriction on certain uses and disclosures of your information
• obtain a paper copy of the notice of information practices upon request
• inspect and obtain a copy of your health record (written request required)
• amend your health record
• obtain an accounting of disclosures of your health information
• request communications of your health information by alternative means or at alternative locations
• revoke your authorization to use or disclose health information except to the extent that action has already been taken

Delaune’s may charge a fee for the costs of copying, mailing or other associated supplies regarding your medical information. If you believe that the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request a copy of the amendment as long as the information is kept by Delaune’s and is available. Your request must be in writing. Please note that Delaune’s is not required to agree to your request. However, we always do our best to work with our customers and patients.

Delaune’s Responsibilities

Delaune’s is required to:

• maintain the privacy of your health information
• provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• abide by the terms of this notice
• notify you if we are unable to agree to a requested restriction
• accommodate reasonable requests you may have to communicate health information by alternative means or alternative locations

We will not use or disclose your health information without your authorization, except as described in this notice.

If you believe that your privacy rights have been violated, you can file a complaint with our Privacy Contact or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact our Privacy Contact, Mr. Carol Melancon, at (337) 364-7671 for further information about the complaint process.

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a therapist, physician or other member of your healthcare team will be recorded in your record and used to determine the course of treatment, medication or service that should work best for you. We may provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you.

Different personnel in our office may share information about you and disclose information to others in our office and people who do not work in our office in order to coordinate your care. Family members and other health care providers may be part of your medical care outside this office and may require information about you that we have.

We will use your health information for payment.

For example: A bill may be sent to your or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may use and disclose health information about you so that the treatment and/or services you received from Delaune’s may be billed to and payment may be collected from you, your insurance company or a third party payor. We may also tell your health plan about a treatment or service you are going to receive to obtain prior approval, or to determine whether your plan will cover the treatment or service. An example would be to obtain prior approval for a wheel chair or hospital bed.

We will use your health information for regular health operations.

For example: Members of our quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide. We may use the information to evaluate the performance of our staff in caring for you.

Health related products and services: We may contact you or your health care provider about health related products or services that we feel you may need.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include our accounting service, our computer service or other outside consultants. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked then to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information. In fact, the business associate is required by law to protect your health information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. An example may be a personal care nurse or CAN taking care of you in your home. This nurse may be required to give you your medications and need to know possible side effects.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral directors, Coroners, and Medical examiners: We may disclose health information to funeral directors consistent with applicable law to carry out their duties. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine a cause of death.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donations and transplant.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and products defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.. Should you be involved in a lawsuit or a dispute, we may be required by law to disclose health information about you in response to a court or administrative order.

Family and Friends: We may disclose health information about you to your family members or friends. We may assume you agree to our disclosure of your personal health information to your spouse or child that is necessary to your health care. If you are unable to give consent, Delaune’s has the option to assume you agree to our disclosure of your personal health information.

Health Oversight Agency’s: Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

This notice was published at the above date and becomes effective on April 14, 2003.

To Our Customers:

The above information is not meant to encompass all the various ways in which Delaune’s may use your health information. It is intended to help you understand how your health information may be used. We at Delaune’s want to assure you that we will do our best to keep the information about you and on your medical records confidential. Delaune’s reserves the right to change this notice at any time. Changes can/will be retroactive. Delaune’s has the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. A notice of changes to this notice will be posted in Delaune’s with its effective date. You are entitled to a copy of the notice currently in effect.

You have a right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you agree to receive a copy of this notice electronically, you are still entitled to a paper copy. Please call Delaune’s at 337-364-7671 or come to Delaune’s at 308 North Lewis Street in New Iberia, LA 70563, should you want a paper copy of this notice.

Should you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the department of Health and Human services. To file a complaint with Delaune’s please contact Mr. Carol Melancon at the above number or address. You will not be penalized for filing a complaint. We at Delaune’s would appreciate to opportunity to help resolve any complaints and thereby improve our services.