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Family Fresh Market Notice of Pharmacy Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Nash Finch Company and its subsidiaries including Family Fresh Market (“The Company”) are dedicated to protecting your protected health information (PHI). We are required by law to maintain the privacy of PHI and to provide you with this Notice of our legal duties and privacy practices with respect to PHI. The Company is required by law to abide by the terms of this Notice.

HOW YOUR PHI WILL BE USED AND DISCLOSED:
We will use your PHI as part of rendering patient care, which includes your treatment, our obtaining payment for your treatment, and our healthcare operations. For example, your PHI may be used by the pharmacist in contacting your doctor or clinic for prescription information, to process your payment from your medical plan for your medication and by administrative personnel reviewing the quality of the care you receive.

We may also use and/or disclose your PHI when required by law, or when permitted under federal and state laws for the following purposes:

Prescription Refill Reminders-
We may contact you to provide prescription refill reminders.

 

Health Information-
We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

 

Disclosure to Department of Health and Human Services-
We may disclose PHI when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.

 

Family and Friends-
We may disclose your PHI to family members, other relatives, personal representatives or close personal friends when the PHI is directly relevant to that person’s involvement with your care or the payment for your care, but not if you tell us that you object to us doing so.

 

Notification-
We may use or disclose your PHI to notify a family member, a personal representative or another person responsible for your care of your location, general condition or death.

 

Disaster Relief-
We may disclose your PHI to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts.

 

Health Oversight Activities-
We may use or disclose your PHI for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your PHI to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.

 

Abuse or Neglect-
We may disclose your PHI when it concerns abuse, neglect or violence to you in accordance with federal and state law.

 

Legal Proceedings-
We may disclose your PHI in the course of certain judicial, administrative or other legal proceedings.

 

Law Enforcement-
We may disclose your PHI for law enforcement purposes or other specialized governmental functions.

 

Public Safety-
We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or to the public.

 

Workers’ Compensation-
We may disclose your PHI as authorized by laws relating to workers’ compensation or similar programs.

 

Business Associates-
We may disclose your PHI to a business associate with whom we contract to provide services on our behalf. To protect your PHI, we require our business associates to appropriately safeguard the PHI of our patients.

 

Coroners, Medical Examiners and Funeral Directors-
We may disclose your PHI to a coroner, medical examiner or a funeral director.

 

Organ Donation-
If you are an organ donor, we may disclose your PHI to an organ donation and procurement organization.

 

Research-
We may use or disclose your PHI for certain research purposes if an Institutional Review Board or a privacy board has altered or waived individual authorization, the review is preparatory to research or the research is on only decedent’s information.

 

If you receive pharmacy services from us in any state that prohibits or materially limits any use or disclosure listed above, we will abide by the applicable state law, regulation, or requirement. More restrictive state requirements are described at the end of this notice.

AUTHORIZATIONS:
We will not use or disclose your PHI for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time, except to the extent that we have taken action in reliance on your authorization.

YOUR RIGHTS REGARDING YOUR PHI:
Under federal law, you have the following rights with respect to your PHI:

• You may ask us, in writing, to restrict certain uses and disclosures of your PHI. We are not required to agree to your request, but if we do, we will honor it, unless the PHI is needed for your emergency treatment.
• You have the right to request to receive communications from us in a confidential manner. We will honor all reasonable requests.
• You may request a copy of your PHI. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.
• You may ask us, in writing, to amend your PHI. We may deny your request for certain specific reasons. If we deny your request, we will provide you with a written explanation for the denial and information regarding further rights you may have at that point.
• You have the right to receive an accounting of the disclosures of your PHI made by us and our business associates during the last six years (following April 14, 2003), except for disclosures for treatment, payment or healthcare operations, disclosures that you authorized and certain other specific disclosure types. You may be charged a reasonable fee for the accounting, except for the first accounting in any 12 month period. Requests for the accounting must be made in writing.
• You may request a paper copy of this Notice of Pharmacy Privacy Practices.
• You have the right to complain to us and/or to the Secretary of the Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way. To complain to us, please contact:

THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003.

REVISION OF NOTICE OF PRIVACY PRACTICES
We reserve the right to change the terms of this Notice, making any revision applicable to all the PHI we maintain. If we revise the terms of this Notice, we will post a revised notice at The Company’s Retail Pharmacies and on the websites listed above, and will make paper copies of the revised Notice of Privacy Practices available upon request.

Privacy Practices Required by Certain States:

In Minnesota
We will not divulge the contents or provide copies of your prescription orders except to (a) you and your agent, or another pharmacist acting on behalf of you or your agent; (b) the licensed practitioner who issued the prescription or is then treating you; (c) drug enforcement authorities engaged in a specific investigation; (d) government agencies charged with providing medical care; (e) insurance carriers or attorneys, but only with your written authorization; and (f) persons authorized by court order. We will not release your health records to an external researcher except as permitted under Section 144.335 of the Minnesota Statutes. And unless we have obtained your oral or written consent or a court order, we will not reveal other than to pharmacies and your physician the nature of pharmaceutical services provided to you.

In Wisconsin
Without your written authorization, your patient health care records, including prescription records, will only be released to you, to your personal representatives, and to those persons and entities specified in Section 146.82 of the Wisconsin Statutes. While the releases required or allowed by Section 146.82 include a number of the situations described in this notice, there are several exceptions. For example, we may not release your health care records to your family and friends or to our business associates without your written authorization.