THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes the privacy practices of Avita Pharmacy the members of its Affiliated Covered Entity (“Avita ACE”). An Affiliated Covered Entity is a group of Covered Entities and Health Care Providers under common ownership or control that designates itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The members of the Avita ACE will share Protected Health Information (“PHI”) with each other for the treatment, payment and health care operations of the Avita ACE and as permitted by HIPAA and this Notice. For a complete list of the members of the Avita ACE, please contact the Avita Privacy Office.
Avita Pharmacy wants you to know that nothing is more central to our operations than maintaining the privacy of your personal protected health information (“PHI”). PHI is information about you that we obtain to provide our services to you and that can be used to identify you. It includes your name and other basic contact information as well as information about your health, medical conditions and prescriptions. We take our responsibility to protect this information very seriously.
Our Pledge Regarding Your Health Information
We are required by law to protect the privacy of your PHI and to provide you with this Notice explaining our legal duties and privacy practices regarding your PHI. This Notice describes how we may use and disclose your PHI. We have provided you with examples; however, not every permissible use or disclosure will be listed in this Notice. This Notice also describes your rights and the obligations we have regarding the use and disclosure of your PHI. We and our employees and workforce members are required to follow the terms of this Notice or any change to it that is in effect. We are required to follow state privacy laws when they are stricter (or more protective of your PHI) than the federal law. The states in which this is the case are attached as a State Specific Requirement Addendum. Note that some types of sensitive PHI, such as HIV information, genetic information, alcohol and/or substance abuse records and mental health records may be subject to additional confidentiality protections under state or federal law.
Uses and Disclosures of Your PHI for Treatment, Payment and Health Care Operations
We may use and disclose your PHI for treatment, payment and health care operations without your written authorization. The following categories describe and provide some examples of the different ways that may use and disclose your PHI for these purposes:
Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professional who may provide treatment or who may be consulted by staff members. PHI obtained by Avita Pharmacy will be used to dispense prescription medication. We will document information related to the medications dispensed and services provided in your record. We may contact you to provide treatment related services such as refill reminders, treatment alternatives (e.g., available generic products), and other health-related benefits and services that may be of interest to you.
Payment. We may use your health information to seek payment from your health plan, from other sources of coverage such as your insurer, payor, automobile insurer, other agent, or from credit card companies that you may use to pay for services. We may have to share your PHI with that entity in order to determine whether it will pay for your prescription and the payment amounts. For example, your health plan may request and receive information on the dates of service, the services provided, and the medical condition being treated. We may also contact you about a payment or balance due for prescriptions dispensed to you by Avita Pharmacy.
Health care operations. Your health information may be used as necessary to support the day-to-day activities and management of Avita Pharmacy, including to monitor the effectiveness and quality of our health care services, to provide customer services to you and to resolve complaints. We may transfer your PHI for purposes of carrying out pharmacy services if we buy or sell pharmacy locations. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality. We may also use your PHI to tell you about opportunities that may be of interest to you, such as benefits for preferred Avita Pharmacy customers or clinical research projects.
Other Uses and Disclosures of Your PHI that Do Not Require Authorization
We are also allowed or required to share your PHI, without your authorization, in certain situations or when certain conditions have been met.
Individuals Involved in Your Care or Payment for Care. We may disclose your PHI to a friend, personal representative, family member or any other person you identify as a caregiver, who is involved in your care or the payment related to that care. For example, we may provide prescriptions and related information to your caregiver on your behalf. We may also make these disclosures after your death unless doing so is inconsistent with any prior expressed preference documented by Avita Pharmacy. Upon your death, we may disclose your PHI to an administrator, executor or other individual authorized under law to act on behalf of your estate. If you are a minor, we may release your PHI to your parents or legal guardians when permitted or required by law.
Business Associates. When we contract with third parties to perform certain services for us, such as billing or consulting, these third party service providers, known as Business Associates, may need access to your PHI to perform these services. They are required by law and their agreements with us to protect your PHI in the same way we do.
Required By Law. We will disclose your PHI when required to do so to comply with federal, state or local law.
Organ and Tissue Procurement Organizations. Consistent with applicable law, we may disclose your PHI to organizations engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Coroners, Medical Examiner and Funeral Director. We can share health information with a coroner, medical examiner, or funeral director when an individual dies. This may be done to assist in identifying a deceased person or to determine the cause of death, and to funeral directors to carry out their duties.
Workers’ Compensation. We may disclose your PHI to the extent authorized and necessary to comply with laws relating to worker’s compensation or similar programs established by law.
Law Enforcement and Other Government Requests. We may disclose your PHI to law enforcement officials as permitted or required by law. For example, we may use or disclose your PHI to report certain injuries or to report criminal conduct that occurred on our premises. We may also disclose your PHI in response to a court order, subpoena, warrant or other similar written request from law enforcement officials.
National Security and Intelligence Activities. We may disclose your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose your PHI to authorized federal officials so that they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.
Responding to lawsuits and legal actions. We can use or share health information about you in response to a court or administrative order, or in response to a subpoena. For example, we may disclose your PHI in response to a court order, subpoena, warrant, or summons. If you are involved in a lawsuit or legal dispute, we may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Public health reporting. Your health information may be disclosed to public health agencies, including federal, state, or local authorities, as required by law. We may also disclose your PHI to any other entity charged with preventing or controlling disease injury, or disability for public health activities. For example, we are required to report certain communicable diseases to the state’s public health department, and disclose personal information to help with product recalls, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety. We are required to report certain adverse reactions to medications. Additionally, we may have to report reactions to medications or other products to the U.S. Food and Drug Administration or other authorized entity; disclosures to notify individuals of recalls, exposure to a disease, or risk for contracting or spreading a disease or condition.
Health Oversight Activities. We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for government monitoring of the health care system, government programs, and compliance with federal and applicable state law.
United States Department of Health and Human Services. Under federal law, we are required to disclose your PHI to the U.S. Department of Health and Human Services to determine if we are in compliance with federal laws and regulations regarding the privacy of information.
Research. Under certain circumstances, we may use or disclose your PHI for research purposes. However, before disclosing your PHI, the research project must be approved by an institution review board or privacy board that has reviewed the research proposal and established protocols to protect your PHI.
Notification. We may use or disclosure your PHI to assist in a disaster relief effort so that your family, personal representative, or friends may be notified about your condition, status, and location.
Correctional Institution. If you are to become an inmate of a correctional institution, we may disclose to the institution or its agents, PHI is necessary for your health and the health and safety of others.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI to appropriate authorities when necessary to prevent a serious threat to your health and safety or the health and safety of another person or the public.
As Required by Law. We must disclose your PHI when required to do so by applicable federal or state law.
Other uses and disclosures require your authorization. Disclosure of your health information or its use for purposes other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization to the Avita Pharmacy – Privacy Office, 5551 Corporate Blvd., Suite 102, Baton Rouge, LA 70808. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization. Your revocation will become effective upon our receipt of your written notice.
Additional Uses of Information
Appointment or Refill reminders. Your health information will be used by our staff to send you appointment or refill reminders.
Information about treatments. Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition. We may also send you information describing other health-related products and services that we believe may interest you. We can use or share your information for health research.
We will never share your information for marketing purposes or sell your information to a third party unless you give us written permission.
Please note that we do not create or manage a hospital directory nor do we create or maintain psychotherapy notes.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, tell us what you would like us to do, and we will follow your instructions. You have the right and the choice to tell us to:
Your Rights
You have certain rights under the federal privacy standards. These include:
Avita Pharmacy – Privacy Office
ATTN: Privacy Officer
5551 Corporate Blvd, Suite 102
Baton Rouge, LA 708089
Phone: (225) 236-1538
Fax: (866) 550-7485
Email: [email protected]
Our Duties
We are required by law to maintain the privacy and security of your protected health information and to provide you with this notice of privacy practices.
We are required to abide by the privacy policies and practices that are outlined in this notice and give you a copy of it.
We are required to promptly notify affected individuals if a breach occurs that may have compromised your protected health information.
For more information visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any pharmacy visit. The new notice will also be available in our offices and on our website. The revised policies and practices will be applied to all protected health information we maintain. We will also post the revised Notice in our retail locations and on our website at http://www.avitapharmacy.com/ .
Request to Inspect Privacy Practices
You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that request to inspect access to your records by contacting our Privacy Officer at Avita Pharmacy – Privacy Office, 5551 Corporate Blvd., Suite 102, Baton Rouge, LA 70808. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.
HIV Test Results
We will not disclose medical record information that indicates HIV test results without your authorization or that of your legally authorized representative, except as authorized by State law or required by federal law.
Immunization Records
We will not disclose your immunization records without your authorization, except as permitted by State law.
Complaints
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concern to:
Avita Pharmacy – Privacy Office
Privacy Officer
5551 Corporate Blvd, Suite 102
Baton Rouge, LA 708089
Fax: (866) 550-7485
Email: [email protected]
If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address.
You may also file a complaint with the U.S. Department of Health and Human Service Officer for Civil Rights by sending a letter to 200 Independence Avenue, S.W. Washington, D.C. 20201, calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ .You will not be penalized or otherwise retaliated against for filing a complaint.
Contact Person
The name and address of the person you can contact for further information concerning our privacy practices is:
Avita Pharmacy – Privacy Office
ATTN: Privacy Officer
5551 Corporate Blvd, Suite 102
Baton Rouge, LA 708089
Phone: (225) 236-1538
Fax: (866) 550-7485
Email: [email protected]
Effective date
This Notice is effective on or after January 1, 2021.
Alabama
Disclosure – We will not disclose your professional records to anyone without your authorization, except where it is in your best interest or where the law requires the disclosure.
Medicaid – We will disclose information pertaining to your treatment (including billing statements and itemized bills) only to:
Arizona
Communicable Diseases– We will not disclose any confidential communicable disease related information about an individual, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
California
Disclosure – California law limits disclosure of your medical information in ways that would otherwise be permitted under federal law. In the situations described below, the pharmacy will disclose your medical information as follows:
Connecticut
Disclosure – We will not disclose information about pharmaceutical services rendered to you to third parties without your consent, except to the following persons:
Sale of Information: We will not sell your individually identifiable medical record information.
Florida
Disclosure – We will not disclose your pharmacy records without your written authorization, except to:
Georgia
Disclosure – Unless authorized by you, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities:
We may also disclose your confidential information without your consent pursuant to a subpoena issued and signed by an authorized government official or a court order issued and signed by a judge of an appropriate court.
HIV/AIDS – We will not disclose AIDS confidential information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Hawaii
HIV/AIDS – We will not disclose any HIV/AIDS/ARC-related information, except in situations where the subject of the information has provided us with prior written consent allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Idaho
Disclosure – We will not release your identifiable prescription information to anyone other than you or your designee, unless requested by any of the following persons or entities:
Indiana
Disclosure – We will disclose your confidential information only when it is in your best interests, when the information is requested by the Board of Pharmacy or its representatives or by a law enforcement officer charged with the enforcement of laws pertaining to drugs or devices or the practice of pharmacy, or when disclosure is essential to our business operations.
Iowa
HIV/AIDS – We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Kentucky
Disclosure – We will not disclose your patient information or the nature of professional services rendered to you without your express consent or without a court order, except to the following authorized persons:
Minimum Necessary – We will only use your information to provide pharmacy care.
Maine
Disclosure – We will not disclose your health care information for fundraising purposes or to coroners or funeral directors, without your authorization.
Communicable Diseases – We will only disclose patient identifiable communicable disease information to Department of Human Services for adult or child protection purposes or to other public health officials, agents or agencies or to officials of a school where a child is enrolled, for public health purposes. In a public health emergency, as declared by the state health officer, we may also release your information to private health care providers and agencies for preventing further disease transmission.
Massachusetts
Medicaid – We will restrict disclosure of your information to purposes directly connected with the administration of the Medicaid program .
Michigan
Disclosure – Unless authorized by you, we will not disclose your prescription or equivalent record on file, except to the following persons:
HIV/AIDS – We will not disclose AIDS-related information about an individual except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Minnesota
Disclosure – For pharmacies that elect to obtain consent pursuant to state law: We will not disclose your pharmacy records without your consent, except:
We will not disclose your prescription orders or the contents thereof, except to:
Unless we have obtained your oral or written consent, we will not disclose the nature of pharmaceutical services rendered to you, except as follows:
Missouri
Disclosure – Unless specifically authorized by you, we will not release your pharmacy records to anyone other than:
Medicaid – We will restrict disclosure of your information to purposes directly related to your treatment, for promotion of improved quality of care, and to assist with an investigation, prosecution, or civil or criminal proceeding related to the administration of the Medicaid program.
HIV/AIDS – We will not disclose any HIV/AIDS-related information, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Montana
Children’s Health Insurance Program – We will restrict disclosure of your information to purposes related to the administration of the CHIP program.
Medicaid – We will only use your information for purposes related to administration of the Montana Medicaid program. We will not disclose your information without your written consent, except to state authorities.
Sexually Transmitted Diseases – We will not disclose information concerning persons infected, or reasonably suspected to be infected with a sexually transmitted disease, except to:
New Hampshire
Disclosure – We will only disclose your professional records if:
Sales or Marketing – We will not use, release, or sell your identifiable medical information for the purposes of sales or marketing of services or products unless you have provided us with a written authorization permitting such activity.
New Jersey
Pharmaceutical Assistance to the Aged and Disabled – We will not disclose your personally identifiable information without your or your agent’s consent, except for purposes directly connected to the administration of the PAAD program or as otherwise permitted by state or federal law.
New Mexico
Disclosure – Unless we receive a written consent from you, we will not disclose your confidential information to anyone other than you or your authorized representative, except to the following persons or entities:
New York
Disclosure – A copy of a prescription for a controlled substance will not be furnished to the patient, but may be furnished to any licensed practitioner authorized to write such a prescription.
Common Electronic File/Database – We will not access a common electronic file or database used to maintain required personally identifiable dispensing information except upon your, or your agent’s, express request.
North Carolina
Disclosure – We will not disclose or provide a copy of your prescription orders on file, except to:
North Dakota
Disclosure – We will not disclose the nature of the services we provide to you to anyone other than you, without first obtaining your oral or written consent, except that we may disclose such information:
Ohio
Disclosure – Unless we have obtained your written consent, we will only disclose your pharmacy records to:
Oklahoma
Disclosure – Patient Confidences: We will not divulge the nature of your problems or ailments or any confidence you have entrusted to the pharmacist in his professional capacity, except in response to legal requirements or where it’s in your best interest.
Communicable and Venereal Diseases – We will not disclose information which identifies any person who has or may have a communicable or venereal disease, unless authorized by the individual or as otherwise permitted under state law. Whenever possible, we will de-identify such information prior to disclosure.
Pennsylvania
HIV/AIDS – We will not disclose any HIV-related information, except in situations where the subject of the information has provided us with a written consent allowing the release or where we are authorized or required by state or federal law to make the disclosure.
Rhode Island
Disclosure – Pharmacist-Specific: We will only disclose your prescription information to our agents and persons directly involved in your care.
Disclosure – Health Care Provider: We will not disclose your confidential health care information without your consent, except in the following situations:
South Carolina
Disclosure – Prescription Information Privacy Act: We will not disclose your prescription drug information without first obtaining your consent, except in the following circumstances:
Disclosure – Pharmacist-Specific: We will not disclose your information or the nature of professional pharmacy services rendered to you, without your express consent or the order or direction of a court, except to:
South Dakota
Social Services – We will only use your information for purposes directly connected to the administration of the medical assistance program. We will not disclose your information without obtaining your approval.
Tennessee
Disclosure – We will not disclose your name and address or other identifying information, except to:
We will obtain your authorization before we disclose your patient records for any reason, except where:
Sale of Information – We will not sell your name and address or other identifying information for any purpose.
Texas
Disclosure – We will only release your confidential record to you, your agent, or to:
Utah
Disclosure – We will not release or discuss information in your prescription or medication profile to anyone except:
Vermont
Unprofessional Conduct – Unless we have your consent or a court order, we will not disclose your information or the nature of services rendered to you, except to the following persons:
Washington
Disclosure – Unless authorized by you, we will not disclose your health care information, except if the recipient needs to know the information and the disclosure is:
Sexually Transmitted Diseases – We will not disclose any information regarding an individual’s treatment for a sexually transmitted diseases, except in situations where the subject of the information has provided us with a written authorization allowing the release or where we are authorized or required by state or federal law to make the disclosure.
West Virginia
Mental Health – We will not disclose confidential information relating to an individual who is obtaining or has obtained treatment for a mental illness, without the individual’s written consent, except in the following circumstances:
Wisconsin
Disclosure – We will not disclose your prescription records to anyone other than you or someone authorized by you without first obtaining your written informed consent.
Wyoming
Disclosure – Unless we have received an authorization from you, we will only disclose your confidential information to:
This California Personnel Privacy Notice (“Personnel Privacy Notice”) describes the personal information that Avita Pharmacy (“Avita” or “we” or “us” or “our”) collects about you in the context of your role as an employee, owner, director, officer or contractor of Avita, as well as the purposes for which Avita collects your personal information. We are providing you this Personnel Privacy Notice in effort to be transparent about how we handle your personal information.
We may collect the following categories of personal information in connection with your employment with us:
• Identifiers: We collect information that directly identifies you, such as your name (including other names used), address, email address, phone number, social security number, and government-issued identification numbers (e.g., driver’s license number or passport number).
• Protected characteristics: We collect some information regarding certain characteristics that are provided special protection under California law, such as your age, citizenship, and marital status. If you choose to provide this information to us, we may also collect information related to your sex, gender, race, ethnicity, medical history, veteran status, disability status, sexual orientation.
• Professional and employment-related information: We collect your professional and employment-related information, such as your title, date of hire, work schedule and status, compensation history, work eligibility information, employment history, education background, certificates and licenses, and other information contained within any resume and cover letter you submit to us, as well as information provided to us about you through background checks and your LinkedIn account (if applicable). We also collect benefits and leave information, and information related to any legal issues or disputes that may arise during the course of your employment or other similar professional relationship with us.
• Beneficiary and dependent information: If you provide this information to us, we collect information about your beneficiaries and dependents, such as their names, contact information, dates of birth, social security numbers and other similar information related to beneficiaries and dependents.
• Internet and electronic network activity information: We collect information about your work email account, and your usage of the internet, our electronic network, our computers, phones, and other devices to which you have access. This information includes your browsing and search history.
• Other personal records: In addition to the categories of information collected above, we may also collect other personal information that relates to, describes, or is capable of being associated with you, such as, your signature, your photograph or other depictions of your physical characteristics, birth date, financial account information, medical insurance and other benefits information, and emergency contact information.
• Inferences: We collect, through making inferences drawn from the personal information we collect in order to create a profile about you reflecting your preferences, characteristics, abilities and aptitudes. We collect the above categories of personal information to manage our employment or other similar professional relationship with you. For example, we use the above categories of personal information for the following business purposes:
• Personnel administration: We use your personal information to verify your identity and information, to provide your human resources services, to manage tax and social security services, to manage personnel work schedules, to process employee/personnel work-related claims and other similar personnel administration purposes.
• Processing personnel benefits: We use your personal information to administer and process your medical, life, retirement, or other benefits.
• Processing professional or employment-related interactions and transactions: We use your personal information to process payroll, to process expense reimbursements, and to manage salaries, sick pay, paid time off, and leaves of absences. We also use your personal information to manage employee job duties and conduct performance reviews and evaluations.
• Complying with federal and state law: We use your personal information to comply with federal and state laws. Some of these laws require us to maintain and disclose certain records and information related to you.
• Maintaining security: We use some of your personal information to monitor the use of our equipment and property for security purposes, such as detecting security risks and incidents, protecting against fraudulent or illegal activity, verifying and maintaining the quality and security of company-issued devices, and ensuring compliance with our policies and procedures.
• Our own business purposes: We may use some of your personal information to perform analytics to discover ways to improve our business, identify trends in our workforce and enhance our service offerings.
If you have questions about this Privacy Notice, please contact Human Resources at [email protected]