Ken’s Pharmacy Notice in Privacy Practices
Effective Date: Sept. 9th, 2013



Section A: Uses and Disclosures of Patient Health Information

We understand that medical information about you and your health is personal. By law, Ken’s Pharmacy is required to protect the privacy of your personal Health Information. We are also required to abide by the terms of this Notice, and provide you with a copy of this Notice regarding our legal duties and privacy procedures pertaining to your Health Information. A copy of this Notice may be obtained from Ken’s Pharmacy upon request, or by visiting our website at KensRX.Com.

Ken’s Pharmacy is permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and healthcare operation purposes. We may obtain information to dispense prescriptions, and for the documentation of pertinent information in your records that may assist us in managing your medication therapy.

For some activities, we must have your written authorization to use or disclose your Health Information. However, law permits Ken’s Pharmacy to use or disclose your Health Information for some purposes without your authorization, such as:


For treatment purposes, such use and disclosure will take place in providing, coordinating, or managing healthcare and its related services by one or more of your providers, such as when your pharmacist consults with your physician or a specialist regarding your medications, treatment or condition.

For payment purposes, such use and disclosure will take place to obtain billing & collection for providing pharmaceutical care services. For reimbursement purposes, your Health Information may be disclosed to one or several intermediaries employed by your plan sponsor including but not limited to insurers, pharmacy benefits managers, claims administrators and computer switching companies.

For healthcare operations. Ken’s Pharmacy may use and disclose Health Information about you for pharmacy operations. These uses and disclosures are necessary to run the pharmacy and make sure you receive quality customer service.

As Required by Law. The Pharmacy will disclose Health Information about you when required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety. Ken’s Pharmacy may use and disclose Health Information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public. Any disclosure, however, would only be made to an entity able to prevent such a threat.

Public Health Risk. The Pharmacy may disclose Health Information about you for public health activities. These activities generally include the following: (1) To prevent or control disease, injury, or disability; (2) to report reactions to medications or problems with products; (3) to notify people of recalled products they may be using; (4) to notify a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition; (5) to responsibly notify the appropriate government authority if it is believed a person has been a victim of abuse, neglect, or domestic violence (we will only make such disclosures if you agree and when required by law).

Health Oversight Activities. Your Health Information may be disclosed to a health oversight agency or Health and Human Services (HHS) for activities authorized by law. These oversight activities, which are necessary for the government to monitor the health care system, include audits, investigations, inspections and licensure.

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, Ken’s Pharmacy may disclose Health Information about you in response to a court order or administrative order. We may disclose Health Information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if satisfactory efforts have been made by the requesting party to contact you about the request beforehand. In the event a Protective Order is placed on your Health Information Ken’s Pharmacy will comply with any such order.

For Specific Government Functions. Ken’s Pharmacy may disclose Health Information for the following government functions: (1) Health Information of military personnel, as required by military command authorities; (2) Health Information of inmates, to a correctional institution or law enforcement official; (3) in response to a request from law enforcement, if certain conditions are satisfied; and (4) for national security reasons.

Storage of Health Information. Ken’s Pharmacy accesses and stores some of your Health Information on electronic media files. Reasonable safeguards are employed to protect all Health Information stored on these electronic media files. If these safeguards are ever breached we are required to inform the local media, and HHS.

Business Associates. From time to time Ken’s Pharmacy may employ the services of business associates who may assist us in one or more tasks and who may use, change, create, or destroy your Health Information. Business associates are also required to comply with all privacy regulations on your behalf.

Other Disclosures. Ken’s Pharmacy may use your name to reference your prescriptions and pharmaceutical care services. In addition, Ken’s Pharmacy may use or disclose your Health Information, even if you have restricted this use or disclosure, to notify, identify, locate a member of your family, your personal representative, persons responsible for care, or certain disaster relief agencies, if you are incapacitated, or there is an emergency. A pharmacist will do in their best judgment what has been determined to be in your best interest regarding such disclosures. This pharmacy will also use its judgment and experience regarding your best interest in allowing people to pick-up filled prescriptions, or other similar forms of Health Information. Other uses and disclosures will be made only with your written authorization, and you may revoke your authorization by notifying the pharmacy as described in Section B. You may be required to sign a signature log form to acknowledge receipt of service, to acknowledge receipt of this Notice and prohibit these uses and disclosures by notifying us orally or in writing of your restriction or prohibition. Ken’s Pharmacy is not required by law to honor all your requests. This pharmacy is able to provide treatment services to you even if you object to signing the acknowledgment of the receipt of this Notice or if it has been decided to not honor a request regarding the information in this document. From time to time this pharmacy may mail you product offerings using your pharmacy records. Only your name and address will be used. You may opt-out of this service at anytime with a written request to the pharmacy.


Your Rights Concerning Your Health Information

  1. You have the right to request restrictions on the use and disclosures of your Health Information. Ken’s Pharmacy, in certain circumstances, is not required to agree to restrictions you may request. If the pharmacy has agreed to any restrictions, the agreement will be put in writing and followed, except in emergency situations. Ken’s Pharmacy cannot agree to limit uses and disclosures of information required by law.

  2. You have the right to inspect and copy your Health Information as long as this pharmacy maintains such Health Information. Your Health Information will include prescription and billing records. To inspect or copy your Health Information, you must submit a written request to the pharmacy. You have the right to choose to obtain a summary instead of a copy of your Health Information. We may charge a fee for the cost of copying, mailing and other supplies that are necessary to complete your request. Ken’s Pharmacy may deny your request to inspect and copy in certain limited circumstances. If you are denied access to your Health Information, you may request that the denial be reviewed.

3. You have the right to request that Ken’s Pharmacy amend your Health Information that is incorrect or incomplete as long as the pharmacy stores such information. To request an amendment you must submit a written request to Ken’s Pharmacy (form available from your pharmacist) along with the reason for the request. Ken’s Pharmacy is not required to amend Health Information that is accurate and complete. Ken’s Pharmacy will provide you with information about the procedure for addressing any disagreement with such a denial

4. You may request, and we must accommodate the request, if reasonable, to receive communications of Health Information by alternative means or at alternative locations. To make this request please contact, in writing, the pharmacy’s Compliance Officer. (See, Section B)

5. You have the right to request that Ken’s Pharmacy disclose to one of your family members, a relative, a close personal friend, or any other person identified as your Personal Representative, Health Information that is directly relevant to the person’s involvement with your care or payment related to your care. In the event of an emergency or your incapacity, our pharmacist’s will act with reasonable judgment as to what is consistent with your known preference, and what is determined to be in your best interest.

6. You have a right to receive an accounting of disclosures of your Health Information this pharmacy has made after April 14, 2003 for purposes other than disclosures (1) for Ken’s Pharmacy treatment, payment or healthcare operation, (2) to you or based upon your authorization and (3) for certain government functions. To request an accounting you must submit a written request to the pharmacy. You must also specify the time period, which may be no longer that six years.

Changes to this Notice of Privacy Practices

Ken’s Pharmacy reserves the right to change the terms of this Notice and to make new Notice provisions effective for all Health Information this pharmacy maintains. Any revised Notice will be posted in the pharmacy. You may receive a copy of this Notice by contacting the pharmacy, at our website, or as outlined in Section B or upon the receipt of pharmacy care services.

For More Information or to Report a Problem

If you believe that your privacy rights have been violated, you may contact the pharmacy at the location described in Section B or the Secretary of the Department of Health and Human Services (HHS). There will be no retaliation against an individual for filing a complaint.

Section B: Contacting Ken’s Pharmacy

Pharmacy Compliance Officer
Phone: (937) 898-3221
Matthew Farst
330 E. National Rd.
Vandalia, OH 45377