Notice Of Privacy Practices
THIS NOTICEDESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOWYOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
KV Supply, LLC (also known as "KV Supply" and "KV Vet") is required by law to maintain theprivacy of Protected Health Information ("PHI") and to provide youwith notice of KV Vet's legal duties and privacy practices with respect to PHI.PHI is information that may identify you and that relates to your past, presentor future physical or mental health or condition and related health careservices.
This Noticeof Privacy Practices ("Notice") describes how KV Vet may use anddisclose PHI to carry out treatment, payment or health care operations and forother specified purposes that are permitted or required by law. The Notice alsodescribes your rights with respect to your PHI. KV Vet is required to providethis notice to you by the Health Insurance Portability and Accountability Act("HIPAA").
KV Vet isrequired to follow the terms of this Notice. KV Vet will not use or discloseyour PHI without your written authorization, except as described or otherwisepermitted by this Notice. KV Vet reserves the right to change its practices andthis Notice and to make the new Notice effective for all PHI KV Vet maintains.Upon request, KV Vet will provide any revised Notice to you.
Examples of How KV Vet Uses and Discloses Protected Health Information About You
The following describes different ways that KV Vet uses and discloses your PHI.Certain categories include examples; however, KV Vet has not identified everyway in which KV Vet may use or disclose your PHI.
KV Vet may use your health information to provide and coordinate the treatment,medications and services you receive. For example, KV Vet may contact youregarding medications, equipment, supplies, compliance programs such as drugrecommendations, therapeutic substitution, refill reminders, other product orservice recommendations such as specialty and infusion therapies, counselingand drug utilization review (DUR), product recalls or disease state management.
KV Vet may use your health information for various payment-related functions.Example: KV Vet may contact your insurer, pharmacy benefit manager or other healthcare payor to determine whether it will pay for your medications, equipment andsupplies and the amount of your co-payment. KV Vet will bill you or athird-party payor for the cost of medications, equipment and supplies dispensedto you. The information on or accompanying the bill may include informationthat identifies you, as well as the medications you are taking.
Health Care Operations
KV Vet may use your health information for certain operational, administrativeand quality assurance activities. Example: KV Vet may use information in yourhealth record to monitor the performance of the staff and pharmacists providingtreatment to you. This information will be used in an effort to continuallyimprove the quality and effectiveness of the health care and service KV Vetprovides. KV Vet may disclose health information to business associates if theyneed to receive this information to provide a service to us and will agree toabide by specific HIPAA rules relating to the protection of health information.
KV Vet may also use your health information to provide you with information about benefitsavailable to you, and, in limited situations, about health-related products orservices that may be of interest to you. If you register your email address onKVVet.com, or any of its other websites, you may elect to receive thisinformation via email.
KV Vet ispermitted to use or disclose your PHI for the following purposes. However, KVVet may never have reason to make some of these disclosures.
To Communicate with Individuals Involved in Your Care or Payment for Your Care.
KV Vet may disclose to a family member, other relative, close personal friend or any otherperson you identify, PHI directly relevant to that person's involvement in your care or payment related to your care.
Food and Drug Administration (FDA).
KV Vet may disclose to the FDA, or persons under the jurisdiction of the FDA,PHI relative to adverse events with respect to drugs, foods, supplements,products and product defects, or post-marketing surveillance information toenable product recalls, repairs, or replacement.
KV Vet may disclose your PHI to the extent authorized by and to the extentnecessary to comply with laws relating to worker's compensation or othersimilar programs established by law.
As required by law, KV Vet may disclose your PHI to public health or legalauthorities charged with preventing or controlling disease, injury, ordisability.
KV Vet may disclose your PHI for law enforcement purposes as required by law orin response to a subpoena or court order.
As Required by Law.
KV Vet will disclose your PHI when required to do so by federal, state, or local law.
Health Oversight Activities.
KV Vet may disclose your PHI to an oversight agency for activities authorizedby law. These oversight activities include audits, investigations, inspections,and credentialing, as necessary for licensure and for the government to monitorthe health care system, government programs, and compliance with civil rightslaws.
Judicial and Administrative Proceedings.
If you are involved in a lawsuit or a dispute, KV Vet may disclose your PHI inresponse to a court or administrative order. KV Vet may also disclose healthinformation about you in response to a subpoena, discovery request, or otherlawful process instituted by someone else involved in the dispute, but only ifefforts have been made, either by the requesting party or us, to tell you aboutthe request or to obtain an order protecting the information requested.
KV Vet may disclose your PHI to researchers when their research has beenapproved by an institutional review board or privacy board that has reviewedthe research proposal and established protocols to ensure the privacy of yourinformation.
Coroners, Medical Examiners, and Funeral Directors.
KV Vet may release your PHI to a coroner or medical examiner. This may benecessary, for example, to identify a deceased person or determine the cause ofdeath. KV Vet may also disclose PHI to funeral directors consistent withapplicable law to enable them to carry out their duties.
Organ or Tissue Procurement Organizations.
Consistent with applicable law, KV Vet may disclose your PHI to organprocurement organizations or other entities engaged in the procurement,banking, or transplantation of organs for the purpose of tissue donation andtransplant.
KV Vet may use or disclose your PHI to notify or assist in notifying a familymember, personal representative, or another person responsible for your care,regarding your location and general condition.
If you are or become an inmate of a correctional institution, KV Vet maydisclose to the institution or its agents PHI necessary for your health and thehealth and safety of other individuals.
To Avert a Serious Threat to Health or Safety.
KV Vet may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Veterans.
If you are a member of the armed forces, KV Vet may release PHI about you asrequired by military command authorities. KV Vet may also release PHI aboutforeign military personnel to the appropriate foreign military authority.
National Security, Intelligence Activities, and Protective Services for the Presidentand Others.
KV Vet may release PHI about you to federal officials for intelligence,counterintelligence, protection to the President, and other national securityactivities authorized by law.
Victims of Abuse or Neglect.
KV Vet may disclose PHI about you to a government authority if KV Vetreasonably believes you are a victim of abuse or neglect. KV Vet will onlydisclose this type of information to the extent required by law, if you agreeto the disclosure, or if the disclosure is allowed by law and KV Vet believesit is necessary to prevent serious harm to you or someone else.
Other Uses and Disclosures of PHI
KV Vet will obtain your written authorization before using or disclosing yourPHI for purposes other than those provided for above (or as otherwise permittedor required by law). You may revoke an authorization in writing at any time.Upon receipt of the written revocation, KV Vet will stop using or disclosingyour PHI, except to the extent that KV Vet has already taken action in relianceon the authorization.
Your Health Information Rights
Obtain a paper copy of the Notice upon request.
You may request a copy of KV Vet's current Notice at any time. Even if you haveagreed to receive the Notice electronically, you are still entitled to a papercopy. You may obtain a paper copy from a pharmacy, home care facility, mailservice location or the Privacy Office.
Request a restriction on certain uses and disclosures of PHI.
You have the right to request additional restrictions on KV Vet's use ordisclosure of your PHI by sending a written request to the Privacy Office. KVVet is not required to agree to those restrictions. KV Vet cannot agree torestrictions on uses or disclosures that are legally required, or which arenecessary to administer KV Vet's business.
Inspect and obtain a copy of PHI.
In most cases, you have the right to access and copy the PHI that KV Vetmaintains about you. To inspect or copy your PHI, you must send a writtenrequest to the Privacy Office. KV Vet may charge you a fee for the costs ofcopying, mailing and supplies that are necessary to fulfill your request. KVVet may deny your request to inspect and copy in certain limited circumstances.
Request an amendment of PHI.
If you feel that PHI KV Vet maintains about you is incomplete or incorrect, youmay request that KV Vet amend it. To request an amendment, you must send awritten request to the Privacy Office. You must include a reason that supportsyour request. In certain cases, KV Vet may deny your request for amendment.
Receive an accounting of disclosures of PHI.
You have the right to receive an accounting of the disclosures KV Vet has madeof your PHI after December 27, 2012 for most purposes other than treatment,payment, or health care operations. The right to receive an accounting issubject to certain exceptions, restrictions, and limitations. To request anaccounting, you must submit a request in writing to the Privacy Office. Yourrequest must specify the time period. The time period may not be longer thansix years and may not include dates before December 27, 2012.
Request communications of PHI by alternative means or at alternative locations.
For instance, you may request that KV Vet contact you at a different residenceor post office box. To request confidential communication of your PHI, you mustsubmit a request in writing to the Privacy Office. Your request must tell ushow or where you would like to be contacted. KV Vet will accommodate all reasonablerequests.
Where to obtain forms for submitting written requests.
You may obtain forms for submitting written requests by contacting the PrivacyOfficer at KV Supply, LLC, PO Box 245 David City, NE 68632 or toll-free bytelephone at 800-423-8211. You can also visit www.KVSupply.com to obtain theseforms.
KV Vet will make reasonable efforts to avoid incidental disclosures ofprotected health information. An example of an incidental disclosure isconversations that may be overheard between the pharmacy staff and the patientat the drive-thru, as a result of the speaker system. To reduce the likelihoodof this happening, KV Vet recommends that you go inside the store to thepharmacy for any consultations.
If you are a minor who has lawfully provided consent for treatment and you wishfor KV Vet to treat you as an adult for purposes of access to and disclosure ofrecords related to such treatment, please notify a staff member, pharmacist orthe Privacy Office.
For More Information or To Report a Problem
If you have questions or would like additional information about KV Vet'sprivacy practices, you may contact KV Vet's Privacy Officer at KV Supply, LLC,Privacy Officer, PO Box 245 David City, NE 68632 or toll-free by telephone at 800-423-8211.If you believe your privacy rights have been violated, you can file a complaintwith the Privacy Officer or with the Secretary of Health and Human Services.You can also file a complaint through www.KVSupply.com, and KV Vet will routeyour complaint to the Privacy Office. There will be no retaliation for filing acomplaint.
This Notice is effective as of December 27, 2012.