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Marc Glassman, Inc.
NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed
and how you can get access to this information.
PLEASE REVIEW IT CAREFULLY
The Pharmacy is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future medical health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted by law. The Notice also describes your rights with respect to PHI about you. The Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.
Your Health Information Rights
You have the following rights with respect to PHI about you:
Obtain a Paper Copy of the notice Upon Request. You may request a copy of the Notice at any time.
Request a Restriction on Certain Uses and Disclosures of PHI. You have the right to request additional restrictions on our use of or disclosure of your PHI about you by sending a written request to the address listed below. We are not required to agree to those restrictions.
Inspect and Obtain a copy of PHI. You have the right to access and request a copy of your PHI which includes your prescription and billing records. Send such written requests to the address listed below. We may charge you a fee for the costs of copying, mailing and supplies necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an Amendment of PHI. If you feel that your PHI with us is incomplete or incorrect, you may request that we amend it. Send such written requests to the sddress listed below. You must include a reason that supports your request. We may deny your request for amendment, you may request that the denial be reviewed.
Request an Accounting of Disclosures of PHI. You have the right ro receive an accounting of the disclosures we have made of PHI about you for purposes other than treatment, payment or health care options. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorized, disclosures to friends or family members involved in your care and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations. Send such requests in writing to the address listed below. We will notify you of any costs involved and you may choose to withdraw or modify your request at that time.
Request Communication of PHI by Alternative Means or Alternative Locations. You may request that we contact you about your medical matters only in writing or at a different residence or post office box. Send such requests in writing to the address below. Your request must be reasonable and state how or where you would like to be contacted.
Examples of How We May Use and Disclose PHI
We Will Use PHI for Treatment. We will record your prescription information relating to the medication dispensed to you and our services provided to you. We may use this information to contact your physician and to counsel you or your caregivers.
We Will Use PHI for Payment. We will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescriptions and the amount of your co-payment. We will bill you or a third-party payer for the cost of presciption medication dispensed to you.
We Will Use PHI for Health Care Operations. We may use information in your records to monitor the performance of our pharmacists providing treatment to you. We may use this information to contact your physician regarding alternative medications.
Business Associates. There are some services provided by us through contracts with business associates. To protect your PHI, we require the business associates to appropriately safeguard the PHI.
Communication With Individuals Involved in Your Care or Payment for Your Care. Our pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to the person's involvement in your care or payment related to your care.
Health-Related Communications. We may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and service that may be of interest to you.
Food and Drug Administration (FDA). We may disclose to the FDA, persons under the jurisiction of the FDA, or other health oversight agencies PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or other information to enable product recalls, repairs or replacements.
Substance Use Disorder Treatment Information. We may disclose Substance Use Disorder (SUD) Program treatment information when the patient has signed a valid consent or when a specific exception applies such as a medical emergency, court order or subpoena.
As Required by Law. We must disclose PHI about you when required to do so by law.
Other Uses and Disclosures of PHI
The Pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. Information disclosed pursuant to your consent may be subject to redisclosure by the recipient and may no longer be protected by federal privacy rules or laws. However, with respect to records protected by 42 CFR Part 2, the recipient is generally prohibited from making further diclosures of your SUD records without your express written consent or as otherwise permitted by law.
Our Responsibilities
The Pharmacy is required by law to maintain the privacy and security of your protected health information. We will promptly inform you if a breach occurs that may have compromised the privacy or security of your protected health information. The Pharmacy is required to follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing sent to the Privacy Officer at the address listed below.
For More Information or to Report a Problem
If you have questions or would like additional information about the Pharmacy's privacy practices, you may contact the Privacy Officer at MARC GLASSMAN, INC., 5841 West 130th Street, Parma, Ohio 44130. If you believe your privacy rights have been violated, you can file a complaint with the Marc Glassman, Inc. Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Effective Date: This Notice is effective as of February 1, 2026.
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