Privacy Policy for Formulate Rx Pharmacy, LLC

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFOR- MATION. PLEASE REVIEW IT CAREFULLY.

Effective Date: April 15, 2024

Formulate Rx Pharmacy, LLC (“we,” “us,” or “our”) is committed to protecting the privacy of your Protected Health Information (“PHI”) in compliance with the Health Insurance Portability and Accountability Act (“HIPAA”), the Florida Information Protection Act (“FIPA”), and other applicable federal and state laws. This Notice of Privacy Practices (“Notice”) explains how we collect, use, disclose, and safeguard your PHI, your rights regarding your PHI, and our legal obligations. PHI includes any individually identifiable information related to your past, present, or future health condition, the provision of health care services, or payment for such services.

We are a covered entity under HIPAA and are required by law to maintain the privacy and security of your PHI and to provide you with this Notice outlining our legal duties and privacy practices. As a pharmacy providing pharmacy services, we ensure that our employees and workforce members adhere to the terms of this Notice.

1. How We Collect and Use Your PHI

We collect and use PHI to provide pharmacy services. The information we collect may include:

Personal Information: Name, address, phone number, email address, and payment details.
Protected Health Information (PHI): Prescription records, medical history, insurance details, and other health-related information provided by you or your healthcare providers.

We use and disclose your PHI for purposes such as:

Treatment: To fill prescriptions, coordinate care with your healthcare providers, and arrange shipping of medications.
Payment: To process payments.
Health Care Operations: To improve service quality, train staff, or conduct internal audits (using de-identified data where possible).

2. Uses and Disclosures of PHI Without Your Authorization

We may use or disclose your PHI without your prior authorization for purposes permitted by law, including:

Treatment: Sharing PHI with pharmacists, physicians, or other healthcare providers to coordinate your care.
Payment: Process payments.
Health Care Operations: Analyzing PHI to enhance service efficiency or quality, such as evaluating compounding processes.
Business Associates: Sharing PHI with third parties under agreements that ensure PHI protection.
Public Health: Reporting adverse drug reactions to the FDA or other authorities to prevent disease or injury.
Law Enforcement: Disclosing PHI in response to a court order, subpoena, or other lawful request, as permitted by law.
Health Oversight Activities: Providing PHI to government agencies for audits, investigations, or licensure requirements.
Research: Using or disclosing PHI for approved research studies, with safeguards to protect your privacy.
Coroners and Funeral Directors: Sharing PHI to identify a deceased person or determine the cause of death.
Organ Donation: Disclosing PHI to organ procurement organizations, as permitted by law.
To Avert Serious Threats: Using PHI to prevent serious harm to you or others.
Workers’ Compensation: Disclosing PHI to comply with workers’ compensation laws.
Military and National Security: Sharing PHI with military authorities or federal officials, as required by law.

Certain types of PHI, such as HIV information, genetic information, or substance abuse records, may be subject to additional protections under Florida or federal law. We will comply with these special protections.

3. Uses and Disclosures Requiring Your Authorization

We will obtain your written authorization before using or disclosing your PHI for:

Psychotherapy notes
Marketing purposes, except as permitted by law.
Sale of PHI.
Any other purpose not described in this Notice or permitted by law.

You may revoke an authorizatiion in writing at any time, and we will stop using or disclosing your PHI for that purpose, except to the extent we have already acted in reliance on it.

4. Your Rights Regarding Your PHI

You have the following rights concerning your PHI:

Right to Access: You may inspect or obtain a copy of your PHI in our records. If we maintain electronic health records, you may request an electronic copy or direct us to send it to a designated third party.
Right to Amend: You may request corrections to inaccurate or incomplete PHI by submitting a written request to our Privacy Official with a supporting reason.
Right to an Accounting of Disclosures: You may request a list of disclosures of your PHI made in the past six years, except for disclosures for treatment, payment, or health care operations.
Right to Request Restrictions: You may request restrictions on how we use or disclose your PHI. We are not required to agree, except when the disclosure is to a health plan for payment or health care operations, pertains to a service you paid for in full, and is not required by law.
Right to Confidential Communications: You may request that we communicate with you about your PHI in a specific way or at a specific location (e.g., a different address or email).
Right to a Paper Copy: You may request a paper copy of this Notice, even if you agreed to receive it electronically.
Right to Breach Notification: You will be notified in the event of a breach of your unsecured PHI, as required by law.

To exercise these rights, contact our Privacy Official (details below). We may deny certain requests (e.g., access to specific records) in limited circumstances, and you may request a review of such denials.

5. Our Legal Duties

Formulate Rx Pharmacy, LLC is required by law to:

Maintain the privacy and security of your PHI.
Notify you promptly of any breach of your unsecured PHI.
Adhere to the terms of this Notice, as currently in effect.
Provide you with this Notice to explain our privacy practices and legal obligations.

6. Data Security and Retention

We implement robust safeguards to protect your PHI, including:

Encryption of electronic PHI during storage and transmission.
Access controls to limit PHI to authorized personnel.
Secure processes for prescription fulfillment and shipping medications.
Regular staff training on HIPAA and Florida privacy laws.

We retain PHI only as long as necessary for the purposes outlined in this Notice or as required by law. When no longer needed, we securely dispose of PHI through shredding or secure deletion.

7. Changes to this Notice

We may revise this Notice to reflect changes in our practices or legal require- ments. If we make material changes, we will post the updated Notice on our website (www.formulaterx.com) and make it available at our pharmacy. The effective date will be updated, and we will provide a revised copy upon request.

8. Website Data Collection

When you visit www.formulaterx.com, we may collect non-PHI data, such as IP addresses or browsing activity, to improve our website’s functionality. This data is not linked to your PHI unless you provide it (e.g., through an online contact form). We use secure sockets layer (SSL) encryption for data transmitted via our website.

9. Contact Information

For questions, complaints, or to exercise your rights regarding your PHI, contact our Privacy Official:

Name: Steven Miller
Phone: (877) 340-0042 (toll-free) or (407) 707-9797
Address: Formulate Rx Pharmacy, LLC, 1049 Willa Springs Dr STE 1051, Winter Springs, Florida 32708

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.