HIPAA 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 carefully.

I. Notice Intent/Purpose: This Notice describes the privacy practices of your specialty pharmacy and infusion company.

II. Our Privacy Obligations: FOSRX/FAST Pharmacy is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. When FOSRX/FAST Pharmacy uses or discloses your PHI, we are required to abide by the terms of this Notice (or other Notice in effect at the time of the use or disclosure).

III. Permissible Uses and Disclosures Without Your Written Authorization: In certain situations, which are described in Section IV, FOSRX/FAST Pharmacy must obtain your written authorization in order to use and/or disclose your PHI. However, we do not need any type of authorization from you for the following uses and disclosures:

a. 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 professionals who may provide treatment or who may be consulted by staff members.

b. Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

c. Healthcare Operations. Your health information may be used as necessary to support the day-to-day activities and management of FOSRX/FAST Pharmacy. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

d. Law Enforcement. Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law – enforcement investigations, and to comply with government mandated reporting.

e. Public Health Activities. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

f. Victims of Abuse, Neglect, or Domestic Violence. If we have reason to believe that you are a victim of abuse, neglect or domestic violence, we may disclose your PHI to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect or domestic violence.

g. Other uses and disclosures require your authorization. Disclosure of your health information or its use for any 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. 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. Without your authorization, we are prohibited to use or disclose your protected health information for marketing purposes when financial remuneration is involved. We may not sell your protected health information without your authorization. We may not use or disclose most psychotherapy notes contained in your protected health information. We will not use or disclose any of your protected health information that contains genetic information that will be used for underwriting purposes.

IV. Additional Uses of Information

a. Appointment Reminders. Your health information will be used; by our staff to communicate prescription refills, appointment reminders, and post infusion and/or therapy administration follow up.

b. Information About Treatments. Your health information may be used to send you information on the treatment and management of your medical condition that you may find interesting. We may also send you information describing other health – related products and services that we believe may interest you. FOSRX/FAST Patient Management & Resource Guide [Revised 09/2017] 7 V. Your Rights Regarding Your Protected Health Information. You have certain rights under the federal privacy standards. These include: a. Right to request restriction on the use and disclosure of your protected health information. You may request restriction on our use and disclosure of your PHI: (1) for treatment, payment and healthcare operations; (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care; or (3) to notify or assist in the notification of such individuals regarding your location and general condition. While we will consider all requests for restrictions carefully, we are not required to agree to a requested restriction except that in certain instances we must agree to a restriction relating to a disclosure to a health plan for the purposes of carrying out payment or healthcare provider involved has already been paid out of pocket in full. b. Right to receive confidential communications concerning your medical condition and treatment. You may request, and we will accommodate, any reasonable written request for you to receive your PHI by alternative means of communication or at alternative locations.

c. Right to inspect and copy your protected health information. You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the pharmacy. Your request will be reviewed and will generally be approved unless there is legal and or medical reason to deny the request.

d. Right to amend or submit corrections to your protected health information. You have the right to request that we amend PHI maintained in your medical or billing records. If you desire to amend your records, please send a written request with the amendment, including the reason for the amendment, to the FOSRX/FAST Pharmacy. You may also obtain an amendment form from the pharmacy. We will comply with your request unless we believe that the information already on file is accurate or complete or other special circumstances apply.

e. Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your PHI made by us during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to September 1st, 2014.

f. For Further Information; Complaints. If you desire further information about your privacy rights and protected health information or if you would like to submit a comment or complaint about our privacy practices and or your protected health information, you can do so by sending a letter outlining your concerns to: Corporate Compliance Officer, FOSRX/FAST Pharmacy, 308 Virginia Ave, Cumberland, MD 21502. 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 will not be penalized or otherwise retaliated against for filing a complaint.

g. Right to Receive a Printed Copy of This Notice. The name and address of the person you may contact for further information concerning our privacy practices is: Corporate Compliance Officer, FOSRX/FAST Pharmacy, 308 Virginia Ave, Cumberland, MD 21502. Pharmacy: Toll-free phone: 833-FOS-FAST (367-3278), Toll-free fax: 844-504-3278.

This notice is effective on or after September 1st, 2014

Right to Revise Privacy Practices and/or Change the Terms of This Notice: 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. If we change this Notice, we will post the new Notice in our facility and on our website: www.fosrxfast.com. Upon request, we will provide you with the most recently revised notice.

FOSRX/FAST Duties: We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices outlined in this notice. In the event of a breach of unsecured protected health information, if your information has been compromised it is our duty to notify you.