Azina, LLC 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 

This Notice 

The Health Insurance Portability and Accountability Act (HIPAA), Health Information Privacy and Security Rule, and the Health Information Technology for Economic and Clinical Health (HITECH) Act enacted as part of the American Recovery and Reinvestment Act of 2009 require that covered healthcare providers provide patients with a “Notice of Privacy Practices” (NPP). 

Our Notice serves Azina, LLC (Azina), collectively referred to as “we,” “our,” or “us.” Specifically, our Notice describes our Privacy Practices and that of any Azina and the health care professionals authorized to enter information into your records. 

Our Pledge to You 

Azina is committed to protecting the privacy of medical information we create or obtain about you. This Notice tells you how we may use and disclose your medical information. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information. We are required by law to: 

• Payment for such products or services.
• Make sure your medical information is protected.
• Give you the Notice describing privacy practices concerning your medical information.
• Follow the terms of the Notice that is currently in effect.

Our Duties 

The privacy practices described in this Notice will be followed by our healthcare professionals, employees, medical staff, trainees, and students. 

We respect the confidentiality and personal nature of your health information. We are committed to protecting your health information and to informing you of your rights regarding such information. We are required by law to protect the privacy of your protected health information, provide you with notice of these legal duties, and notify you following a breach of unsecured protected health information. This Notice explains how, when, and why we typically use and disclose health information and your privacy rights regarding your health information. In our Notice, we refer to our uses and disclosures of health information as our “Privacy Practices.” 

Protected Health Information (PHI) Explained 

PHI is information about you that we need to provide our services to you and that may be used to identify you. It includes your name, contact information, and information about your health, medical conditions, and prescriptions. It may also relate to your: 

• Past, present, or future physical or mental health or condition.
• Provision of health care products and services to you.
• Payment for such products or services.

How we use and share your PHI 

We may use and share your PHI for the following reasons: 

Treatment: We may use and disclose your PHI to provide and help you get the treatment, medication, and services you receive. For example, we may: 

• Share your PHI with other parties (such as doctors, hospitals, or other health care providers) to help them provide care to you or coordinate your treatment.
• Contact you to offer services related to your treatment. These may include:

o Reminders to refill your medicine. 

o Suggestions for other medication options (such as generic medicines). 

o Messages about your medication treatment plan. 

Payment: We may use and share your PHI to obtain payment for the medication we provide. For example, we may: 

• Share your PHI with your insurer, pharmacy benefit manager, or other health care payor to determine whether it will pay for your medication. This also may tell us how much you may owe.
• Contact you about a payment or balance due for prescriptions you get from us.
• Share your PHI with other healthcare providers, health plans, or HIPAA Covered Entities who may need it for payment.

Health care operations: We may use and share your PHI for our healthcare operations. Those are activities we need to do to carry out our health care business. For example, we may: 

• Use and share your PHI to monitor the quality of our services, provide customer services to you, resolve complaints, and coordinate your medication.
• Transfer or receive your PHI if we buy or sell pharmacy locations.
• Use and share your PHI to contact you about health-related products and programs.
• Share your PHI with other HIPAA Covered Entities that have provided services to you. We do this so they can improve the quality and value of the health care services they offer or for their health care operations.
• Use your PHI to create de-identified data. This is data that no longer identifies you. We may use or share it for analytics, business planning, or other reasons.

Business associates: We may allow access to those who provide services for us, including third parties who perform billing or consulting services. They are required by law and their agreements with us to protect your PHI as we do. 

People involved in your care or for payment: We may share your PHI with certain people who are involved in your care or the payment of it. This may include a friend, personal representative, family member, or any other person you identify as a caregiver. For example, we may provide prescriptions 

and related information to your caregiver on your behalf. In addition, if you are a minor, we may release your PHI to your parents or legal guardians when permitted or required by law. 

Workers' compensation: We may share your PHI to comply with workers’ compensation laws or similar programs. 

Law enforcement: We may share your PHI with law enforcement officials as permitted or required by law. For example, we may share your PHI to report specific injuries or criminal conduct that happens on our premises. Also, we may share it in response to a court order, subpoena, warrant, or similar written request from law enforcement. 

Required by law: We will share your PHI to comply with federal, state, or local law. 

Judicial and administrative proceedings: We may share your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process. 

Public health and safety purposes: We may share your PHI in certain situations to help with public health and safety issues. For example, to: 

• Prevent disease.
• Report adverse reactions to medicine.
• Report suspected abuse, neglect, or domestic violence.
• Prevent or reduce a threat to a person’s health or safety.

Health oversight activities: We may share your PHI with an oversight agency for certain activities, including: 

• Audits, investigations, inspections, licensure, or disciplinary actions.
• Civil, administrative, and criminal proceedings.
• As necessary for oversight of the health care system, government programs, or compliance with civil rights laws.

Research: Under certain circumstances, we may use or disclose your PHI for research purposes. For example, we may use or disclose your PHI as part of a research study when an institutional review board has approved the research, and there is an established protocol to ensure the privacy of your information. 

Coroners, medical examiners, and funeral directors: We may share your PHI with these entities so they may carry out their duties. 

Organ or tissue donation: We may share your PHI with organ procurement organizations. 

Notification: We may use or share your PHI to notify or help notify a family member or any other person responsible for your care about your general condition. We may also disclose your PHI to disaster relief groups so that your family or others responsible for your care can learn of your location, general condition, or death. 

Correctional institution: We may share your PHI with a correctional institution or its agents if you are or become an inmate. This is to help them provide your healthcare and protect the health and safety of you and of others. 

Specialized government functions and Military: We may share your PHI with authorized federal officials for military, national security activities, and other specialized government functions. We may disclose your PHI for activities deemed necessary by appropriate command authorities or under the law if you are a member of the U.S. armed forces or the foreign military. 

Authorization required uses and disclosures 

In some situations, we may only use and share your PHI when you give us permission in writing to use or disclose your PHI. For example, without it, we won't: 

• Use or disclose your PHI for marketing purposes.
• Sell your PHI to third parties. However, we may do so without your permission if we transfer a business to another healthcare provider that must comply with HIPAA.
• Share psychotherapy notes if we have any.

We will need your written approval before using or disclosing your PHI for purposes other than those described in this Notice or permitted by law. You may revoke your approval anytime. Just send a written notice to the AZINA Privacy Team. Your revocation will be effective upon receipt. But it will not undo any use or sharing of your PHI that has already happened based on your permission. 

Your health information rights 

Written requests and other information: You may ask for more information about our privacy practices or obtain forms for submitting written requests. Just contact the AZINA Privacy Team 

• By writing: AZINA Attn: Privacy Officer 655 Metro Place South, Suite 450, Dublin, OH 43017
• By email: cps.privacy@cps.com 
• By phone: Toll-free at 1-800-968-6962

Obtain a copy of the Notice: You have the right to a paper copy of our current Notice anytime. You may do so by coming into the pharmacy. You can also contact the AZINA Privacy Team. 

Inspect and obtain a copy of your PHI: With a few exceptions, you have the right to see and get a copy of the PHI we have about you. To inspect or get a copy of your PHI, send a written request to the AZINA Privacy Team. You may also ask us to provide someone else with a copy of your PHI. We may charge a reasonable fee for this. HIPAA and or state law allows this fee. Sometimes, we may deny your request to inspect and copy your record. If we do, we will notify you in writing. We will let you know if you may request a review of the denial. 

Request a change: If you feel the PHI we have about you is wrong or incomplete, you may ask us to fix it. For example, if your date of birth is incorrect, you may ask us to correct it. Send a written request to the AZINA Privacy Team. You must include a reason for your request. If we deny your request, we will explain in writing why we did so. 

Receive a report of disclosures: You have the right to request a list of certain disclosures we make of your PHI for purposes other than treatment, payment, or healthcare operations. This is called an "accounting." (Note certain disclosures are not required in the report we give you.) 

Send a written request to the AZINA Privacy Team to get a list of the disclosures. We will provide one report every 12 months free of charge. But we may charge you for the cost of any other reports. We will notify you in advance of the price. You may withdraw or modify your request at that time. 

Request a restriction on certain uses and disclosures: You have the right to ask for limits on the way we use or share your PHI. Just send a written request to the AZINA Privacy Team. 

We aren’t required to agree to your request except where the disclosure: 

• Is to a health plan or insurer to carry out payment or health care operations.
• Is not otherwise required by law.
• Is PHI related to a health care item or service for which you, or a person on your behalf, has paid in full out of pocket.

If you want to avoid a claim sent to your health plan, talk to your pharmacist when you check in for care or before your prescription is sent to the pharmacy. 

Request confidential communications: You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may ask that we contact you only in writing at a specific address. 

To request confidential communication of your PHI, send a written request to the AZINA Privacy Team. Your request must state how, where, or when you want us to contact you. We will accommodate all reasonable requests. 

Notification of breach: You have a right to know if there is a breach of your unsecured PHI, as HIPAA defines. 

Reporting a concern 

Submit all complaints in writing. We won’t penalize you or retaliate against you in any way if you file a complaint. 

Complaints: If you believe your privacy rights were violated, you can file a complaint with the following: 

• AZINA Privacy Team or
• Secretary of the U.S. Department of Health and Human Services. For online complaint forms and contact information for the Regional OCR offices: Contact Us (OCR) | HHS.gov  

Changes to this Notice 

We may change the terms of this Notice and our privacy policies anytime. If we do, the new terms and policies will be effective for all the information we have about you. And they’ll apply to any information that we may get or hold in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. 

You can ask for a copy of the revised Notice by the following: 

• Ask the AZINA Privacy Team.
• Review the revised Notice that is posted in our retail stores and on our website atazinarx.com.
• Get a copy at our locations where you receive healthcare products and services.

A copy of the current effective Notice will be mailed to new patients in the Welcome Packet. 

Effective Date. This Notice is effective as of 5.26.2023.