HIPAA 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.

When this Notice of Privacy Practices (“Notice”) refers to “we” or “us,” it is referring to Origin Wellness and all the pharmacists who provide health care services and the employees of our pharmacy. We are required by law to maintain the privacy of your protected health information (“PHI”), to follow the terms of the Notice currently in effect, to give you this Notice setting forth our legal duties and privacy practices concerning your PHI and to notify affected individuals following a breach of unsecured PHI. This Notice describes how we may use and disclose your PHI. Additionally, this Notice explains the rights you have with respect to your PHI, and certain obligations we must abide by in accordance with the law. We reserve the right to amend this Notice. If we make any material revisions to this Notice, we will post a copy of the revised Notice in the pharmacy, on our website and will offer you a copy of the revised Notice.

I. Use and Disclosure of Your PHI

We will use and disclose your PHI for treatment, payment and health care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization. The following lists examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will only be made with your explicit written authorization, which you may revoke at any time by providing us with written notice of your revocation.

Treatment

We may use and disclose your PHI in order to provide you with prescription and supply services. We may disclose your PHI to other pharmacists, pharmacy technicians and health care providers that are involved in your care. You will receive an individual notice and have the opportunity to opt out of any subsidized treatment communications.

Payment

We will use and disclose your PHI in order to obtain payment for the health care services we provide to you. We may also need to disclose your PHI to receive prior approval from your health plan or to determine if your health plan will cover a certain prescription or service.

Health Care Operations

We may use and disclose your PHI in connection with the management of our pharmacy. For example, this may include: quality assessment and improvement, internal compliance audits, and performance evaluations. Additionally, we may use your PHI for our business management and general administrative activities.

Prescription Refill Reminders, Treatment Alternatives or Health-Related Benefits

We may use and disclose your PHI to contact you to remind you about prescription refills, to tell you about treatment options or alternatives, or to inform you about health-related benefits or services that may be of interest to you.

Family Members, Relatives or Close Friends

Unless you object to such disclosure, we may disclose your PHI to your family members, relatives or close personal friends, or any other persons identified by you as being involved in the treatment or payment for your medical care. If you are not present to agree or object to our disclosure of your PHI to a family member, relative or friend, we may exercise our professional judgment to determine whether the disclosure is in your best interest. If we decide to disclose your PHI, we will only disclose the PHI that is relevant to your treatment or payment.

Other Permitted and Required Uses and Disclosures

We may use your PHI without obtaining your authorization and without offering you the opportunity to agree or object as follows:

• as required by law, provided however, that the use or disclosure will be made in compliance with applicable law;
• to a public health authority that is authorized by law to collect or receive such information, including for purposes of preventing or controlling disease, injury or disability, and other public health activities as permitted by law.

II. Your Rights as Our Patient

As our patient, you have a number of rights associated with your PHI. You have the right to request restrictions or limitations on how we use and/or disclose your PHI, to request confidential communications, to inspect and copy your PHI, to request an amendment, to receive an accounting of certain disclosures, and to receive a paper copy of this Notice upon request. These rights are exercised in accordance with applicable law and our policies.

III. Additional Information, Questions or Complaints

If you need any additional information about this Notice or wish to exercise any of your rights set forth in this Notice, please contact the Privacy Officer at the following address:

If you believe your privacy rights have been violated, you may file a complaint without retaliation with the Privacy Officer of the pharmacy or with: