Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL AND PRESCRIPTION INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
Our Pledge Regarding Health Information
GOOD SAMARITAN PHARMACY INC is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our pharmacy business, we create and maintain records of the prescription medications, consultation notes, and billing information we process on your behalf.
How We May Use and Disclose PHI
- Treatment: We disclose prescription details to dispense medications, contact your prescribing physician regarding refills or dosage questions, and counsel you on drug interactions.
- Payment: We submit claims to your health plan, Medi-Cal, or Medicare Part D insurer to receive reimbursement for covered prescriptions.
- Healthcare Operations: We use records for quality reviews, packaging audits, and compliance with California Board of Pharmacy regulations.
Your Privacy Rights
You have the right to inspect and copy your pharmacy records, request amendments to medical notes, request confidential communications, and obtain an accounting of disclosures.
For full inquiries or to speak with our pharmacy privacy officer: GOOD SAMARITAN PHARMACY INC, 8137 Malachite Ave, Suite A, Rancho Cucamonga, CA 91730, Phone: (909) 774-1115.