Notice of Privacy Practices

Health Insurance Portability and Privacy Act


Houck Pharmacy is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specifies purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you.

Houck Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.


The United States Department of Health and Human Services has adopted privacy standards, “the HIPAA Privacy Standards”, which protect your health information. The HIPAA Privacy Standards establish rules for when healthcare providers, such as Houck Pharmacy, may use or disclose your health information. Importantly, the HIPAA Privacy Standards also tell us what we cannot do with your health information. Activities that are not permitted under HIPAA will require your written authorization.


The HIPAA Privacy Standards allow us to use and disclose your health information, to perform the activities listed below in our role as a pharmacy. These examples are not exhaustive.

Treatment: We are permitted to use and disclose your health information to fill your prescriptions and provide appropriate care. For example, we may use and disclose your health information to review and interpret your prescriptions, screen your prescriptions to ensure the prescribed medications are safe for you, contact your physician to address questions regarding your prescriptions, refill your prescription when you request, document information regarding your prescriptions and any other services provided to you.

Payment: We are permitted to use and disclose your health information, as needed, to obtain payment for our services. For example, we may bill you for the cost of prescription medication dispensed to you, or provide your health plan or its agents with the health information they need so they can manage your prescription benefit. The information on or accompanying the bill may include information that identifies you as well as the prescriptions you are taking.

Healthcare operations: We are permitted to use and disclose your health information for the general administrative and business activities for us to operate as a pharmacy. For example, we may review and evaluate the performance of our pharmacists and staff , collect medical history and drug allergy information from you, or you, send communications informing you of the status of your prescriptions, communications about products or services we offer and information about other health related benefits and services that may be of interest to you.

Business Associates: There are some services provided by us through contacts with business associates, such as computer software support. When these services are contracted for, we may disclose PHI about you to our business associates so that they can perform the job we have asked them to do. To protect PHI about you we require the business associate to appropriately safeguard the PHI.

Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers’ Compensation: We may disclose PHI about you as authorized by and as necessary to comply with the laws relating to a worker’s compensation or similar programs established by law.

Public Health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability. This disclosure may be used to report births and deaths, report reactions to medications or problems with products, notify a person who may have been exposed to a disease or who may be at risk for spreading or contracting a disease or condition.

Law Enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.

As required by law: We may disclose PHI about you when requested to do so by law.

Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI.

Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine cause of death. We may also disclose to funeral directors consistent with applicable law to carry out their duties.

Organ or tissue procurement organizations: consistent with applicable law, we may disclose PHI about you to an organ procurement organization or other entities engaged in the procurement, banking, or transplantation of organs for the tissue donation and transplant.

Fundraising: We may contact you as a part of a fundraising effort.

Notification: We may use of disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and your general condition.

Correctional Institutions: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.

Military and veterans: If you are a member of the armed forces we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate authority.

Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as social service or protective services agency. If we reasonably believe you are a victim of abuse, neglect, or domestic violence, we will only disclose this type of information to the extent regulated by law. If you agree to the disclosure or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or to someone else or the law enforcement or public officials that is to receive the report represents that it is necessary and will not be used against you.



The pharmacy will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI, except to the extent that we have already taken action in the reliance on the authorization.


You have the following rights with respect to PHI about you:

Obtain a paper copy of the Notice upon request. You may request a copy of the notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy.

Request a restriction on certain uses and disclosures of PHI. You may request restrictions on how we use and disclose your health care information, and whether we disclose your health information to family members or others involved in your care. We are not required to agree to those restrictions if we believe the request is not in the best interest of either party or we are unable to accommodate the request.

Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it, for as long as we maintain PHI. You must include a reason that supports your request. However, we are not required to honor your request if, for example, the information you want to amend is accurate and complete.

Receive an accounting of disclosures of your PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you for most purposes other than treatment, payment or health care operations. This accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. Your request must specify the time period, but may not be longer than six years. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings.

Request confidential communications. You may request that we communicate with you using alternate means or at an alternative location. Your request must state how or where you would like to be contacted. We will accommodate reasonable requests when possible.

To exercise any of your privacy rights, please put your request in writing and mail to Houck Pharmacy at the address below. To ensure the accuracy of your report, the request must include the following information: your name, full address, date of birth, and telephone number.


If you have any concerns about our privacy practices. Or if you feel your privacy rights have been compromised, you have the right to file a complaint with the Privacy Officer at Houck Pharmacy or with the United States Department of Health and Human Services, Secretary of HHS, 200 Independence Ave. S.W., Washington D.C. 29291 or at  Please be assured that if you file a privacy complaint, your complaint will be handled in a professional manner, and you will not be subject to any type of penalty or retaliation for filing the complaint.



Houck Pharmacy, Attention HIPAA Privacy Official
101 South Monroe Avenue
Mason City, Iowa 50401
Phone: 641.422.9333

This Notice is effective in its entirety as January 1. 2015