THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU OR THE INDIVIDUAL UNDER YOUR CARE MAY BE USED AND DISCLOSED AND HOW YOU OR THE INDIVIDUAL UNDER YOUR CARE CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY. REFERENCES TO “YOU” AND “YOUR” REFER TO YOU AS A PATIENT AND TO THE INDIVIDUAL UNDER YOUR CARE IF YOU ARE A CAREGIVER.
The Qsymia Engage: Home Delivery Pharmacy services ("Services") are operated by Medvantx ("we," "us," or "our"). Medvantx is required by law to maintain the privacy of Protected Health Information ("PHI"), to provide you with notice of our legal duties and privacy practices with respect to PHI, and to notify you in the event of a breach of the privacy or security of your PHI. 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 specified purposes that are permitted or required by law. The Notice also describes your rights with respect to your PHI. We are required to provide this Notice to you by the Health Insurance Portability and Accountability Act and its implementing regulations ("HIPAA").
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We know that keeping your personal information or the personal information of the individual under your care private is important. That’s why Medvantx wants to indicate how we use and disclose the information you share with us.
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Medvantx maintains physical, electronic, and procedural safeguards that meet state and federal regulations. Access to patient information is limited only to people that need the information for authorized pharmacy purposes.
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Medvantx may disclose information when required by law in order to respond to a subpoena, prevent fraud or comply with an inquiry by a government agency.
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Any disclosure of your information or the information of the individual under your care will be done in compliance with HIPAA.
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Medvantx or companies operating on its behalf may contact you by phone to provide refill reminders or information on other health-related benefits or services we offer.
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Other permitted uses and disclosures will be made only with your consent, authorization or opportunity to object unless permitted or required by law. If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.
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Information requested on patient order forms including names, addresses, credit card information, health conditions and allergies.
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Data pertaining to your prescription profile, such as: name of prescription medication, strength, dosing instructions, physician’s name.
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Information collected from your healthcare provider, such as: gender, height, weight, family history, and medical diagnosis. This information is needed so Medvantx pharmacists can utilize their clinical expertise to deliver the best quality of care. Collecting this information is consistent with the patient-doctor-pharmacist relationship.
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Treatment: We may use and disclose your PHI or the PHI of the individual under your care to provide and manage the medications and services that you or the individual under your care receive from your healthcare professionals.
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Payment: We may use and disclose your PHI or the PHI of the individual under your care to manage your account for payment-related purposes.
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Healthcare Operations: In an effort to continually improve the level of quality we provide our customers, we may use and disclose your PHI or the PHI of the individual under your care to gain a better understanding of our business operations and the effectiveness of our service. In the event that your PHI or the PHI of the individual under your care is disclosed to outside business associates, they agree to abide by specific HIPAA requirements, to the extent required by HIPAA. We may also disclose your PHI or the PHI of the individual under your care to your health plan (regardless of payment method) so they can track and improve their own quality programs.
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Individuals Involved in Your Care or Payment for Your Care: We may disclose your PHI to someone who assists with your care, is responsible for paying for your care or has your permission to act on your behalf. Adequate proof must be provided by this person that he or she has your permission. You can write to us to specifically prevent this type of disclosure.
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Abuse, Neglect or Domestic Violence: We may disclose your PHI or the PHI of the individual under your care to government authorities if we have reason to believe you or the individual under your care are a victim of abuse, neglect or domestic violence. We will inform you of our disclosure unless informing you will place you at risk of serious harm, and we will disclose only the minimum amount of information required by law.
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Public Health: We may disclose your PHI or the PHI of the individual under your care for public health purposes to the requisite authorities to help prevent or control disease, track product defects or monitor the performance and side effects of a product after it has been approved for public use.
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Health Oversight: We may disclose PHI to a health oversight agency performing activities authorized by law, such as investigations and audits. These agencies include governmental agencies that oversee the healthcare system, government benefit programs, and organizations subject to government regulation and civil rights laws.
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To Avert Serious Threat to Health or Safety: We may disclose your PHI or the PHI of the individual under your care to prevent a serious threat to the health and safety of you, another person or the public. Such disclosure will only be made to those responsible for preventing the threat.
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Law Enforcement: We may disclose your PHI or the PHI of the individual under your care, as required by law, in response to a subpoena, warrant, summons, or in some circumstances, to report crime.
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Coroners and Medical Examiners: Your PHI or the PHI of the individual under your care may be disclosed to coroners and medical examiners to identify the deceased person or determine cause of death.
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Organ, Eye and Tissue Donation: Consistent with applicable law, we may disclose your PHI or the PHI of the individual under your care to organizations involved in organ procurement or transplantation to facilitate donation and transplantation.
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Judicial Proceedings: If you or the individual under your care are involved or a lawsuit or legal dispute, we may disclose your PHI or the PHI of the individual under your care in response to a subpoena, discovery request or court order related to those proceedings but only after efforts have been made to further protect the requested information and to inform you that the information has been requested.
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Correctional Facilities: If you or the individual under your care are or become an inmate in a correctional institution or under the custody of a law enforcement official, we may disclose your PHI or the PHI of the individual under your care to those parties if disclosure is necessary to provide for your health and the health and safety of others.
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As Otherwise Required By Law: We will disclose PHI about you or the individual under your care when required by law. If additional protections are granted to you or the individual under your care by federal, state or local law, we will disclose your PHI or the PHI of the individual under your care in accordance with those laws.
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Other Uses and Disclosures: In the event that your PHI or the PHI of the individual under your care may be disclosed for reasons other than those outlined in this Notice, we will obtain your written authorization. Unless you provide us with an authorization, we will not use or disclose your PHI or the PHI of the individual under your care for marketing purposes or sell your PHI or the PHI of the individual under your care to third parties. You may revoke that authorization in writing at any time, and we will stop using or disclosing your PHI or the PHI of the individual under your care, except to the extent that we have already taken action in reliance on the authorization.
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State Privacy Laws: We are required to follow state privacy laws when they are stricter (or more protective of your PHI or the PHI of the individual under your care) than HIPAA. Note that some types of sensitive PHI, such as HIV information, genetic information, alcohol and/or substance abuse records and mental health records may be subject to additional confidentiality protections under state or federal law.
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Access and Copy: At any time, you can request a copy of your PHI or the PHI of the individual under your care, including your prescription history with Medvantx. To do this, simply write to us at Medvantx, PO Box 5736, Sioux Falls SD 57117-5736. Please be sure to sign and date the request.
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Request Restrictions: We will agree to a request by you not to disclose your medical information to your health plan if it relates to a prescription drug for which you paid in full and the disclosure is not otherwise required by law. Additionally, you have the right to request that we place other restrictions on our use or disclosure of your medical information. We are not required to agree to these other restrictions, but if we do, we will abide by our agreement (except in an emergency). Requests for all restrictions must be in writing, signed by you or a person authorized to make such an agreement on your behalf. Mail it to Medvantx, PO Box 5736, Sioux Falls, SD 57117-5736. All restrictions you request, to which we agree, shall begin from date of your written request.
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Right to a Paper Copy of this Policy: You have the right to request a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy. You may obtain a paper copy by printing this page using the printing prompt or by sending a written request to the Medvantx Privacy Officer at PO Box 5736, Sioux Falls, SD 57117-5736.
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Right to Amend: If you believe your PHI or the PHI of the individual under your care is incorrect or incomplete, you may request that we amend your medical information. Your request must be in writing and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended and the originator remains available or for certain other reasons.
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Disclosure Accounting: You have a right to receive a list of instances in which we or our business associates disclosed your medical information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities, since April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to which we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information.
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Notification of Breach: You have a right to be notified if there is a breach of the privacy or security of your PHI or the PHI of the individual under your care, as defined by HIPAA.
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Confidential Communications: You may ask that we communicate with you in a particular way and in a particular place in order to protect the confidentiality of your PHI or the PHI of the individual under your care. Your request must be in writing, and you must specify an alternative method or location you would like us to communicate your PHI to you. Mail your request to Medvantx, PO Box 5736, Sioux Falls, SD 57117-5736.
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Complaints/Privacy Violation: If you feel that your privacy rights have been violated, you can file a complaint by writing to our Privacy Officer or to the Secretary of the United States Department of Health and Human Services. Please indicate what violation occurred and the date(s) of occurrence. Send this to Medvantx Privacy Officer, PO Box 5736, Sioux Falls SD 57117-5736 or call our privacy office at 866-7440621. Please note that Medvantx, Inc.’s home delivery pharmacy operation was formerly named AmeriPharm, Inc. Any references to Medvantx in this Privacy Policy shall also include AmeriPharm, Inc. In this document, Medvantx refers to both Medvantx, Inc. and AmeriPharm, Inc. d/b/a Medvantx Pharmacy Services. You will not be retaliated against for filing a complaint.
Medvantx may make changes to this Online Privacy Statement without prior notice. We may make the revised Notice effective for PHI we already have about you or the individual under your care as well as PHI that we receive about you or the individual under your care in the future, as of the effective date of the revised Notice. We are required to comply with the terms of the Notice that are currently in effect. Upon request to the Privacy Officer, we will provide a revised Notice to you. We will also post the revised Notice on our website at QsymiaEngage.MedVantxRX.com.
A revision date will be posted at the bottom of this Notice. Please check this statement periodically for any changes that might occur.
Rev. July, 2022
© Medvantx, Inc.
At Medvantx, your privacy is of the utmost importance. That’s why Medvantx wants you to know how we use the information you share with us when you use the Qsymia Engage; Home Delivery Pharmacy Services.
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Contact information submitted through online request forms including name, email address and phone number.
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Information requested on patient order forms including names, addresses, credit card information, demographic information, health conditions, allergies and other medications you are taking.
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Data pertaining to your prescription profile, such as: name of prescription medication, strength, dosing instructions, and physician’s name.
In order to improve your experience using our website, we collect “cookies” and similar technologies that track the pages you visit in order to help them load more quickly during future visits. These technologies help us to recognize you, customize or personalize your experience and analyze the use of our Services to make them more useful to you. These technologies also allow us to aggregate demographic and statistical data.
Any information you provide to us will be used for the purposes of administering our Services, including the following purposes:
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to generally improve the content and layout of our Services;
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to evaluate your experience with the Services;
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to notify you about updates to our Services;
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to contact you for marketing purposes;
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to prevent, investigate, or provide notice of fraud, unlawful or criminal activity, or unauthorized access to or use of information, our Services or data systems; or to meet legal obligations;
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to investigate and resolve disputes and security issues and enforcing our Terms of Use and other agreements; and
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any other lawful, legitimate business purpose.
In order to support the continuity of the Services and your customer experience, your information may be shared with the pharmaceutical providers and third parties that work for us.
You may choose to share information about your visit to our public websites through email and social media sites that are not affiliated with Medvantx. If these sites are accessed through our public websites, Medvantx will allow third-party companies to collect anonymous information about your visits and to provide information about goods and services that they offer. In the event that we have a change in control, dissolution, or, if all, or substantially all, of our assets are sold to a third party, or if the pharmaceutical provider transfers operation of the Services to another party, we may transfer information from our customer file to the third party. The acquiring company may continue to operate the Services. Information may also be disclosed in the event of insolvency, bankruptcy or receivership
We may share information with governmental agencies or other companies assisting us in fraud prevention or investigation. We may do so when: (1) permitted or required by law; or, (2) trying to protect against or prevent actual or potential fraud or to protect the rights, property or safety of us or others; or, (3) investigating fraud which has already taken place.
When contacting us through email, do not include information you wish to keep private. While we do all we can to secure our email system, it is not a HIPAA-approved means of communicating personal information. Please call us at 866-744-0621 if you wish to discuss private information or request that a Customer Experience Representative call you.
Occasionally, we may post links to third-party websites that we believe could provide you with valuable information, products or services. Unless otherwise noted, we do not own or control that site, and make no guarantees of the quality, safety, accuracy, security of privacy practices of that site. Be sure to read the privacy policies of each site.
Medvantx may make changes to this Online Privacy Statement without prior notice. If we make any material changes in the way we use your personal information, we will notify you by prominently posting notice of the changes on the Services and updating the effective date below. Please check this statement periodically for any changes that might occur.
Rev. July, 2022.
© Medvantx, Inc.