Effective Date: January 17, 2004

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.

PrairieStone Pharmacy knows that maintaining the trust of its customers is among its most important missions. PrairieStone Pharmacy and its employees are dedicated to earning and keeping your trust – every day. We recognize that an important element of that trust is keeping your medical information confidential.

PrairieStone Pharmacy is committed to protecting your privacy by complying with state and federal laws that require PrairieStone Pharmacy to maintain the privacy of protected health information. “Protected health information” consists of all individually identifiable information which is created or received by PrairieStone Pharmacy and which relates to your past, present or future physical or mental health or condition, the provision of health care to you or the past, present or future payment for health care provided to you.

PrairieStone Pharmacy is also required to provide individuals with notice of its legal duties and privacy practices and to abide by the terms of this Notice of Privacy Practices ("Notice"). A copy of the Notice will be posted at each pharmacy counter. The effective date of this Notice of Privacy Practices is set forth on the first page of this Notice in the upper right corner. If this Notice of Privacy Practices has been changed since your last visit, the most current Notice will be posted. You may obtain a copy of the current Notice by calling PrairieStone Pharmacy and requesting that one be sent to you in the mail or by asking for one when you are at a PrairieStone Pharmacy.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
1. Alternative Communications: You have the right to request that you receive communications of your protected health information from PrairieStone Pharmacy in alternative means or at alternative locations. For example, you may want us to send prescription reminders to your office rather than your home. PrairieStone Pharmacy will accommodate all reasonable requests. To request that PrairieStone Pharmacy make communications of your protected health information by alternative means or at alternative locations, please ask your pharmacist for the appropriate form to send to PrairieStone Pharmacy’s Privacy Officer.

2. Access to Protected Health Information: You have the right to inspect and obtain a copy of your protected health information that PrairieStone Pharmacy maintains about you. To see or obtain your health information, please ask your pharmacist for the appropriate form to send to PrairieStone Pharmacy’s Privacy Officer. If you request a copy of your protected health information, PrairieStone Pharmacy may charge a fee for the cost of copying and mailing the information.

3. Restriction of Use and Disclosure: You have the right to request that PrairieStone Pharmacy impose additional restrictions on your protected health information. If you wish to request a restriction on the use and disclosure of your protected health information, please ask your pharmacist for the appropriate form to send to PrairieStone Pharmacy’s Privacy Officer. The Privacy Officer will review your request and notify you whether or not PrairieStone Pharmacy will agree to your requested restriction. PrairieStone Pharmacy is not required to agree to the requested restrictions.

4. Amending Protected Health Information: Your health care records should be correct. If you think there is a mistake, you have the right to request that PrairieStone Pharmacy amend your protected health information that it maintains. To request that an amendment be made, please ask your pharmacist for the appropriate form to send to PrairieStone Pharmacy’s Privacy Officer. Your written request must provide a reason that supports the requested amendment. PrairieStone Pharmacy may deny your request if it does not contain a reason that supports the requested amendment. Additionally, PrairieStone Pharmacy may deny your request in certain instances. If we deny your request for amendment, you may send a statement disagreeing with us that will be included in your records.

5. Accounting of Disclosures of Your Protected Health Information: You have the right to request a listing of certain disclosures of your protected health information made by PrairieStone Pharmacy during the period of up to six (6) years prior to the date on which you make your request. For example, any accounting you request will not include disclosures made to carry out treatment, payment or health care operations or disclosures made to you. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations set forth in applicable statutes and regulations.

To request an accounting of the disclosures of your protected health information made by PrairieStone Pharmacy, please ask your pharmacist for the appropriate form to send to PrairieStone Pharmacy’s Privacy Officer. PrairieStone Pharmacy will provide one free accounting during each twelve (12) month period. If you request additional accountings during the same twelve (12) month period, you will be charged for all costs PrairieStone Pharmacy incurs in preparing and providing that accounting. PrairieStone Pharmacy will inform you of the fee for each accounting in advance and will allow you to modify or withdraw your request in order to reduce or avoid the fee.

6. Obtaining a Copy of this Notice: You have the right to request and receive a paper copy of this Notice of Privacy Practices from PrairieStone Pharmacy at any time.

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION FOR WHICH YOUR CONSENT OR AUTHORIZATIONS IS NOT REQUIRED
PrairieStone Pharmacy needs to use or disclose your protected health information to process your prescriptions, communicate with your doctor or insurance company and for a variety of other purposes.

1. Treatment: PrairieStone Pharmacy will use and disclose your protected health information to dispense your prescription, provide you with information and for other purposes related to your treatment. For example, PrairieStone Pharmacy may disclose your protected health information to your doctor or other health care providers to ensure that they have the necessary information they need.

2. Payment: PrairieStone Pharmacy will use and disclose your protected health information, as needed, to obtain payment for your prescriptions. For example, PrairieStone Pharmacy may disclose to your insurance carrier the prescription you are going to receive to ensure that your insurance carrier will cover that prescription.

3. Health Care Operations: PrairieStone Pharmacy may use or disclose your protected health information in order to support the business activities of PrairieStone Pharmacy. These activities include, but are not limited to, quality assessment and improvement activities, business management and general administrative activities. For example, PrairieStone Pharmacy may use your protected health information to ensure that all of the pharmacists at PrairieStone Pharmacy provide the highest quality health care.

4. Reminders: PrairieStone Pharmacy may use or disclose your protected health information in order to contact you. For example, PrairieStone Pharmacy may remind you to refill a prescription or renew a prescription.

5. Treatment Alternatives: PrairieStone Pharmacy may use or disclose your protected health information to inform you about treatment alternatives.

6. Health-Related Benefits and Services: PrairieStone Pharmacy may use and disclose your protected health information to inform you about health-related benefits and services that may be of interest to you.

7. Others Involved in Your Health Care and Disaster Relief: Unless you object, PrairieStone Pharmacy may disclose to a family member, other relative or close personal friend protected health information related to that person’s involvement in your health care or payment related to your health care. For example, PrairieStone Pharmacy may give information about your prescription to a family member who picks up a prescription.

8. Public Health: PrairieStone Pharmacy may disclose your protected health information to a public health authority authorized to collect such information for purposes such as preventing or controlling disease, injury or disability. For example, we may disclose your health information to report adverse reactions to medications.

9. Food and Drug Administration: PrairieStone Pharmacy may disclose your protected health information to a person subject to the jurisdiction of the Food and Drug Administration (“FDA”) for the purpose of activities related to the quality, safety or effectiveness of FDA regulated products.

10. Communicable Diseases: PrairieStone Pharmacy may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of spreading a disease or condition.

11. Abuse, Neglect or Domestic Violence: PrairieStone Pharmacy may disclose your protected health information to a government authority authorized to receive reports of abuse, neglect or domestic violence if PrairieStone Pharmacy reasonably believes that you are a victim of abuse, neglect, or domestic violence. Any such disclosure will be made (1) to the extent it is required by law, (2) to the extent that the disclosure is authorized by statute or regulation and PrairieStone Pharmacy believes the disclosure is necessary to prevent serious harm to you or other potential victims or (3) if you agree to the disclosure.

12. Health Oversight Activities: PrairieStone Pharmacy may disclose your protected health information to a health oversight agency for any oversight activities authorized by law, including audits; investigations; inspections; licensure or disciplinary actions; civil, criminal, or administrative actions or proceedings; or other activities necessary for the oversight of the health care system, government benefit programs, compliance with government regulatory program standards or compliance with applicable civil rights laws.

13. Judicial and Administrative Proceedings: PrairieStone Pharmacy may, upon certain conditions, disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal, a subpoena, discovery request, or other lawful process.

14. Law Enforcement Purposes: PrairieStone Pharmacy may disclose your protected health information for law enforcement purposes to a law enforcement official. For example, PrairieStone Pharmacy may disclose health information in accordance with a court order or subpoena.

15. Coroners, Medical Examiners and Funeral Directors: PrairieStone Pharmacy may disclose your protected health information to a coroner or medical examiner for the purpose of identifying you, determining a cause of death or other duties authorized by law. PrairieStone Pharmacy may disclose your protected health information to a funeral director, consistent with all applicable laws, in order to allow the funeral director to carry out his or her duties.

16. Organ and Tissue Donation: PrairieStone Pharmacy may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation or organs, eyes or tissue for the purpose of facilitating organ, eye and tissue donation and transplantation.

17. Medical Research: PrairieStone Pharmacy may disclose your protected health information for research purposes, provided that an institutional review board authorized by law or a privacy board waives the authorization requirement and provided that the researcher makes certain representations regarding the use and protection of the protected health information to be disclosed.

18. Serious Threat to Health or Safety: PrairieStone Pharmacy may disclose your protected health information, in a manner which is consistent with applicable laws, if the disclosure if necessary to prevent or lessen a serious threat to health or safety or the information is necessary to apprehend an individual.

19. Military and Veterans Activities: PrairieStone Pharmacy may, if you are a member of the United States or foreign Armed Forces, disclose your protected health information for activities that are deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.

20. National Security and Protection of the President and Others: PrairieStone Pharmacy may disclose your protected health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security activities authorized by law. Additionally, PrairieStone Pharmacy may disclose your protected health information to authorized federal officials for the provision of protective services to the President, foreign heads of state, or other people authorized by law and to conduct investigations authorized by law.

21. Inmates: PrairieStone Pharmacy may disclose your protected health information to a correctional institution or a law enforcement official if the correctional institution or law enforcement represents that the information is necessary to (1) provide health care to you; (2) protect the health and safety of others; or (3) the safety, security and good order at the correctional institution.

22. Workers’ Compensation: PrairieStone Pharmacy may disclose your protected health information as authorized by, and in compliance with, laws relating to workers’ compensation and other similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Any use or disclosure of your protected health information that is not listed above will be made only with your written authorization. You have the right to revoke your authorization at any time, except to the extent that PrairieStone Pharmacy has already used or disclosed your protected health information in reliance on the authorization.

COMPLAINTS
If you believe that your privacy rights have been violated, you may file a complaint with PrairieStone Pharmacy or with the Secretary of Health and Human Services. To file a complaint with PrairieStone Pharmacy, please contact Lew Zeidner at (952) 745-4515. All complaints must be submitted in writing. PrairieStone Pharmacy will not retaliate against your for filing a complaint.

CHANGES TO THIS NOTICE
PrairieStone Pharmacy reserves the right to change the terms of this Notice at any time. Any revised Notice will apply to all protected health information that PrairieStone Pharmacy maintains.

If you have any questions or wish to receive additional information about the matters covered by this Notice of Privacy Practices, please contact Lew Zeidner at (952) 745-4515.