Notice of Privacy Practices
June 27, 2005
If you would like a copy of this notice in Spanish, please contact the IPDP Privacy Office at 1-317-713-9627 or at 1-800-457-4584. Si usted desea una copia de esta noticia en Español, por favor contacte a la Oficina Privada de IPDP al (317) 713-9627o al 1-800-457-4584.
This notice is to all Indiana Prescription Drug Program (IPDP) enrollees. This notice is for your information only. You do not need to take any action as a result of this notice.
|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.|
This notice tells how the IPDP may use or release your health information. It also tells you about your rights and the IPDP's requirements concerning the use and release of your health information. Your health information will not be shared without your written authorization except as described in this notice, or when required or permitted by law. If you give us your written authorization, you may change your mind by telling us in writing. The IPDP may change its privacy practices and make the new privacy practices effective for all protected health information we maintain. If the terms of this notice change we will mail you a revised copy of this notice to the address you have supplied.
|Our Responsibilities and Commitment to You||We understand that your health care information is personal. We take our responsibility to keep your personal health information private very seriously. We are committed to following all state and federal laws that protect your health information. We are required to protect your health information, tell you about your rights to your health information, and to give you this notice explaining our responsibilities and the ways we use and share your health information.|
|Use and Disclosure of Your Health Information||We do not create health records. We receive health information to help us make decisions about whether you qualify for certain programs or services. We use your health information to pay for services provided to you by your pharmacy provider, for your prescription drugs, for health care operations, and to evaluate the quality of services you receive. While we cannot describe all cases related to the use of your health information, the following are some common examples of how we use your personal health information:
|Your Health Information Rights||
Please note: All requests about your health information must be in writing and sent to the IPDP Privacy Office address listed in the contact information section at the end of this notice.
|Contact Information or Filing a Complaint||
If you have questions or want additional information, you can contact the IPDP using the following address or phone number.
If you have a complaint about our health information practices or believe that we have violated your privacy rights, please submit the complaint in writing to the IPDP to the following address. All complaints must be submitted in writing.
IPDP Privacy Office
You can also file a complaint with the Department of Health and Human Services at the following address:
Region V, Office for Civil Rights, U.S.
We will never take action against you for filing a complaint and it will not impact the health care services provided to you.
Effective June 27, 2005