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Medical Information Privacy Notice

One Source Pharmacy and Medical Supplies, LLC and its affiliates* ("we" or "One Source Pharmacy and Medical Supplies") is committed to protecting your privacy. Therefore, One Source Pharmacy and Medical Supplies has developed policies and procedures to ensure that the information you provide to us through our web site, the, is collected and maintained in a manner that respects your privacy. This Medical Information Privacy Notice explains these important policies and procedures so that you will be aware of how we collect and use the information you provide us, and how you may modify and/or delete this information.

Because your privacy is important to us, One Source Pharmacy and Medical Supplies does not track or collect personal information unless it is purposefully and knowingly provided to us. In other words, we do not collect your information without your knowledge.

Should you request that we contact you to provide additional information about our products and services, and you have provided us with personal information so that we may do so, we will not use or disclose this information outside of One Source Pharmacy and Medical Supplies without your consent, unless required by law. In the event that you use One Source Pharmacy and Medical Supplies products/services, we may use and/or disclose the information that you provide to us in communications with your treating physician and/or insurance plans.

To summarize, it is our policy: (1) not to collect your personal information without your knowledge and consent; (2) to protect the privacy of any personal information you choose to provide to us; (3) to notify you of our policies and procedures regarding your personal information; and (4) to abide by the terms of this Privacy Statement. We are dedicated to fulfilling this policy.

Privacy notice for the use and disclosure of medical information

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.

One Source Pharmacy and Medical Supplies and its Affiliates provide health related products, services and information to patients through mail or package delivery, telephone, and online communications. In order to provide these products, services, and information, One Source Pharmacy and Medical Supplies uses and discloses medical information about patients as described in this Privacy Notice.

One Source Pharmacy and Medical Supplies and its covered entities are required by law to maintain the privacy of legally protected individually identifiable health-related information ("your medical information") about you and to provide you with this notice of our legal duties and privacy practices with respect to this information.

How One Source Pharmacy and Medical Supplies and its affiliates use and disclose your medical information

  1. Your medical information will be used or disclosed in connection with your health care treatment. For example, your medical information may be used to provide health-related products to you and to coordinate with your doctor to ensure that you receive the products that your doctor has prescribed to you.
  2. Your medical information will be used and disclosed as needed to collect payments for the products and services that you receive, such as when One Source Pharmacy and Medical Supplies bills Medicare, your private insurance carrier, or you for the items you receive.
  3. Your medical information will be used and disclosed as needed to manage and improve the quality of One Source Pharmacy and Medical Supplies’s internal health care operations, including uses such as quality assessments, audits, and other similar functions. Limited medical information about you may also be disclosed to your insurers or doctors for managing their internal health care operations.
  4. Your medical information may be disclosed to third parties that provide certain services to us, such as data processing, billing, legal, or accounting services, under contracts that protect your medical information from unauthorized use or disclosure.
  5. Your medical information may be disclosed to family members, other relatives, close personal friends, or other persons whom you may authorize, as we determine in our professional judgment to be relevant to their involvement in your health care.
  6. We may contact you to provide prescription refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
  7. Your medical information may be used or disclosed to the Food and Drug Administration (FDA) or to entities regulated by the FDA relative to adverse events involving products or to enable product recalls, repairs, or replacements of products; to public health or legal authorities responsible for safeguarding public health or preventing injury or disease; or to health oversight agencies for activities such as audits, investigations, inspections, or other proceedings to monitor our operations, the health care system, government health programs, or compliance with civil rights laws.
  8. Your medical information may be disclosed to provide information needed for law enforcement purposes or for a legal proceeding. Your medical information may be disclosed for judicial or administrative proceedings pursuant to a court or administrative order or in response to a subpoena, discovery request or other lawful process, provided that in the absence of a court or administrative order, reasonable efforts are made to notify you of the request or to secure a protective order preventing the information from being used for other purposes.
  9. We are permitted to disclose your medical information to social services, protective services, or other government authorities if we reasonably believe that you are a victim of abuse, neglect, or domestic violence, provided that the disclosure is either required by law, authorized by you, allowed by law and necessary to prevent harm to you or someone else, or a law enforcement or public official represents that the information is necessary and will not be used against you.
  10. In addition, federal regulations allow us to use or disclose your medical information for other specific purposes, including: compliance with worker's compensation laws; assisting coroners, medical examiners and funeral directors in performing their functions; aiding organ or tissue procurement organizations in performing their donation, banking, or transplantation functions; notifying family members, personal representatives, or caregivers of your location and general condition; providing information to military command authorities if you are in a military service, a correctional institution if you are an inmate, or legally authorized national security, intelligence, or protective service authorities; or for research under approved protocols to protect your privacy.
  11. Your medical information may be disclosed to provide emergency information to law enforcement, emergency response, or disaster relief officials; to avert a serious threat to the health or safety of you, the public, or another person; or as otherwise required by law.
  12. We will obtain your written authorization before we use or disclose your medical information for purposes other than those described above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time, requiring us to stop using or disclosing your medical information except to the extent that we have already acted in reliance on your authorization.

Your rights concerning your medical information

You have a right to inspect, copy and request amendments to your medical information by sending a written request to the Privacy Officer at the address provided below. We may deny requests for access and amendment in certain instances. You have a right to ask that most denials of access be reconsidered, and you have a right to submit a statement disagreeing to a decision to reject a proposed amendment, to which we may respond.

You have a right to request and receive an accounting of disclosures of your medical information that we or our business associates may make to certain third parties without your authorization (for information recorded on or after April 14, 2003) for most purposes other than treatment, payment or health care operations. We may charge a fee if you request more than one accounting during any 12-month period. Your request must specify the time period to be covered in the accounting, up to 6 years.

You have a right to request reasonable arrangements to ensure that communications containing your medical information are provided to you in a confidential manner or to an alternative location.

You have a right to request restrictions on certain uses and disclosures of your medical information, although we are not required to agree to a requested restriction.

You have a right to request and receive a paper copy of this Privacy Notice.

If you believe that your privacy rights have been violated, you have a right to complain to One Source Pharmacy and Medical Supplies, its affiliates or the U. S. Department of Health and Human Services. You may contact One Source Pharmacy and Medical Supplies Privacy Officer at the address or phone number provided below. No adverse action or retaliation will be taken against you for filing a complaint.

We are required to abide by the terms of this Privacy Notice currently in effect. We reserve the right to change the terms of this notice and make the new notice effective for all of the medical information about you that we maintain. Any revised Privacy notice will be posted on our web site, inserted in packages that we send to new customers, and provided in response to written, telephone or e-mail requests.

For further information about our privacy policies and practices, or to exercise any of your rights as described above, please contact our Privacy Officer by mail at the address shown below or call our toll free number 844-693-6372 and ask to speak with the Privacy Officer.

Privacy Officer
One Source Pharmacy and Medical Supplies, LLC
15727 San Pedro Ave
San Antonio, TX 78232

Medicare prescription drug coverage and your rights

Your Medicare rights

You have the right to request a coverage determination from your Medicare drug plan if you disagree with information provided by the pharmacy. You also have the right to request a special type of coverage determination called an “exception” if you believe:

  • you need a drug that is not on your drug plan’s list of covered drugs. The list of covered drugs is called a “formulary;”
  • a coverage rule (such as prior authorization or a quantity limit) should not apply to you for medical reasons; or
  • you need to take a non-preferred drug and you want the plan to cover the drug at the preferred drug price.
What you need to do

You or your prescriber can contact your Medicare drug plan to ask for a coverage determination by calling the plan’s toll-free phone number on the back of your plan membership card, or by going to your plan’s website. You or your prescriber can request an expedited (24 hour) decision if your health could be seriously harmed by waiting up to 72 hours for a decision. Be ready to tell your Medicare drug plan:

  1. The name of the prescription drug that was not filled. Include the dose and strength, if known
  2. The name of the pharmacy that attempted to fill your prescription
  3. The date you attempted to fill your prescription
  4. If you ask for an exception, your prescriber will need to provide your drug plan with a statement explaining why you need the off-formulary or non-preferred drug or why a coverage rule should not apply to you.

Your Medicare drug plan will provide you with a written decision. If coverage is not approved, the plan’s notice will explain why coverage was denied and how to request an appeal if you disagree with the plan’s decision.

Refer to your plan materials or call 1-800-Medicare for more information.