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Notice of Privacy Practice


Effective Date: September 19, 2013

Our Promise

At Reliance Rx, we recognize our responsibility to actively protect your personal information. We value the relationship we have with our patients and are committed to protecting your information with administrative, technical, and physical safeguards to guard against unauthorized access as well as threats and hazards to its security and integrity. We take great care to safeguard your personal information using industry best practices. We train our employees on a regular basis about the importance of protecting your personal information. We protect the privacy of your information in accordance with federal and state privacy and security laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), as amended from time-to-time.

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.

What is Your Personal Information
Personal information is any information about you received or created by Reliance Rx for the purpose of dispensing your prescriptions. This includes any information that can identify you as an individual, such as your name, address and Social Security Number, as well as your financial, health, and other information.

How Reliance Rx Uses and Discloses Your Personal Information
Reliance Rx may use and disclose your personal information in the following ways:

Uses and Disclosures Required By Law
We may use or disclose your personal information without your authorization when required by law:

Other Uses and Disclosures
We may also use or disclose your personal information without your authorization in the following miscellaneous circumstances:

Special Considerations
Either State or Federal law contain important limitations on how we can disclose your personal health information pertaining to HIV/Aids, mental health, alcohol and substance abuse and sexually transmitted diseases. For those conditions, we follow rigorous standards that provide heightened privacy protections to you. These additional standards are designed to give you added security and confidence regarding our handling of such information while still allowing you to obtain needed medical treatment freely and without hesitation.

Uses and Disclosures that Require Your Authorization
If we disclose your information for a reason that does not fit in one of the general categories listed above, we must obtain your written permission. This written permission is called an "authorization." Here are examples of instances when we must ask for your permission before disclosing your personal information:


If you give us written permission and then change your mind about that permission, you may take back or revoke your written permission at any time, except if we have already acted based on your permission.

Your Rights Regarding Your Personal Information
By law, you have several important rights with respect to your personal information. You may exercise any of the rights described below.

Our Obligation
We are required by law to maintain the privacy of your personal health information, give you notice of our legal duties and privacy practices, notify you following a breach of your personal information, and to follow the terms of the notice currently in effect. We may change the terms of this notice at any time. The revised notice will apply to any personal information we maintain. Once revised, we will give you the new notice by United States mail and will post it on our website.

Your Responsibility
If you have questions about this Notice, contact HIPAA Privacy, Reliance Rx, Earhart Dr, Suite 110, Amherst NY, 14221 or call 1-800-809-4763. If you believe your privacy rights have been violated, you may file a written complaint, and there will be no retaliation, with the Compliance Officer at the above address, or with the Secretary of the Department of Health and Human Services, Office of Civil Rights.