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.
KV Vet Supply Co., including its subsidiaries ( KV Vet ), is required by law to maintain the privacy of Protected
Health Information ("PHI") and to provide you with notice of KV Vet’s legal duties and privacy practices with respect
to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental
health or condition and related health care services.
This Notice of Privacy Practices ("Notice") describes how KV Vet 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. KV Vet is required to provide this notice to you by the Health Insurance
Portability and Accountability Act ("HIPAA").
KV Vet is required to follow the terms of this Notice. KV Vet will not use or disclose your PHI without your written
authorization, except as described or otherwise permitted by this Notice. KV Vet reserves the right to change its
practices and this Notice and to make the new Notice effective for all PHI KV Vet maintains. Upon request, KV Vet will
provide any revised Notice to you.
Examples of How KV Vet Uses and Discloses Protected Health Information About You
The following describes different ways that KV Vet uses and discloses your PHI. Certain categories include examples;
however, KV Vet has not identified every way in which KV Vet may use or disclose your PHI.
Treatment
KV Vet may use your health information to provide and coordinate the treatment, medications and services you receive.
For example, KV Vet may contact you regarding medications, equipment, supplies, compliance programs such as drug
recommendations, therapeutic substitution, refill reminders, other product or service recommendations such as
specialty and infusion therapies, counseling and drug utilization review (DUR), product recalls or disease state
management.
Payment
KV Vet may use your health information for various payment-related functions. Example: KV Vet may contact your
insurer, pharmacy benefit manager or other health care payor to determine whether it will pay for your medications,
equipment and supplies and the amount of your co-payment. KV Vet will bill you or a third-party payor for the cost
of medications, equipment and supplies dispensed to you. The information on or accompanying the bill may include
information that identifies you, as well as the medications you are taking.
Health Care Operations
KV Vet may use your health information for certain operational, administrative and quality assurance activities.
Example: KV Vet may use information in your health record to monitor the performance of the staff and pharmacists
providing treatment to you. This information will be used in an effort to continually improve the quality and
effectiveness of the health care and service KV Vet provides. KV Vet may disclose health information to business
associates if they need to receive this information to provide a service to us and will agree to abide by specific
HIPAA rules relating to the protection of health information.
KV Vet may also use your health information to provide you with information about benefits available to you, and, in
limited situations, about health-related products or services that may be of interest to you. If you register your
email address on KVVet.com, or any of its other websites, you may elect to receive this information via email.
KV Vet is permitted to use or disclose your PHI for the following purposes. However, KV Vet may never have reason
to make some of these disclosures.
To Communicate with Individuals Involved in Your Care or Payment for Your Care.
KV Vet may disclose to a family member, other relative, close personal friend or any other person you identify, PHI
directly relevant to that person's involvement in your care or payment related to your care.
Food and Drug Administration (FDA).
KV Vet may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with
respect to drugs, foods, supplements, products and product defects, or post-marketing surveillance information to
enable product recalls, repairs, or replacement.
Worker's Compensation.
KV Vet may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to
worker's compensation or other similar programs established by law.
Public Health.
As required by law, KV Vet may disclose your PHI to public health or legal authorities charged with preventing or
controlling disease, injury, or disability.
Law Enforcement.
KV Vet may disclose your PHI for law enforcement purposes as required by law or in response to a subpoena or court
order.
As Required by Law.
KV Vet will disclose your PHI when required to do so by federal, state, or local law.
Health Oversight Activities.
KV Vet may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities
include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to
monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings.
If you are involved in a lawsuit or a dispute, KV Vet may disclose your PHI in response to a court or administrative
order. KV Vet may also disclose health information about you in response to a subpoena, discovery request, or other
lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the
requesting party or us, to tell you about the request or to obtain an order protecting the information requested.
Research.
KV Vet may disclose your PHI to researchers when their research has been approved by an institutional review board or
privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your
information.
Coroners, Medical Examiners, and Funeral Directors.
KV Vet may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a
deceased person or determine the cause of death. KV Vet may also disclose PHI to funeral directors consistent with
applicable law to enable them to carry out their duties.
Organ or Tissue Procurement Organizations.
Consistent with applicable law, KV Vet may disclose your PHI to organ procurement organizations or other entities
engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Notification.
KV Vet may use or disclose your PHI to notify or assist in notifying a family member, personal representative,
or another person responsible for your care, regarding your location and general condition.
Correctional Institution.
If you are or become an inmate of a correctional institution, KV Vet may disclose to the institution or its agents
PHI necessary for your health and the health and safety of other individuals.
To Avert a Serious Threat to Health or Safety.
KV Vet may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the
health and safety of the public or another person.
Military and Veterans.
If you are a member of the armed forces, KV Vet may release PHI about you as required by military command authorities.
KV Vet may also release PHI about foreign military personnel to the appropriate foreign military authority.
National Security, Intelligence Activities, and Protective Services for the President and Others.
KV Vet may release PHI about you to federal officials for intelligence, counterintelligence, protection to the
President, and other national security activities authorized by law.
Victims of Abuse or Neglect.
KV Vet may disclose PHI about you to a government authority if KV Vet reasonably believes you are a victim of abuse or
neglect. KV Vet will only disclose this type of information to the extent required by law, if you agree to the
disclosure, or if the disclosure is allowed by law and KV Vet believes it is necessary to prevent serious harm to
you or someone else.
Other Uses and Disclosures of PHI
KV Vet will obtain your written authorization before using or disclosing your PHI for purposes other than those
provided for above (or as otherwise permitted or required by law). You may revoke an authorization in writing at any
time. Upon receipt of the written revocation, KV Vet will stop using or disclosing your PHI, except to the extent that
KV Vet has already taken action in reliance on the authorization.
Obtain a paper copy of the Notice upon request.
You may request a copy of KV Vet’s current Notice at any time. Even if you have agreed to receive the Notice
electronically, you are still entitled to a paper copy. You may obtain a paper copy from a pharmacy, home care
facility, mail service location or the Privacy Office.
Request a restriction on certain uses and disclosures of PHI.
You have the right to request additional restrictions on KV Vet’s use or disclosure of your PHI by sending a written
request to the Privacy Office. KV Vet is not required to agree to those restrictions. KV Vet cannot agree to
restrictions on uses or disclosures that are legally required, or which are necessary to administer KV Vet’s
business.
Inspect and obtain a copy of PHI.
In most cases, you have the right to access and copy the PHI that KV Vet maintains about you. To inspect or copy
your PHI, you must send a written request to the Privacy Office. KV Vet may charge you a fee for the costs of
copying, mailing and supplies that are necessary to fulfill your request. KV Vet may deny your request to inspect
and copy in certain limited circumstances.
Request an amendment of PHI.
If you feel that PHI KV Vet maintains about you is incomplete or incorrect, you may request that KV Vet amend it.
To request an amendment, you must send a written request to the Privacy Office. You must include a reason that
supports your request. In certain cases, KV Vet may deny your request for amendment.
Receive an accounting of disclosures of PHI.
You have the right to receive an accounting of the disclosures KV Vet has made of your PHI after April 14, 2003
for most purposes other than treatment, payment, or health care operations. The right to receive an accounting
is subject to certain exceptions, restrictions, and limitations. To request an accounting, you must submit a
request in writing to the Privacy Office. Your request must specify the time period. The time period may not be
longer than six years and may not include dates before April 14, 2003.
Request communications of PHI by alternative means or at alternative locations.
For instance, you may request that KV Vet contact you at a different residence or post office box. To request
confidential communication of your PHI, you must submit a request in writing to the Privacy Office. Your request
must tell us how or where you would like to be contacted. KV Vet will accommodate all reasonable requests.
Where to obtain forms for submitting written requests.
You may obtain forms for submitting written requests by contacting the Privacy Officer at KV Vet Supply Co.
PO Box 245 David City, NE 68632 or toll-free by telephone at 800-423-8211. You can also visit www.KVSupply.com
to obtain these forms.
Incidental Disclosures
KV Vet will make reasonable efforts to avoid incidental disclosures of protected health information. An example of
an incidental disclosure is conversations that may be overheard between the pharmacy staff and the patient at the
drive-thru, as a result of the speaker system. To reduce the likelihood of this happening, KV Vet recommends that
you go inside the store to the pharmacy for any consultations.
Minors
If you are a minor who has lawfully provided consent for treatment and you wish for KV Vet to treat you as an
adult for purposes of access to and disclosure of records related to such treatment, please notify a staff member,
pharmacist or the Privacy Office.
For More Information or To Report a Problem
If you have questions or would like additional information about KV Vet’s privacy practices, you may contact KV Vet’s
Privacy Officer at KV Vet Supply Co. Privacy Officer, PO Box 245 David City, NE 68632 or toll-free by telephone at
800-423-8211. If you believe your privacy rights have been violated, you can file a complaint with the Privacy
Officer or with the Secretary of Health and Human Services. You can also file a complaint through www.KVSupply.com,
and KV Vet will route your complaint to the Privacy Office. There will be no retaliation for filing a
complaint.
Effective Date
This Notice is effective as of April 13, 2003.
