APOTHECARY PHARMACY HIPAA DISCLOSURE

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.

We understand that your medical information is personal. We are committed to protecting your medical information.

Apothecary Pharmacy is required by law to maintain the privacy of your protected health information, to follow the terms of this Notice,

and to give you this Notice of our legal duties and privacy practices concerning your health information. We must follow the terms of the

current Notice.

How Apothecary Pharmacy May Use or Disclose Your Health Information

Apothecary Pharmacy protects the privacy of your health information. For some activities, we must have your written authorization to

use or disclose your health information. However, the law permits Apothecary Pharmacy to use or disclose your health information for

the following purposes without your authorization:

For Treatment — We may use your PHI to dispense prescriptions to you. We may disclose your PHI to treating physicians,

pharmacists and other persons who are involved in dispensing your prescription.

For Payment — We may use and disclose your PHI so that your pharmacy services may be billed to, and payment collected from you, your

insurance company or a third party.

For Healthcare Operations — We may use and disclose your PHI for pharmacy operations, which include activities necessary to run

the pharmacy, and to make sure that you receive quality customer service.

For Prescription ReVill Reminders and Health - Related Products and Services — We may use or disclose your PHI for prescription reVill

reminders, to tell you about health-related products or services, or to recommend possible treatment alternatives that may be of

interest to you.

Individuals Involved in Your Care or Payment for Your Care — We may disclose your PHI to a family member or friend who is involved in your

medical care or payment for your care, provided you agree to this disclosure, or we give you an opportunity to object to the disclosure. If you

are unavailable or are unable to object, we will use our best judgment to decide whether this disclosure is in your

best interests.

As Required by Law — We will disclose your PHI when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety — We 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. Any disclosure, however, would only be to someone

able to help prevent the threat.

Lawsuits and Disputes — If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We

may also disclose your PHI in response to a subpoena, discovery request or other lawful process by someone else

involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice), or to

obtain an order protecting the information requested.

Specialized Government Functions — We may disclose your PHI (1) if you are a member of the armed forces, as required by military command

authorities; (2) if you are an inmate, or in custody, to a correctional institution or law enforcement ofVicial; (3) in response to

a request from law enforcement, under certain conditions; (4) for national security reasons authorized by law; and (5) to authorized federal

ofVicials to protect the President, other authorized persons, or foreign heads of state.

Workers Compensation — We may disclose your health information for workers' compensation or similar programs.

Incidental Disclosures at the Drive-Thru Window — In some locations we offer a drive-thru window. A conversation with the pharmacy might be

overheard by someone in or near the pharmacy. If you would like additional privacy, we suggest you conduct any

pharmacy transactions within the store.

Personal Representatives — We may disclose your PHI to a person legally authorized to act on your behalf, such as a parent, legal guardian,

administrator or executor of your estate, or other individual authorized under applicable law.

Other Uses and Disclosures of Your Health Information

Except as described in this Notice, we will not use or disclose your PHI without your written authorization. If you do give us authorization to use

or disclose your PHI, you may cancel your authorization in writing at any time. If you cancel your authorization,

this will stop any further use or disclosure for the purposes covered by your authorization, except where we have already acted on

your permission. Please refer to the State Law Supplement for any stricter state laws regarding your PHI. If your state is not listed, its laws are

not stricter than the federal privacy law.

You Have the Following Rights With Respect to Your Health Information in Our Records:

You may request restrictions on the use or disclosure of your PHI for treatment, payment or healthcare operations, or when using or disclosing

your PHI to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to

your request. If we agree, we will comply with your request except in certain emergency situations or as required

by law.

You may inspect and copy your pharmacy records, with certain exceptions. Usually, this includes prescription and billing records. We

may charge you for the costs of your request. We may deny your request in some circumstances, in which case, you may request

that the denial be reviewed. You may request that we amend your health information if it is incorrect or incomplete. You must provide a reason

that supports your request. We may deny your request if the health information is accurate and complete, or is not part of the health

information kept by or for Apothecary Pharmacy . If we deny your request, you have the right to submit a statement of disagreement regarding any item in

your record you believe is incomplete or incorrect. If you request this, it will become part of your medical record. We will attach it to your

records and include it when we make a disclosure of the item or statement you believe to be incomplete or incorrect.

You may request an accounting of disclosures of your PHI.

This is a list of the disclosures made of your health information, other than for treatment, payment or health care operations, and other exceptions allowed by law. Your request must specify a time period, which may not be longer than six years and may not include dates before April 14, 2003.

You may request that we contact you in a certain way or at a certain location. For example, you may request we contact you only at work or at

a different residence or post ofVice box. Your written request must state how or where you wish to be contacted. We will grant all reasonable

requests.

If you would like to exercise any of these rights, contact the pharmacy location that provided your services to get the appropriate form, or

submit a written request to Apothecary Pharmacy , HIPAA Privacy, 1700 National Blvd Ste L, Los Angeles, CA 90064. A paper copy of this Notice

may be obtained from Apothecary Pharmacy upon request.

Changes to this Notice of Privacy Practices

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI we already have about

you and any information we receive in the future. We will post a copy of the current Notice in the pharmacy. If we change our Notice, you may

obtain a copy of the revised Notice by Asking any of our staff.

Additional Information About Your Privacy Rights

This section was last updated on March 31, 2025.

This section provides further detail to ensure compliance with HIPAA and other healthcare privacy regulations.

Our Legal Duties

We are required by law to protect the privacy of your health information, provide this Notice of Privacy Practices, and inform you of our legal obligations and privacy practices. We also must notify you in the event of a breach involving your health information.

How We May Use and Disclose Your Health Information

1. Treatment

To provide, coordinate, or manage your healthcare and related services, including coordination with other healthcare providers.

2. Payment

To obtain reimbursement for healthcare services provided to you, including billing, collections, and payment verification with insurance or government programs.

3. Healthcare Operations

To carry out internal functions such as audits, staff training, accreditation, licensing, and quality assessment.

4. Legal and Public Health Requirements

We may disclose information when required by law, such as for public health reporting, law enforcement, health oversight activities, and workers’ compensation claims.

5. Other Permitted Uses Without Authorization

Including research under certain conditions, responding to legal proceedings, and preventing or controlling disease or injury.

Uses Requiring Your Authorization

Any use or disclosure of your health information for purposes not listed above — including marketing, sale of data, or sharing psychotherapy notes — requires your written authorization. You may revoke that authorization at any time in writing.

Your Rights

You have the right to:

Access your health recordsRequest corrections to your recordsReceive a list of disclosures madeRequest restrictions on certain uses/disclosuresReceive confidential communicationsObtain a paper copy of this Notice

How to Contact Us

If you have questions about this Notice or wish to exercise your rights, please contact us at:

HIPAA Compliance Officer

Stay Well US / Apothecary Pharmacy

721 N Main St #220

Layton, UT 84040

801-675-8032

[email protected]

Filing a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.