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.
At MediVera Compounding Pharmacy, we’re committed to providing quality customer service and keeping you informed. Federal and Michigan law require us to protect the privacy of your health information. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act and the 2013 HIPAA Omnibus Rule, and the HIPAA Breach Notification Rule (45 CFR §§ 164.400–414), together with Michigan’s Public Health Code (MCL 333.17751 et seq.) and Michigan Board of Pharmacy administrative rules (e.g., Mich. Admin. Code R. 338.589), govern how we may use and disclose your protected health information (PHI) and the rights you have with respect to it. This notice reflects those requirements as currently in effect. We are committed to keeping your healthcare information confidential. You may obtain a paper copy of this notice upon request at any time. To obtain a paper copy, contact the store Privacy Officer at (248) 267-5002.
You may request a restriction on certain uses and disclosures of PHI. To request additional restrictions on uses or disclosure of your PHI, send a written request to the store Privacy Officer at 5225 Crooks Rd., Troy, MI 48098. We are generally not required to agree to those restrictions. However, if you pay for a prescription or service in full, out of pocket, and request that we not disclose information about that item or service to your health plan for purposes of payment or healthcare operations, we are required by law to honor that request unless disclosure is otherwise required by law.
This means you may come to our offices and inspect and copy most of the medical information about you that we maintain. The designated record set will usually include prescription and billing records. If any part of your designated record set is maintained electronically, you may request an electronic copy in the format we use, or another readily producible electronic format if you prefer. If you wish to inspect and copy your medical information, you must send a written request to the store Privacy Officer at 5225 Crooks Rd., Troy, MI 48098. We may charge you a reasonable, cost-based fee for copying, mailing, labor, and supplies necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
If you feel the PHI we maintain about you is incomplete or incorrect, you may request that we amend it, for as long as we maintain the PHI. To request an amendment, you must send a written request to the store Privacy Officer at 5225 Crooks Rd., Troy, MI 48098, including a reason that supports your request. In certain cases, we may deny your request. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision, and we may give a rebuttal to your statement.
You have the right to request an accounting of most disclosures we have made of your PHI (other than those relating to treatment, payment, or healthcare operations). The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to family members or friends involved in your care, and disclosures for notification purposes. To request an accounting, you must send a written request to the store Privacy Officer at 5225 Crooks Rd., Troy, MI 48098, specifying a time period of no longer than six years. The first accounting you request within a 12-month period will be provided free of charge; you may be charged a reasonable, cost-based fee for additional accountings within that period, and we will notify you of any cost before proceeding.
You may request that we communicate with you about medical matters by alternative means or at an alternative location — for example, in writing or at a different address. To make this request, send a written request to the store Privacy Officer at 5225 Crooks Rd., Troy, MI 48098 stating how or where you would like to be contacted. We will accommodate all reasonable requests.
If a breach of unsecured PHI about you occurs, we are required to notify you without unreasonable delay and no later than 60 days after discovery of the breach, in accordance with the HIPAA Breach Notification Rule and applicable Michigan law. The notice will describe what happened, the types of information involved, steps you should take to protect yourself, what we are doing to investigate and mitigate the breach, and how to contact us with questions.
You have the right to a paper copy of this notice at any time, even if you have agreed to receive it electronically. Contact the store Privacy Officer at (248) 267-5002 to request one.
Information obtained by the pharmacist will be used to dispense prescription medications to you. We will document in your record information related to the medications dispensed to you and the services provided to you.
If you have insurance coverage, we will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your copayment. We will bill you or a third-party payor for the cost of the medications dispensed to you. Billing information may include information that identifies you as well as the prescriptions you are taking.
We may use information in your health record to monitor the performance of the pharmacists providing treatment to you, in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Some services are provided through contracts with business associates, such as our pharmacy computer software vendor, prescription insurance companies or pharmacy benefit managers, claim processing vendors, and our legal counsel in cases of litigation. Business associates are required by written agreement to appropriately safeguard your PHI, including maintaining safeguards consistent with the HIPAA Security Rule and providing breach notification to us if an incident occurs.
Healthcare professionals such as pharmacists, using their professional judgment, may disclose to a family member, another relative, close personal friend, or any person you identify, PHI relevant to that person’s involvement in your care or payment related to your care.
We may contact you to provide refill reminders, or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
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 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 deficits, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
We may disclose PHI about you as authorized by, and as necessary to comply with, laws relating to worker’s compensation or similar programs established by law.
As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
We must disclose PHI about you when required to do so by federal or Michigan law, including reporting requirements under the Michigan Public Health Code and Michigan Board of Pharmacy administrative rules.
We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.
We may disclose PHI about you to researchers when an institutional review board has reviewed the research proposal and established protocols to ensure the privacy of your information.
We may disclose PHI to identify a deceased person, determine a cause of death, or allow these parties to carry out their duties as authorized by law.
Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, for purposes of tissue donation and transplant.
We may use or disclose PHI about you to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care of your location and general condition.
If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.
We may disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
If you are a member of the armed forces, we may release PHI about you as required by military command authorities, and we may release PHI about foreign military personnel to the appropriate military authority. We may also release PHI to authorized federal agents for intelligence, counterintelligence, and other national security activities authorized by law, and to authorized federal officials providing protection to the President, other authorized persons, or foreign heads of state, or conducting special investigations.
We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it necessary to prevent serious harm and the recipient agency represents that the information will not be used against you.
We will obtain your written authorization before using or disclosing PHI about you for any purpose other than those described above, or as otherwise permitted or required by law. You may revoke that authorization in writing at any time by sending a written request to the store Privacy Officer at 5225 Crooks Rd., Troy, MI 48098. Upon receipt of your revocation, we will stop using or disclosing the information, except to the extent we have already taken action in reliance on the authorization. If revoked, we may not be able to continue serving your pharmacy healthcare needs.
In addition to your federal HIPAA rights, Michigan law imposes independent confidentiality obligations on us. Under the Michigan Public Health Code, we are required to take reasonable precautions when discussing the names of prescribed drugs in the presence of anyone other than you, and to provide adequate security to protect the confidentiality and integrity of your PHI, including PHI transmitted or accessed electronically. Where Michigan law provides greater protection for your health information than federal law, Michigan law controls to the extent of that additional protection.
For more information about our privacy practices, or to report a problem, contact the store at (248) 267-5002. If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. There will be no retaliation for filing a complaint.
We reserve the right to change the terms of this notice and to make the revised notice effective for PHI we already maintain, as well as any information we receive in the future. If we make a material change, we will update this notice and make copies available upon request.
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This document is a template updated to reflect currently effective federal HIPAA requirements and Michigan pharmacy confidentiality provisions as of August 2026. It is provided for general informational purposes and is not legal advice. Because HIPAA and Michigan Board of Pharmacy rules are updated periodically (including a February 2026 federal update affecting notices that touch 42 CFR Part 2 substance-use-disorder records), please have counsel confirm this notice matches your pharmacy’s current practices before use.