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.

The Pharmacy is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide individuals with notice of our 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 we 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 PHI about you.

The Pharmacy is required to follow the terms of this Notice.  We will not use or disclose PHI about you without your written authorization, except as described in this Notice.  We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain.  Upon request, we will provide any revised Notice to you.

 Your Health Information Rights

All requests mentioned below must be made in writing by completing the appropriate Reasor’s  Pharmacy’ Protected Health Information Request Form which can be obtained from any of our pharmacies or by contacting the Reasor’s  Pharmacy’ Privacy Officer (see corp. mailing info.).

You have the following rights with respect to PHI about you:

Obtain a paper copy of the Notice upon request.  You may request a copy of the Notice at any time.  Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy.  To obtain a paper copy, contact your Reasor’s Pharmacy.

Request a restriction on certain uses and disclosures of PHI.  You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to Reasor’s Pharmacy Privacy Officer.  We are not required to agree to those restrictions, except if the disclosure is for the purpose of carrying out payment or healthcare operations and is not required by law, or the PHI pertains to a healthcare item or service for which you (or other individual on your behalf) has paid out-of-pocket in full.

Inspect and obtain a copy of PHI.  You have the right to access and copy PHI about you contained in a designated record set for as long as the Pharmacy maintains the PHI.  The designated record set usually will include prescription and billing records.  To inspect or copy PHI about you, you must send a written request to the Reasor’s Pharmacy where your PHI resides.  We may charge you a fee for the costs of copying, mailing and supplies that are 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.  You may also request an electronic copy of your PHI.

Request an amendment of PHI.  If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it.  You may request an amendment for as long as we maintain the PHI.  To request an amendment, you must send a written request to Reasor’s Pharmacy’ Privacy Officer.  You must include a reason that supports your request.  In certain cases, we may deny your request for amendment.  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.

Receive an accounting of disclosures of PHI.  You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for most purposes other than treatment, payment, or health care operations.  The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes.  The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations.  To request an accounting, you must submit a request in writing to Reasor’s Pharmacy’ Privacy Officer.  Your request must specify the time period, but may not be longer than six years.  The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.

Request communications of PHI by alternative means or at alternative locations.  For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box.  To request confidential communication of PHI about you, you must submit a request in writing to the Reasor’s Pharmacy where your PHI resides.  Your request must state how or where you would like to be contacted.  We will accommodate all reasonable requests.

Examples of How We May Use and Disclose PHI

The following are descriptions and examples of ways we use and disclose PHI:

We will use PHI for treatment.  Example:  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 services provided to you.  

We will use PHI for payment.  Example:  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 payer for the cost of prescription medications dispensed to you.  The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.

We will use PHI for health care operations.  Example:  The Pharmacy may use information in your health record to monitor the performance of the 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 we provide.

We are likely to use or disclose PHI for the following purposes:

Business associates:  There are some services provided by us through contracts with business associates.  Examples include billing and delivery services.  When these services are contracted, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do.  If applicable, we may bill you or your third-party payer for services rendered.  To protect PHI about you, we require the business associate to appropriately safeguard the PHI.

Communication with individuals involved in your care or payment for your care:  Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other 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.

Health-related communications:  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.

Food and Drug Administration (FDA):  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 defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Worker’s compensation:  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.

Public health:  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.

Law enforcement:  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.

As required by law:  We must disclose PHI about you when required to do so by law.

Health oversight activities:  We may disclose PHI about you to an oversight agency for activities authorized by law.  These oversight activities include audits, investigations, and inspections, as necessary for our 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, we may disclose PHI about you in response to a court or administrative order.  We may also disclose PHI about you 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 or to obtain an order protecting the requested PHI.

We are permitted to use or disclose PHI about you for the following purposes:

Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

Coroners, medical examiners, and funeral directors:  We may release PHI about you to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.

Organ or tissue procurement organizations:  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 the purpose of tissue donation and transplant.

Fundraising: We may contact you as part of a fundraising effort.

Notification:  We may use or disclose PHI about you to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and your general condition.

Correctional institution:  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.

To avert a serious threat to health or safety:  We may use and 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.

Military and veterans:  If you are a member of the armed forces, we may release PHI about you as required by military command authorities.  We may also release PHI about foreign military personnel to the appropriate military authority.

National security and intelligence activities:  We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective services for the President and others:  We may disclose PHI about you to authorized federal official so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Victims of abuse, neglect, or domestic violence:  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 type of 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 is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.

Other Uses and Disclosures of PHI

We will require your written authorization prior to: any use or disclosure of your psychotherapy notes (except in limited circumstances); any use or disclosure of your PHI for marketing purposes; or sale of your PHI.

The Pharmacy will request your written completion of our Authorization Form before using or disclosing PHI about you for purposes other than those provided for above (or as otherwise permitted or required by law).  You may revoke an authorization in writing by completing our Authorization Revocation Form at any time.  Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization.

We will notify you in the event of a breach of unsecured Protected Health Information that affects you.

For More Information or to Report a Problem

If you have questions or would like additional information about the Pharmacy’s privacy practices, you may contact the Reasor’s Pharmacy Privacy Officer.   If you believe your privacy rights have been violated, you can file a complaint with the Reasor’s Pharmacy Privacy Officer or with the Secretary of Health and Human Services, 200 Independence Ave., SW, Washington DC  20201, phone number (202) 619-0257.  There will be no retaliation for filing a complaint.

 

Effective Date: 08/22/2013

Attn. Privacy Officer

420 South 145th E. Ave, Suite B. Tulsa, OK 74108

918-947-8180 Extension 3079

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    Brand

    Nature's Own
  • Size

    8 oz

    Identifier

    00050091120088

    SKU/UPC

    5009112008
  • Size

    12 pack

    Description

    Est. 1885. Authentic blend of 23 flavors. 150 calories per can. Let's Play: Let's Play! We're donating $15 million to build or fix up 2,000 playgrounds. And 5 million kids will be jumping for joy. Join us at letsplay.com. Consumer comments? 1-888-Drpepper. See unit container for manufacturer's identity. Caffeine Content: 41 mg/12 fl oz. Please recycle. drpepper.com.

    Identifier

    00078000082166

    SKU/UPC

    7800008216

    Manufacturer

    Dr Pepper/Seven Up

    Brand

    Dr Pepper
  • Size

    11 oz

    Identifier

    00070038311317

    SKU/UPC

    7003831131
  • Size

    8 oz

    Description

    Philadelphia Cream Cheese Original. Since 1872. No preservatives. 5 Simple ingredients. 100 Calories per 1 oz. Net Wt 8 oz (226 g). Philadelphia Cream Cheese always starts with fresh milk and real cream, and is made with 5 simple ingredients, nothing extra. The result is the fresh tasting, creamy texture you love. That's how Philadelphia sets the standard. how2recycle.info. Call: 1.800.634.1984. Visit www.creamcheese.com. © Kraft Foods.

    Identifier

    00021000612239

    SKU/UPC

    2100061223

    Manufacturer

    Kraft Heinz Foods Company

    Brand

    Philadelphia
  • Size

    lb

    Identifier

    00201657000003

    SKU/UPC

    20165700000
  • Size

    46 oz

    Description

    Pictures are examples of what cake may look like. Actual product may vary from picture. If there is a character you want but it is not listed please contact the store. If our Cake Designers have any questions they will reach out to you regarding the cake design. Leave writing info or any special instructions in the notes section at order checkout. Any special orders please call the Bakery Department at the store you choose.

    Identifier

    00207825000004

    SKU/UPC

    20782500000
  • Size

    lb

    Description

    Package sizes vary from 3 to 5lb per package

    Identifier

    00201828000009

    SKU/UPC

    20182800000
  • Size

    lb

    Identifier

    00000000041287

    SKU/UPC

    4128
  • Size

    2 ltr

    Description

    0 calories per 12 fl oz serving. Enter code at mycokerewards.com. Low sodium. Caffeine Content: 46 mg/12 fl oz. Consumer information call 1-800-438-2653. www.dietcoke.com. mycokerewards.com. Find the code under cap & enter the code online. Open to legal residents of the 50 US (& DC) age 13 & older. See rules online. Please recycle. No refill.

    Identifier

    00049000050110

    SKU/UPC

    4900005011

    Manufacturer

    Coca Cola

    Brand

    Diet Coke
  • Size

    16 oz

    Description

    Natural and artificial flavor added. The original. Made with loving care. Visit us at www.bluebell.com.

    Identifier

    00071899051015

    SKU/UPC

    7189905101

    Manufacturer

    Blue Bell Creameries

    Brand

    Blue Bell
  • Size

    24 oz

    Identifier

    00072060002560

    SKU/UPC

    7206000256

    Manufacturer

    HILAND DAIRY

    Brand

    HILAND
  • Size

    lb

    Identifier

    00201064000009

    SKU/UPC

    20106400000
  • Size

    20 oz

    Description

    Nature's Own® 100% Whole Wheat Bread. Bread is a low fat, cholesterol free food. 0 grams of trans fat per slice. Per 1 slice. 60 calories. 0g sat fat, 0% DV. 110mg sodium, 4% DV. <1g sugars. No artificial preservatives, colors or flavors. No high fructose corn syrup. 13 grams of whole grain per slice. Heart healthy. Nature's Own 100% Wheat is one of our best-sellers! It offers the nutritional value of whole wheat in a soft, great-tasting loaf. Like all Nature's Own varieties, 100% Whole Wheat contains no artificial preservatives, colors, or flavors. Try a slice with fruit jam for breakfast or with your favorite sandwich filling for lunch or a quick dinner. Nature's Own fast facts: No high fructose corn syrup. 13 grams of whole grain per slice. The Dietary Guidelines for Americans, encourage all Americans to eat a healthy diet and be physically active. The new Dietary Guidelines "MyPlate" is an easy tool to help you think about food choices at each meal, control portion sizes, and ensure balanced nutrition. Grains play a key role in maintaining a healthy diet. Eating grains, especially whole grains, as part of a healthy diet can help reduce the risk of chronic diseases such as diabetes, heart disease, some cancers, and obesity. And, if you're trying to slim down, studies show that adding whole grains can help maintain a healthier body weight. Go with the Grain™. Whole Grain™. 13g or more per serving. wholegrainscouncil.org. Eat 48g or more of whole grains daily. #1 selling variety brand in the U.S.* *Nature's Own brand breads are the #1 selling soft variety breads based on the units sales numbers reported by syndicated IRI data for the total U.S. Our quality pledge. The bakers of Nature's Own have been baking bread since 1919 and are committed to providing you with the highest quality baked foods. Nature's Own breads are made with premium ingredients that are carefully combined in our special recipes and then baked to perfection in our ovens. If the Nature's Own name is on the package, you're certain to find great-tasting breads inside! Also look for delicious specially breads and rolls under our Cobblestone Mill brand. Enjoy! From the flowers family of bakers. *Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat and cholesterol may reduce the risk of heart disease and some cancers. To learn more about making grains a part of your healthy diet and to see "MyPlate" Dietary Guidelines, go to: www.dietaryguidelines.gov. www.choosemyplate.gov. www.health.gov/paguidelines. Visit us at www.naturesownbread.com for delicious recipes. Questions or comments Call 1-866-245-8921.

    Identifier

    00072250037129

    SKU/UPC

    7225003712

    Manufacturer

    Flowers Foods, Inc.

    Brand

    Nature's Own
  • Size

    8.5 oz

    Description

    America's favorite. Quality and value since 1930. Add egg and milk. Packaged in recycled paperboard. Partially produced with genetic engineering. Great products since 1930. Thanks for trying Jiffy! We've been making great muffin and baking mixes since the 1930's. So, when you are looking for delicious muffins, biscuits, desserts, or other great meal solutions, please think Jiffy! - Howdy Holmes, President Chelsea Milling Company. Additional recipes at: www.jiffymix.com. Facebook: Find us on Facebook. Contact us at: 800-727-2460. Mon-Fri 8:00 am - 4:30 pm EST. Made in the USA.

    Identifier

    00072486002205

    SKU/UPC

    7248600220

    Manufacturer

    Chelsea Milling

    Brand

    Jiffy
  • Size

    128 oz

    Identifier

    00072060101041

    SKU/UPC

    7206010104
  • Size

    lb

    Description

    Package Sizes vary from 3 to 5lb per package

    Identifier

    00201832000002

    SKU/UPC

    20183200000
  • Size

    lb

    Identifier

    00201696000002

    SKU/UPC

    20169600000
  • Size

    lb

    Description

    Package weight vary 3 to 5lb per package.

    Identifier

    00201704000000

    SKU/UPC

    20170400000
  • Size

    lb

    Identifier

    00000000047760

    SKU/UPC

    4776
  • Size

    144 oz

    Description

    Diet Coke®. Per 1 can serving: 0 calories. 0g sat fat, 0% DV. 40mg sodium, 2% DV. 0g sugars. 12-12 fl oz cans (144 fl oz). 12-355 ml cans (4.26 l). 12 cans. Please Recycle Cans & Cartons®. Canner's name and address appear on each can. Caffeine content: 46 mg/12 fl oz. ©2016 The Coca-Cola Company. Consumer information call 1-800-438-2653. www.dietcoke.com.

    Identifier

    00049000028911

    SKU/UPC

    4900002891

    Manufacturer

    The Coca-Cola Company

    Brand

    Diet Coke
  • Size

    lb

    Identifier

    00000000031516

    SKU/UPC

    3151
  • Size

    1 ct

    Identifier

    00207008000005

    SKU/UPC

    20700800000
  • Size

    lb

    Description

    Package size will vary from 3 to 5lb per package

    Identifier

    00201815000005

    SKU/UPC

    20181500000
  • Size

    1 ct

    Identifier

    00206993000007

    SKU/UPC

    20699300000
  • Size

    1 lb

    Description

    Fresh taste. Guaranteed! US inspected and passed by Department of Agriculture. Gluten free. Visit us at www.jimmydean.com. For questions or comments, call 1-800-925-Dean.

    Identifier

    00077900115530

    SKU/UPC

    7790011553

    Manufacturer

    Hillshire Brands

    Brand

    Jimmy Dean
  • Size

    lb

    Identifier

    00201702000002

    SKU/UPC

    20170200000
  • Size

    7.25 oz

    Description

    Kraft Original Flavor Macaroni & Cheese Dinner. Smmmile, it's the cheesiest. The taste you love. No artificial flavors. No artificial preservatives. No artificial dyes. Per 1/3 box (unprepared): 250 calories. 1.5g sat fat, 8% DV. 570mg sodium, 24% DV. 6g sugars. See nutrition facts panel for as prepared. Even more reasons to love it. This box of Kraft macaroni & cheese dinner may look simple, but it actually contains some extraordinary things. Inside you'll find happy childhood memories, tons of blissful smiles, and our delicious elbow macaroni waiting to be covered with gooey, cheesy goodness. And now, there are a few things you won't find. Our mouthwatering mac and cheese now contains no artificial flavors, preservatives, or dyes. Of course, it still has the great taste you know and love. Which means you can happily devour it bite by bite, until your bowl contains nothing at all. kraftmacandcheese.com. Kraft Heinz. This product sold by weight; not volume. Some settling of contents may have occurred during handling. Visit us at: kraftheinzcompany.com. 1-800-847-1997. Please have package available. Carton made from 100% recycled paperboard. Minimum 35% post-consumer content. ©Kraft Foods.

    Identifier

    00021000658831

    SKU/UPC

    2100065883

    Manufacturer

    Kraft Heinz Foods Company

    Brand

    Kraft
  • Size

    101.4 oz

    Description

    Dr Pepper®. Est. 1885. 23 authentic blend of 23 flavors. 210 calories per bottle. 16.9 fl oz (500 ml). Please recycle. Caffeine content: 58 mg/16.9 fl oz. Consumer comments 1-888-DRPEPPER. drpepper.com. ©2012 Dr Pepper/Seven Up, Inc.

    Identifier

    00078000003864

    SKU/UPC

    7800000386

    Manufacturer

    Dr Pepper/Seven Up, Inc.

    Brand

    Dr Pepper
  • Size

    lb

    Identifier

    00000000040150

    SKU/UPC

    4015