Notice of Privacy Practices

Effective Date: May 25, 2025

This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Our Commitment to Your Privacy

Mo-Town Pharmacy is committed to maintaining the privacy and security of your protected health information (PHI) in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This Notice describes how we may use and disclose your PHI, your rights, and our obligations regarding the use and disclosure of PHI.

What Is Protected Health Information (PHI)?

Protected Health Information refers to individually identifiable health information, including demographic data, that relates to:

  • Your past, present, or future physical or mental health or condition,

  • The provision of healthcare to you,

  • The past, present, or future payment for your healthcare.

This includes information such as your name, address, birth date, phone number, prescription history, and other identifying information linked to your medical care.

Your Rights Regarding PHI

You have the following rights regarding your health information:

  1. Right to Access
    You have the right to view or receive an electronic or paper copy of your medical records. Requests can be made through our pharmacy, and we will respond within 30 days. A reasonable, cost-based fee may apply.

  2. Right to Request Corrections
    You may request an amendment to your health information if you believe it is incorrect or incomplete. We may deny your request but will provide a written explanation within 60 days.

  3. Right to Request Confidential Communications
    You can request that we contact you in a specific way (such as at a certain phone number or address). We will accommodate all reasonable requests.

  4. Right to Restrict Disclosures
    You may request limitations on how we use or disclose your PHI for treatment, payment, or healthcare operations. While we are not required to agree, we will comply with any request related to services paid in full out-of-pocket.

  5. Right to an Accounting of Disclosures
    You may request a record of disclosures (excluding those made for treatment, payment, or operations) for up to six years.

  6. Right to a Paper Copy of This Notice
    You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

  7. Right to Appoint a Representative
    If someone has medical power of attorney or is your legal guardian, that person may act on your behalf regarding your PHI.

  8. Right to File a Complaint
    If you believe your privacy rights have been violated, you may contact our Privacy Officer or file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you.

To file a complaint, contact:
Sam Salem
Privacy Officer
Mo-Town Pharmacy
sammy@motownpharmacy.com
313-891-2253
20333 Conant, Detroit, MI 48234

You may also file a complaint with the U.S. Department of Health and Human Services at:
www.hhs.gov/ocr/privacy/hipaa/complaints/

How We May Use and Disclose Your Information

We typically use or share your PHI in the following ways:

For Treatment
We may use your information to provide and coordinate your medical care or treatment with other healthcare providers.

For Payment
We may use and disclose your PHI to bill and receive payment from health plans or other entities.

For Healthcare Operations
We may use your PHI to operate and improve our services, evaluate staff performance, and train personnel.

Other Permitted or Required Uses and Disclosures

We may use or disclose your PHI without your written authorization in the following situations:

  • As Required by Law
    When disclosure is required by federal, state, or local law.

  • Public Health and Safety
    To prevent or control disease, report adverse drug events, or notify people of exposure to communicable diseases.

  • Abuse or Neglect Reporting
    If we believe a child, elderly person, or disabled person is the victim of abuse or neglect.

  • Law Enforcement
    To comply with a subpoena, warrant, or similar legal process.

  • Health Oversight Activities
    For audits, investigations, inspections, and licensure.

  • Judicial and Administrative Proceedings
    If ordered by a court or in response to a legal request.

  • Coroners and Funeral Directors
    As needed for identification or determining cause of death.

  • Organ and Tissue Donation
    If you are an organ donor.

  • Workers’ Compensation
    As authorized to comply with workers’ compensation laws.

  • National Security and Armed Forces
    For military or national security functions.

Uses and Disclosures Requiring Your Authorization

We will not use or disclose your PHI for the following purposes without your explicit written permission:

  • Marketing purposes

  • Sale of your health information

  • Most uses of psychotherapy notes

You may revoke your authorization at any time by submitting a written request.

Our Legal Duties

We are required by law to:

  • Maintain the privacy and security of your protected health information

  • Provide you with this Notice of our legal duties and privacy practices

  • Notify you promptly if a breach occurs that may compromise your PHI

  • Abide by the terms of this Notice currently in effect

Changes to This Notice

We reserve the right to update or change this Notice at any time. Changes will apply to all the information we have about you. The revised Notice will be available in our pharmacy and on our website at:
www.motownpharmacy.com/privacy-policy