Notice of Privacy Practices

Farmer’s MedShoppe, LLC

62 Highway 587

Foxworth, MS 39483

601-424-3540

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.

Farmer’s MedShoppe, LLC maintains the highest standards of privacy of your medical

information. We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to medical information. We are also required to abide by the terms of the notice currently in effect.

If you have any questions in reference to this form, please ask to speak with our Compliance Officer in person or by phone at our main phone number.

USES AND DISCLOSURES OF MEDICAL INFORMATION

Your information may be used and disclosed by your pharmacist, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the pharmacy, and any other use required by law.

Treatment: We may use and disclose your medical information to provide, coordinate, or manage your health care and any related services, including coordination of health care with a third party.

Payment: Your medical information may be used to obtain payment for your health care services. For example, we may disclose your medical information to your insurer to get pre-approval for a medication.

Healthcare Operations: We may use or disclose, as-needed, your medical information in order to support the business activities of your pharmacy. These activities may include, but are not limited to, quality assessment, employee review, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your medical information to pharmacy school students that care for patients in our facility. We may call you by name in the waiting area when your medication is ready. We may use or disclose your medical information, as necessary, to contact you in regards to your medication, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.

We may also use or disclose your medical information in the following situations without your authorization: as required by law, public health issues as required by law, reporting communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity and national security, workers’ compensation, inmates, and other required uses and disclosures.

Under the law, we must make disclosures to you upon your request. Under the law, we must also disclose your medical information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements under Section 164.500.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law. Without your authorization, we are expressly prohibited to use or disclose your medical information for marketing purposes, to sell your medical information, or to use or disclose psychotherapy notes contained in your medical information.

YOUR RIGHTS

The following are statements of your rights with respect to your medical and prescription information.

You may revoke the authorization, at any time, in writing, except to the extent that your pharmacy has taken an action in reliance on the authorization.

You have the right to inspect and copy your medical information – Upon your written request, you have the right to inspect or copy your medical information, with certain exceptions, whether in paper or electronic format. Reasonable copy charges will apply.

You have the right to request a restriction of your medical information – You have the right to request that we restrict certain uses or disclosures of any part of your medical information for reasons other than treatment. Your pharmacist is not required to agree to your requested restriction except if you request that the pharmacist not disclose medical and prescription information to your health plan with respect to healthcare for which you have paid in full out of pocket.

You have the right to request to receive confidential communications – You have the right to request Confidential communication from us by alternative means or at an alternative location.

You have the right to request an amendment to your medical information – If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures – You have the right to receive an accounting of disclosures, paper or electronic, that occurred six years prior to the date of the request, except for the following disclosures: (1) pursuant to an authorization, (2) for purposes of treatment, payment, healthcare operations, or (3) required by law. You have the right to receive notice of a breach ~- We will notify you if your unsecured medical information has been breached.

You have the right to obtain a paper copy of this notice from us even if you have agreed to receive the notice electronically. We reserve the right to change the terms of this notice and we will notify you of such changes on the following appointment. We will also make available copies of our new notice if you wish to obtain one.

COMPLAINTS

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us in writing to our HIPAA Privacy Officer at the address listed at the top of this notice. We will not retaliate against you for filing a complaint.