Welcome To Pandia Pharmacy!

PATIENT RESPONSIBILITIES

As our patient, you have the responsibility to:

• Adhere to the plan of treatment or service established by your physician
• Participate in the development of an effective plan of care/treatment/services
• Provide, to the best of your knowledge, accurate and complete medical and personal information necessary to plan and provide care/services
• Ask questions about your care, treatment and/or services, or to have clarified any instructions provided by Pandia Pharmacy representatives
• Communicate any information, concerns, and/or questions related to perceived risks in your services, and unexpected changes in your condition
• Notify Pandia Pharmacy if you are going to be unavailable for scheduled delivery times
• Treat Pandia Pharmacy personnel with respect and dignity without discrimination to color, religion, sex, national or ethnic origin, or any protected status
• Care for and safely use medications, supplies, and/or equipment according to the instructions provided, for the purpose they were prescribed, and only for/on the individual for whom they were prescribed
• Notify Pandia Pharmacy of any changes in your physical condition, physician's prescription, or insurance coverage
• Notify Pandia Pharmacy immediately of any changes to your contact information whether temporary or permanent
• Pay all invoices upon receipt and understand that unpaid accounts will be considered in default
• Understand that Pandia Pharmacy acts solely as an agent for you in filling prescriptions through your insurance or other benefits assigned to Pandia Pharmacy; Pandia Pharmacy assumes no responsibility for ensuring that benefits assigned will be paid; and understand that your account will only be credited when Pandia Pharmacy receives payment
• Submit any forms that are necessary to participate in Pandia Pharmacy's patient management program, to the extent that is required by law
• Notify your treatment provider of participation in Pandia’s patient management program

PANDIA PHARMACY NOTICE OF PRIVACY PRACTICES (NOPP)

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.

As part of the federal Health Insurance Portability and Accountability Act of 1996, known as HIPAA, the facility has created this Notice of Privacy Practices (Notice). This Notice describes the facility's privacy practices and the rights you, the individual, have as they relate to the privacy of your Protected Health Information (PHI). Your PHI is information about you, or that could be used to identify you, as it relates to your past and present physical and mental health care services. The HIPAA regulations require that the facility protect the privacy of your PHI that the facility has received or created.

This facility will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below (including marketing and selling of PHI), the facility will obtain a written authorization from you for that use or disclosure, which you will have the right to revoke at any time, as explained in more detail below. The facility reserves the right to change the facility's privacy practices and this Notice.

How the facility may use and disclose your PHI
The following is an accounting of the ways that the facility is permitted, by law, to use and disclose your PHI.

Uses and disclosures of PHI for treatment: The facility will use the PHI received to fill your prescription and coordinate or manage your health care.

Uses and disclosures of PHI for payment: The facility will disclose the PHI to obtain payment or reimbursement from the insurer for your health care service.

Uses and disclosures of PHI for health care operations: The facility may use the minimum necessary amount of your PHI to conduct quality assessments, improvements, and evaluate the facility workforce.

The following is an accounting of additional ways in which the facility is permitted or required to use or disclose your PHI without your written authorization.

Uses and disclosures as required by law: The facility is required to use or disclose your PHI as required and as limited by law.

Uses and disclosure for public health activities: The facility may use or disclose your PHI to a public health authority that is authorized by law to collect for the purpose of preventing or controlling disease, injury, or disability. This includes the FDA so that it may monitor any adverse effects of drugs, foods, nutritional supplements, and other products as required by law.

Uses and disclosure about victims of abuse, neglect or domestic violence: The facility may use or disclose your PHI to a government authority if it is reasonably believed that you are a victim of abuse, neglect, or domestic violence.

Uses and disclosures for health oversight activities: The facility may use or disclose your PHI to a health oversight agency for oversight activities which may include audits, investigations, inspections as necessary for licensure, compliance with civil laws, or other activities the health oversight agency is authorized by law to conduct.

Disclosures to individuals involved in your care: The facility may disclose your PHI to individuals involved in your care.

Disclosures for judicial and administrative proceedings: The facility may disclose your PHI in the course of any judicial or administrative proceedings, provided that proper documentation is presented to the facility.

Disclosures for law enforcement purposes: The facility may disclose your PHI to law enforcement officials for authorized purposes as required by law or in response to a court order or subpoena.

Uses and disclosures about the deceased: The facility may disclose PHI postmortem, or prior to, and in reasonable anticipation of an individual's death, to coroners, medical examiners, and funeral directors.

Uses and disclosures for cadaveric organ, eye or tissue donation purposes: The facility may use and disclose your PHI for the purpose of procurement, banking, or transplantation of cadaveric organ eyes, or tissues for donation purposes.

Uses and disclosures for research purposes: The facility may use and disclose your PHI for research purposes with a valid waiver of authorization approved by an institutional review board or a privacy board. Otherwise, the facility will request a signed authorization by the individual for all other research purposes.

Uses and disclosures to avert a serious threat to health or safety: The facility may use or disclose your PHI if in good faith and consistency with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.

Uses and disclosures for specialized government functions: The facility may use or disclose your PHI for specialized government functions including military and veterans' activities, national security and intelligence, protective services, department of state functions, and correctional institutions and law enforcement custodial situations.

Disclosure for workers' compensation: The facility may disclose your PHI as authorized by and to the extent necessary to comply with workers' compensation laws or programs established by law.

Disclosures for disaster relief purposes: The facility may disclose your PHI as authorized by law to a public or private entity to assist in disaster relief efforts and for family and personal representative notification.

Disclosures to business associates: The facility may disclose your PHI to the facility's business associates for services that they may provide to or for the facility to assist in providing quality health care. To ensure the privacy of your PHI, the facility requires all business associates to apply appropriate safeguards to any PHI received or created.

The facility may contact you for the following purposes

• To notify you of alternative treatments and/or products
• To notify you of benefits and services the facility provides
• To notify you if the facility participates in a fundraising activity, the facility may send you a fundraising packet using demographic PHI, or the facility may disclose demographic PHI about you to its business associate or an institutionally related foundation to send you a fundraising packet. No further disclosure will be allowed by the business associates or an institutionally related foundation without your written authorization. You will be provided with an opportunity to opt-out of all future fundraising activities.

For all other uses and disclosures The facility will obtain a written authorization from you for all other uses and disclosures of your PHI, and the facility will only use or disclose pursuant to such an authorization. In addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact Pandia Pharmacy at ComplianceHL@pandiapharmacy.com

Your health information rights
The following are a list of your rights regarding your PHI:

• You have the right to request additional restrictions of the facility's uses and disclosures of your PHI. However, the facility is not required to accommodate a request. This includes the right to restrict disclosures to insurances for those products and services you pay out-of-pocket
• You have the right to request that the facility communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require the facility to have an accurate address and home phone number in case of emergencies. The facility will consider all reasonable requests
• You have the right to request access and/or obtain a copy of your PHI that is contained in the facility for the duration the facility maintains your PHI. There may be a reasonable cost-based charge for photocopying documents. You will be notified in advance of incurring such charges
• You have the right to request an amendment of your PHI the facility maintains, if you feel that your PHI the facility has maintained is incorrect or otherwise incomplete. Under certain circumstances the facility may deny your request for amendment. If the request is denied, you will have the right to appeal by someone the facility designates who was not involved in the initial review. You may also ask the Secretary of United States Department of Health and Human Services ("HHS"), or their appropriate designee, to review such a denial
• You have the right to receive an accounting of certain disclosures of your PHI made by the facility
• You have the right to receive additional paper copies of this Notice, upon request, even if you initially agreed to receive the Notice electronically
• You will be notified of any breaches that have compromised the privacy of your PHI Please contact Pandia Pharmacy if you have questions pertaining to your health information rights.

Revisions to the Notice of Privacy Practices
The facility reserves the right to change and/or revise this Notice and make the new revised version applicable to all PHI received prior to its effective date. The facility will also post the revised version of the Notice in the facility.

Effective Date: 06/2022

FOR MEDICARE AND MEDICAID PRESCRIPTIONS

• You have the right to request a coverage determination from your Medicare/ Medicaid drug plan if you disagree with the information provided by the pharmacy. You also have the right to request a special type of coverage determination called an "exception" if you believe:
• You need a drug that is not on your drug plan's list of covered drugs. The list of covered drugs is called a "formulary."
• A coverage rule (such as prior authorization, step therapy or quantity limits) should not apply to you for medical reasons, or you need to take a non-preferred drug and you want the plan to cover the drug at the preferred drug price.

WHAT YOU NEED TO DO:

• You or your prescriber can contact your Medicare/Medicaid drug plan to ask for a coverage determination by calling the plan's toll-free phone number on the back of your plan membership card, or by going to your plan's website. You or your prescriber can request an expedited (24 hour) decision.
• The name of the prescription drug that was not filled, including the dose, strength, and information if known.
• The name of the pharmacy that attempted to fill your prescription.
• The date you attempted to fill your prescription.
• If you ask for an exception, your prescriber will need to provide your drug plan with a statement explaining why you need the off-formulary or non-preferred drug or why a coverage rule should not apply to you.

MEDICARE DMPOS SUPPLIER STANDARDS
The products and/or services provided to you by Pandia Pharmacy are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57 ©. These standards concern business professional and operational matters (e.g., honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov. Upon request we will furnish you with a written copy of the standards.

THINGS YOU CAN DO TO STOP INFECTION

• The tips below will help you learn about actions you can take to protect yourself and others from infection and help stop the spread of germs.
• Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.
• Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Flu and other serious respiratory illnesses, like respiratory syncytial virus (RSV) whooping cough, and COVID-19, are spread by cough, sneezing, or unclean hands.
• Clean your hands. Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.
• Practice other good health habits. Clean and disinfect frequently touched surfaces at home, work or school. Especially when some are ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
• Get vaccinated. Make sure you are up to date on your vaccinations from your healthcare provider. Vaccinations are available for: chicken pox, measles, tetanus, shingles, mumps, meningitis, hepatitis, pneumonia, flu (influenza) and COVID-19.

PATIENT EMERGENCY INFORMATION

It is important to have a general plan when preparing for an emergency. The following tips could be helpful during your preparation.

EVACUATION PLAN

• Know emergency numbers
• Know the location of your nearest emergency shelter
• Have an emergency bag ready to go
• Arrange for assistance if you cannot evacuate yourself
• Have a plan for your pets
• Plan to have pet medication, food, and accessories

MAKE A LIST

• Medication
• Medication Information
• Allergies
• Copies of Health Insurance Cards
• Contact Information

ESSENTIAL ITEMS

• Health Information
• Cell Phone
• Essential medications
• Flashlight and batteries
• Copies of prescriptions
• Emergency Food

HAVE ON HAND

• Two Weeks supply of medication
• Cell Phone
• Flashlights & Batteries
• First Aid Kit
• Battery operated radio

Should you have any questions during your preparation or in the event of an emergency, do not hesitate to call your Pandia pharmacist.

DRUG DISPOSAL

1ST CHOICE: DRUG TAKE-BACK EVENTS
To dispose of prescription and over-the-counter drugs, call your city or county government’s household trash and recycling service and ask if a drug take-back program is available in your community. Some counties hold household hazardous waste collection days, where prescription and over-the-counter drugs are accepted at a central location for proper disposal.

2ND CHOICE: HOUSEHOLD DISPOSAL STEPS
Take your prescription drugs out of their original containers.
Mix drugs with an undesirable substance, such as cat litter or used coffee grounds.
Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag.
Conceal or remove any personal information, including Rx number, on the empty containers by covering it with permanent marker or duct tape, or by scratching it off.
The sealed container with the drug mixture, and the empty drug containers, can now be placed in the trash.

FINANCIAL INFORMATION

Prescription cost will vary depending on your insurance. Because drug pricing can change daily, a final determination of your co-pay cost including deductibles or co-insurance cannot be made until your claim is processed. If your insurance company considers Pandia Pharmacy an out of network pharmacy, an explanation of the medication cost will be provided in writing at the time of dispensing or if requested by patient. Cash price of the medication is also available upon request by calling the pharmacy at (855) 278-5090. You may also call the Member Services phone number on your prescription insurance card to get the most current information. If you are unable to afford the out-of-pocket cost for your prescription, Pandia Pharmacy will work to identify co-pay card assistance, patient assistant programs, or other support and/or charitable organizations. Visit the Pandia Pharmacy ’s website to learn about Patient Assistance.

The cost may also vary depending on the quantity of medication. Your prescription will be filled for medication that the physician prescribes. Please be sure to advise your physician to prescribe for the maximum amount/day supply allowable by your insurance coverage (days allowed may vary by plan).

If you have Medicare Part D drug coverage, the cost of your prescription will change significantly as you meet your deductible and initial co-pay, progress through the “donut hole” and reach total out-of-pocket expense. Patient Care Coordinators can assist you in determining and understanding your options. Visit our website to learn more about these services.

COMPLAINTS

If you have any questions on the facilities practices or would like to see clarification on anything contained within the Notice or file a complaint, please contact our Privacy Office at 855-278-5090 or ComplianceHL@pandiapharmacy.com

The facility will not take any adverse action against you as a result of your filing a complaint.

If you find that your complaint has been inappropriately handled by our facility, you may also contact one of the following agencies and accreditation administrators.

California State Board of Pharmacy
2720 Gateway Oaks Drive, Suite 100
Sacramento, CA 95833
Phone: (916) 518 - 3100
https://www.pharmacy.ca.gov/consumers/complaint_info.shtml

Secretary of The US Department Health and Human Services
200 Independence Ave S.W.
Washington D.C. 20201
Toll Free Center (877) 696-6775

ACHC Complaint Information
Website: https://www.achc.org/contact/
ACHC’s Complaints Department: (855) 937-2242

National Association of Boards of Pharmacy (NABP)
1600 Feehanville Drive
Mount Prospect, IL 60056
Phone: (847) 391- 4406
Email: help@nabp.pharmacy