Wal-Mart Pharmacy Notice of Privacy Practices

Wal-Mart Pharmacy Notice of Privacy Practices Effective Date: April 14, 2003
Revision Date: September 16, 2005

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 understand that your medical information is personal. We are committed to protecting your medical information. Wal-Mart Stores, Inc. and its affiliated
companies (“Wal-Mart”) are required by law to maintain the privacy of your protected health information (“PHI”), to follow the terms of this Notice, and to give
you this Notice of our legal duties and privacy practices concerning your health information. We must follow the terms of the current Notice.

How Wal-Mart May Use or Disclose Your Health Information

• For Treatment. We may use your PHI to dispense prescriptions to you. We may disclose your PHI to treating physicians, pharmacists and other persons
who are involved in dispensing your prescription.

• For Payment. We may use and disclose your so that your pharmacy services may be billed to, and payment collected from you, your insurance
company or a third party.

• For Health Care Operations. We may use and disclose your PHI for pharmacy operations, which include activities necessary to run the Pharmacy and
make sure that you receive quality customer service.

• For Prescription Refill Reminders and Health-Related Products and Services. We may use or disclose your PHI for prescription refill reminders, to
tell you about health-related products or services, or to recommend possible treatment alternatives that may be of interest to you.

• Individuals Involved in Your Care or Payment for Your Care. We may disclose your PHI to a family member or friend who is involved in your medical
care or payment for your care, provided you agree to this disclosure, or we give you an opportunity to object to the disclosure. If you are unavailable or
are unable to object, we will use our best judgment to decide whether this disclosure is in your best interests.

• As Required by Law. We will disclose your PHI when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and

safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
• Public Health Risks. We may disclose your PHI for public health activities, such as those aimed at preventing or controlling disease, preventing injury,

reporting reactions to medications or problems with products, and reporting the abuse or neglect of children, elders and dependent adults.
• For Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities, which are

necessary for the government to monitor the health care system, include audits, investigations, inspections and licensure.
• Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may

also disclose your PHI 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 (which may include written notice) or to obtain an order protecting the information requested.
• Specialized Government Functions. We may disclose your PHI (1) if you are a member of the armed forces, as required by military command
authorities; (2) if you are an inmate or in custody, to a correctional institution or law enforcement official; (3) in response to a request from law
enforcement, under certain conditions; (4) for national security reasons authorized by law; and (5) to authorized federal officials to protect the President,
other authorized persons, or foreign heads of state.
• Workers’ Compensation. We may disclose your health information for workers’ compensation or similar programs.
• Incidental Disclosures at the Drive-Thru Window. In some locations we offer a drive-thru window. A conversation with the pharmacy might be
overheard by someone in or near the pharmacy. If you would like additional privacy, we suggest you conduct any Pharmacy transactions within the store.
• Organ and Tissue Donation. We may also disclose your PHI to organ procurement or similar organizations for purposes of donation or transplant.
• Coroners and Funeral Directors. We may release your PHI to a coroner or medical examiner, for example, to determine a person's cause of death. We
may also disclose your PHI to funeral directors consistent with applicable law to enable them to carry out their duties.
• Personal Representatives. We may disclose your PHI to a person legally authorized to act on your behalf, such as a parent, legal guardian,
administrator or executor of your estate, or other individual authorized under applicable law.

Other Uses and Disclosures of Your Health Information

Except as described in this Notice, we will not use or disclose your PHI without your written authorization. If you do give us authorization to use or disclose
your PHI, you may cancel your authorization in writing at any time. If you cancel your authorization, this will stop any further use or disclosure for the
purposes covered by your authorization, except where we have already acted on your permission. Please refer to the State law attachment for any stricter
State laws regarding your PHI. If your state is not listed, its laws are not stricter than the federal privacy law.

You Have the Following Rights with Respect to Your Health Information in Our Records

• You may request restrictions on the use or disclosure of your PHI for treatment, payment or health care operations, or when using or disclosing your PHI
to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we
agree, we will comply with your request except in certain emergency situations or as required by law.

• You may inspect and copy your Pharmacy records, with certain exceptions. Usually, this includes prescription and billing records. We may charge you
for the costs of your request. We may deny your request in some circumstances, in which case, you may request that the denial be reviewed.

• You may request that we amend your health information if it is incorrect or incomplete. You must provide a reason that supports your request. We may
deny your request if the health information is accurate and complete, or is not part of the health information kept by or for Wal-Mart. If we deny your
request, you have the right to submit a statement of disagreement regarding any item in your record you believe is incomplete or incorrect. If you
request, this will become part of your medical record. We will attach it to your records and include it when we make a disclosure of the item or statement
you believe to be incomplete or incorrect.

• You may request an accounting of disclosures of your PHI. This is a list of the disclosures made of your health information, other than for treatment,
payment or health care operations, and other exceptions allowed by law. Your request must specify a time period, which may not be longer than six
years and may not include dates before April 14, 2003.

• You may request that we contact you in a certain way or at a certain location. For example, you may request we contact you only at work or at a different
residence or post office box. Your written request must state how or where you wish to be contacted. We will grant all reasonable requests.

If you would like to exercise any of these rights, contact the Pharmacy location that provided your services to get the appropriate form, or submit a written
request to Wal-Mart Stores, Inc., HIPAA Privacy, 922 West Walnut, Suite A, Mailstop #3540, Rogers, AR. 72756-3540. A paper copy of this Notice may be
obtained from your Wal-Mart, SAMS, or Neighborhood Market Pharmacy upon request, or online at www.walmart.com or www.samsclub.com .

Changes to this Notice of Privacy Practices

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for PHI we already have about you and
any information we receive in the future. We will post a copy of the current Notice in the Pharmacy. If we change our Notice, you may obtain a copy of the
revised Notice by visiting our website at www.walmart.com or www.samsclub.com , or upon request.

For More Information or to Report a Problem

If you have questions about this Notice, contact HIPAA Privacy, Wal-Mart Stores Inc., 922 West Walnut, Suite A, Mailstop #3540, Rogers, AR. 72756-3540
or phone 1-800-WAL-MART. If you believe your privacy rights have been violated, you may file a written complaint, and there will be no retaliation, with the
Compliance Officer at the above address, or with the Secretary of the Department of Health and Human Services, Office of Civil Rights.

Notice of Privacy Practices ARIZONA medical data processing, or other administrative
State Law Supplement services for providers of health care or health care
Communicable Diseases - We will not disclose any service plans or for any of the persons or entities
We understand that your medical and health confidential communicable disease related information specified above in paragraph (b). However, no
information is personal. Wal-Mart Stores, Inc., and about an individual, except in situations where the information so disclosed may be further disclosed by
its affiliated companies (“Wal-Mart”), are required subject of the information has provided us with a written the recipient in any way that would be violative of
by law to maintain the privacy of your health authorization allowing the release or where we are California laws governing the use and disclosure of
information, to follow the requirements of this authorized or required by state or federal law to make medical information without authorization from the
Notice, and to provide you with this notice of our the disclosure. patient;
legal duties and privacy practices with respect to (d) the information may be disclosed to organized
your health information. CALIFORNIA committees and agents of professional societies or of
medical staffs of licensed hospitals, licensed health
The following information describes state privacy Disclosure - California law limits disclosure of your care service plans, professional standards review
laws that are stricter than the requirements of the medical information in ways that would otherwise be organizations, independent medical review
Federal Health Insurance Portability and permitted under federal law. In the situations described organizations and their selected reviewers, utilization
Accountability Act (“HIPAA”) guidelines. If your below, the pharmacy will disclose your medical and quality control peer review organizations,
state law provides additional restrictions on any information as follows: contractor’s or persons or organizations insuring,
uses and disclosures, we must follow your state (a) the information may be disclosed to providers of responsible for, or defending professional liability that
law. If your state is not listed, it does not have a provider may incur, if the committees, agents,
privacy laws that preempt HIPAA. health care, health care service plans, contractors health care service plans, organizations, reviewers,
or other health care professionals or facilities for contractors or persons are engaged in reviewing the
ALABAMA purposes of diagnosis or treatment of the patient. competence or qualifications of health care
This includes, in an emergency situation, the professionals or in reviewing health care services
Disclosure - We will not disclose your professional communication of patient information by radio with respect to medical necessity, level of care,
records to anyone without your authorization, except transmission or other means between licensed quality of care, or justification of charges;
where it is in your best interest or where the law emergency medical personnel at the scene of an (e) a provider of health care or health care service plan
requires the disclosure. emergency, or in an emergency medical transport that has created medical information as a result of
Medicaid - We will disclose information pertaining to vehicle, and licensed emergency medical employment-related health care services to an
your treatment (including billing statements and personnel at a health facility; employee conducted at the specific prior written
itemized bills) only to: (b) the information may be disclosed to an insurer, request and expense of the employer may disclose
(a) the Medicaid Fiscal Agent; employer, health care service plan, hospital service to the employee’s employer that:
(b) the Social Security Administration; plan, employee benefit plan, governmental
(c) the Alabama Vocational Rehabilitation Agency; authority, contractor or any other person or entity 1. is relevant in a law suit, arbitration, grievance,
(d) the Alabama Medicaid Agency; responsible for paying for health care services or other claim or challenge to which the
(e) insurance companies requesting information about rendered to the patient to the extent necessary to employer and the employee are parties and in
allow responsibility for payment to be determined which the patient has placed in issue his or
a Medicaid claim filed by the provider, an insurance and payment to be made. If the patient is, by her medical history, mental or physical
application, payment of life insurance benefits, or reason of a comatose or other disabling medical condition, or treatment, provided that
payment of a loan; or other providers who need the condition, unable to consent to the disclosure or information may only be used or disclosed in
information for treatment of a patient. medical information and no other arrangements connection with that proceeding;
have been made to pay for the health care services
being rendered to the patient, the information may 2. describes functional limitations of the patient
also be disclosed to a governmental authority to that may entitle the patient to leave from work
the extent necessary to determine the patient’s for medical reasons or limit the patient’s
eligibility for, and to obtain, payment under a fitness to perform his or her present
governmental program for health care services employment, provided that no statement of
provided to the patient. The information may also medical cause is included in the information
be disclosed to another provider of health care or disclosed;
health care service plan as necessary to assist the
other provider or health care service plan in (f) unless the provider of health care or health care
obtaining payment for health care services service plan is notified in writing of an agreement by
rendered by that provider of health care or health the sponsor, insurer, or administrator to the contrary,
care service plan to the patient; the information may be disclosed to a sponsor,
(c) the information may be disclosed to any person or insurer, or administrator of a group or individual
entity that provides billing, claims management, insured or uninsured plan or policy that the patient

seeks coverage by or benefits from, if the CONNECTICUT (d) any law enforcement personnel duly authorized to
information was created by the provider of health receive such information.
care or health care service plan as the result of Disclosure - We will not disclose information about
services conducted at the specific prior written pharmaceutical services rendered to you to third parties We may also disclose your confidential information
request and expense of the sponsor, insurer, or without your consent, except to the following persons: without your consent pursuant to a subpoena issued and
administrator for the purpose of evaluating the (a) the prescribing practitioner or a pharmacist or signed by an authorized government official or a court
application for coverage or benefits; order issued and signed by a judge of an appropriate
(g) the information may be disclosed to a health care another prescribing practitioner presently treating court.
service plan by providers of health care that you when deemed medically appropriate; HIV/AIDS - We will not disclose AIDS confidential
contract with the health care service plan and may (b) a nurse who is acting as an agent for a prescribing information, except in situations where the subject of the
be transferred among providers of health care that practitioner that is presently treating you or a nurse information has provided us with a written authorization
contract with the health care service plan, for the providing care to you in a hospital; allowing the release or where we are authorized or
purpose of administering the health care service (c) third party payors who pay claims for required by state or federal law to make the disclosure.
plan. Medical information may not otherwise be pharmaceutical services rendered to you or who
disclosed by a health care service plan except in have a formal agreement or contract to audit any HAWAII
accordance with the provisions of this part; records or information in connection with such
(h) the information may be disclosed to an insurance claims; HIV/AIDS - We will not disclose any HIV/AIDS/ARC-
institution, agent or support organization of medical (d) any governmental agency with statutory authority related information, except in situations where the subject
information if the insurance institution, agent, or to review or obtain such information; of the information has provided us with prior written
support organization has complied with all (e) any individual, the state or federal government or consent allowing the release or where we are authorized
requirements for obtaining the information pursuant any agency thereof or court pursuant to a or required by state or federal law to make the disclosure.
to the requirements of the California Insurance subpoena; and
Code provisions; (f) any individual, corporation, partnership or other IDAHO
(i) the information may be disclosed to an organ legal entity which has a written agreement with the
procurement organization or a tissue bank pharmacy to access the pharmacy’s database Disclosure - We will not release your identifiable
processing the tissue of a decedent for provided the information accessed is limited to prescription information to anyone other than you or your
transplantation into the body of another person, but data which does not identify specific individuals. designee, unless requested by any of the following
only with respect to the donating decedent for the Sale of Information: We will not sell your individually persons or entities:
purpose of aiding the transplant; identifiable medical record information. (a) the Board of Pharmacy, or its representatives, acting
(j) the information may be disclosed to a third party for
purposes of encoding, encrypting, or otherwise FLORIDA in their official capacity;
anonymizing data. However, no information may (b) the practitioner, or the practitioner’s designee, who
be further disclosed by the recipient in any way that Disclosure - We will not disclose your pharmacy
would be unauthorized manipulation of coded or records without your written authorization, except to: issued your prescription;
encrypted medical information that reveals (a) you; (c) other licensed health care professionals who are
individually identifiable medical information; (b) your legal representative;
(k) for purposes of disease management programs (c) the Department of Health pursuant to existing law; responsible for the your care;
and services, information may be disclosed to any (d) in the event that you are incapacitated or unable to (d) agents of the Department of Health and Welfare
entity contracting with a health care service plan or
the health care service plan’s contractors to request your records, your spouse; and when acting in their official capacity with reference to
monitor or administer care of enrollees for a (e) in any civil or criminal proceeding, upon the issues related to the practice of pharmacy;
covered benefit, provided that the disease (e) agents of any board whose practitioners have
management services and care are authorized by a issuance of a subpoena from a court of competent prescriptive authority, when the board is enforcing
treating physician or to any disease management jurisdiction and proper notice to you or your legal laws governing that practitioner;
organization that complies fully with the physician representative, by the party seeking the records. (f) an agency of government charged with the
authorization requirements, provided that the responsibility for providing medical care for you;
health care service plan or its contractor provides GEORGIA (g) the federal Food and Drug Administration, for
or has provided a description of the disease purposes relating to monitoring of adverse drug
management services to a treating physician or to Disclosure – Unless authorized by you, we will not events in compliance with the requirements of federal
the health care service plan’s or contractor’s disclose your confidential information to anyone other law, rules or regulations adopted by the FDA; and
network of physician. than you or your authorized representative, except to (h) the authorized insurance benefit provider or health
the following persons or entities: plan that provides your health care coverage or
(a) the prescriber, or other licensed health care pharmacy benefits.

practitioners caring for you; INDIANA
(b) another licensed pharmacist for purposes of
Disclosure - We will disclose your confidential
transferring a prescription or as part of a patient’s information only when it is in your best interests, when
drug utilization review, or other patient counseling the information is requested by the Board of Pharmacy or
requirements; its representatives or by a law enforcement officer
(c) the Board of Pharmacy, or its representative; or charged with the enforcement of laws pertaining to drugs

or devices or the practice of pharmacy, or when Disclosure - Unless authorized by you, we will not • Unless we have obtained your oral or written
disclosure is essential to our business operations. disclose your prescription or equivalent record on file, consent, we will not disclose the nature of
except to the following persons: pharmaceutical services rendered to you, except as
IOWA (a) you, or another pharmacist acting on your behalf; follows:
(b) the authorized prescribed who issued the (a) pursuant to an order or direction of a court;
HIV/AIDS - We will not disclose any HIV/AIDS-related (b) to other pharmacies;
information, except in situations where the subject of prescription, or a licensed health professional who (c) to you; or
the information has provided us with a written is currently treating you; (d) drug therapy information to your physician.
authorization allowing the release or where we are (c) an agency or agent of government responsible for
authorized or required by state or federal law to make the enforcement of laws relating to drugs and MISSOURI
the disclosure. devices; or
(d) a person authorized by a court order. Disclosure - Unless specifically authorized by you, we
KENTUCKY HIV/AIDS - We will not disclose AIDS-related will not release your pharmacy records to anyone other
information about an individual except in situations than:
Disclosure - We will not disclose your patient where the subject of the information has provided us (a) you or any other person authorized by you to receive
information or the nature of professional services with a written authorization allowing the release or
rendered to you without your express consent or where we are authorized or required by state or federal the information;
without a court order, except to the following authorized law to make the disclosure. (b) the authorized prescriber who issued the prescription
persons: (a) members, inspectors, or agents of the
Board of Pharmacy; (b) you, your agent, or another MINNESOTA order, or a licensed health professional who is
pharmacist acting on your behalf; (c) another person, currently treating you;
upon your request; (d) licensed health care personnel Disclosure – (c) in response to lawful requests from a court or grand
who are responsible for your care; (e) certain state • For pharmacies that elect to obtain consent jury;
government agents charged with enforcing the (d) a person authorized by a court order;
controlled substances laws; (f) federal, state, or pursuant to state law: (e) to transfer medical or prescription information
municipal government officers who are investigating a • We will not disclose your pharmacy records without between pharmacists as provided by law; or
specific person regarding drug charges; and (g) a (f) government agencies acting within the scope of their
government agency that may be providing medical care your consent, except: statutory authority.
to you, upon that agency’s written request for (a) for a medical emergency when the provider is Medicaid -: We will restrict disclosure of your information
information. to purposes directly related to your treatment, for
Minimum Necessary - We will only use your unable to obtain your consent due to your promotion of improved quality of care, and to assist with
information to provide pharmacy care. condition or the nature of the medical an investigation, prosecution, or civil or criminal
emergency; or proceeding related to the administration of the Medicaid
MAINE (b) to other providers within related health care program.
entities when necessary for your current HIV/AIDS - We will not disclose any HIV/AIDS-related
Disclosure - We will not disclose your health care treatment. information, except in situations where the subject of the
information for fundraising purposes or to coroners or • We will not disclose your prescription orders or the information has provided us with a written authorization
funeral directors, without your authorization. contents thereof, except to: allowing the release or where we are authorized or
Communicable Diseases - We will only disclose (a) you, your agent, or another pharmacist acting required by state or federal law to make the disclosure.
patient identifiable communicable disease information on your behalf or your agent’s behalf;
to Department of Human Services for adult or child (b) the licensed practitioner who issued the MONTANA
protection purposes or to other public health officials, prescription;
agents or agencies or to officials of a school where a (c) the licensed practitioner who is currently Children’s Health Insurance Program - We will restrict
child is enrolled, for public health purposes. In a public treating you; disclosure of your information to purposes related to the
health emergency, as declared by the state health (d) a member, inspector, or investigator of the administration of the CHIP program.
officer, we may also release your information to private board or any federal, state, county, or Medicaid - We will only use your information for
health care providers and agencies for preventing municipal officer whose duty it is to enforce the purposes related to administration of the Montana
further disease transmission. laws of this state or the United States relating Medicaid program. We will not disclose your information
to drugs and who is engaged in a specific without your written consent, except to state authorities.
MASSACHUSETTS investigation involving a designated person or Sexually Transmitted Diseases - We will not disclose
drug; information concerning persons infected, or reasonably
Medicaid - We will restrict disclosure of your (e) an agency of government charged with the suspected to be infected with a sexually transmitted
information to purposes directly connected with the responsibility of providing medical care for you; disease, except to:
administration of the Medicaid program. (f) an insurance carrier or attorney on receipt of (a) personnel of the Department of Public Health and
written authorization signed by you or your
MICHIGAN legal representative, authorizing the release of Human Services;
such information; and (b) a physician who has obtained the written consent of
(g) any person duly authorized by a court order.
the person whose record is requested; or

(c) a local health officer. well-being of a patient or dependent person, as (d) to the Board of Pharmacy or its representative or
determined by the health authority in accordance to such other persons or governmental agencies
NEVADA with regulations of the state board of health; duly authorized by law to receive such
(e) pursuant to specified statutes that require the information;
Disclosure - We will not disclose the contents of your reporting of certain test results;
prescriptions or disclose any copies of your (f) if the disclosure is made to the department of (e) to transfer a prescription to another pharmacy as
prescriptions, other than to you, except to: human resources and the person about whom the required by the provisions of patient counseling;
disclosure is made has been diagnosed as having
(a) the practitioner who issued the prescription; AIDS or an illness related to HIV and is a recipient (f) to provide a copy of a nonrefillable prescription to
(b) the practitioner who is currently treating you; of or an applicant for Medicaid; you;
(c) a member, inspector or investigator of the Board (g) to a fireman, police officer or person providing
emergency medical services if the board has (g) to provide drug therapy information to physicians
of Pharmacy, an inspector of the FDA, or an determined that the information relates to a or other authorized prescribers for their patients;
agent of the investigation division of the communicable disease significantly related to that or
department of public safety; occupation and the information is disclosed in the
(d) an agency of state government charged with the manner prescribed by the state board of health; (h) as required by the provisions of the patient
responsibility of providing medical care for you; and counseling regulations.
(e) an insurance carrier, on receipt of your written (h) if the disclosure is authorized or required by
authorization or your legal guardian authorizing specific statute. NEW YORK
the release of information;
(f) any person authorized by an order of a district NEW HAMPSHIRE Disclosure – A copy of a prescription for a controlled
court; substance will not be furnished to the patient, but may be
(g) a member, inspector, or investigator of a Disclosure - We will only disclose your professional furnished to any licensed practitioner authorized to write
professional licensing board that licenses the records if: such a prescription.
practitioner who orders the prescriptions filled at (a) we have obtained your permission to do so; Common Electronic File/ Database - We will not access
the pharmacy; (b) it is an emergency situation and it is in your best a common electronic file or database used to maintain
(h) other registered pharmacists for the limited required personally identifiable dispensing information
purpose of and to the extent necessary for the interest for us to disclose the information; or except upon your, or your agent’s, express request.
exchange of information regarding persons (c) the law requires us to disclose the information.
suspected of misusing prescriptions to obtain Sales or Marketing - We will not use, release, or sell NORTH CAROLINA
excessive amounts of drugs or failing to use a your identifiable medical information for the purposes of
drug in conformity with the directions for its use, sales or marketing of services or products unless you Disclosure - We will not disclose or provide a copy of
or taking a drug in combination with other drugs in have provided us with a written authorization permitting your prescription orders on file, except to:
a manner that could result in injury to that person; such activity.
and (a) you;
(i) a peace officer employed by a local government NEW JERSEY (b) your parent or guardian or other person acting in
for the limited purpose of and to the extent
necessary to investigate an alleged crime Pharmaceutical Assistance to the Aged and loco parentis if you are a minor and have not lawfully
committed at the pharmacy and reported by an Disabled - We will not disclose your personally consented to the treatment of the condition for which
employee or to carry out a search warrant or identifiable information without your or your agent’s the prescription was issued;
subpoena issued pursuant to a court order. consent, except for purposes directly connected to the (c) the licensed practitioner who issued the prescription
Communicable Diseases - We will not disclose any administration of the PAAD program or as otherwise or who is treating you;
personal information about an individual who has, or is permitted by state or federal law. (d) a pharmacist who is providing pharmacy services to
suspected of having, a communicable disease, without you;
the individual’s written consent, except as follows: NEW MEXICO (e) anyone who presents a written authorization for the
release of pharmacy information signed by you or
(a) for statistical purposes, as long as the identity of Disclosure - Unless we receive a written consent from your legal representative;
the person is not discernible from the information you, we will not disclose your confidential information to (f) any person authorized by subpoena, court order or
disclosed; anyone other than you or your authorized statute;
representative, except to the following persons or (g) any firm, company, association, partnership,
(b) in a prosecution for a violation or a proceeding for entities: business trust, or corporation who by law or by
an injunction brought pursuant to the contract is responsible for providing or paying for
communicable disease laws; (a) pursuant to the order or direction of a court; medical care for you;
(b) to the prescriber or other licensed practitioner (h) any member or designated employee of the Board of
(c) in reporting the actual or suspected abuse or Pharmacy;
neglect of a child or elderly person; caring for you; (i) the executor, administrator or spouse of a deceased
(c) to another licensed pharmacist where it is in patient;
(d) to any person who has a medical need to know (j) Board-approved researchers, if there are adequate
the information for his own protection or for the your best interest; safeguards to protect the confidential information;
and,

(k) the person who owns the pharmacy or his licensed Disclosure – Patient Confidences: We will not divulge drugs from the pharmacy illegally; or to appropriate
agent. the nature of your problems or ailments or any law enforcement personnel or appropriate child
confidence you have entrusted to the pharmacist in his protective agencies if you are a minor child who the
NORTH DAKOTA professional capacity, except in response to legal pharmacist believes, after providing services to you,
requirements or where it’s in your best interest. to have been physically or psychologically abused;
Disclosure - We will not disclose the nature of the Communicable and Venereal Diseases - We will not (d) between or among qualified personnel and health
services we provide to you to anyone other than you, disclose information which identifies any person who care providers within the health care system for
without first obtaining your oral or written consent, has or may have a communicable or venereal disease, purposes of coordination of health care services
except that we may disclose such information: unless authorized by the individual or as otherwise given to you and for purposes of education and
(a) to other pharmacies; permitted under state law. Whenever possible, we will training within the same health care facility;
(b) to your physician; or de-identify such information prior to disclosure. (e) to third party health insurers for the purpose of
(c) as ordered or directed by a court. adjudicating health insurance claims or administering
PENNSYLVANIA benefits, including to utilization review agents, third
OHIO party administrators, and other entities that provide
HIV/AIDS - We will not disclose any HIV-related operational support;
Disclosure - Unless we have obtained your written information, except in situations where the subject of (f) to a malpractice insurance carrier or lawyer if we
consent, we will only disclose your pharmacy records the information has provided us with a written consent have reason to anticipate a medical liability action;
to: allowing the release or where we are authorized or (g) to our own lawyer or medical liability insurance
(a) you; required by state or federal law to make the disclosure. carrier if you initiate a medical liability action against
(b) the prescriber who issued the prescription or our pharmacy;
PUERTO RICO (h) to public health authorities in order to carry out their
medication order; designated functions. These functions include, but
(c) certified/licensed health care personnel who are Consent - We will not disclose your health information are not restricted to, investigations into the causes of
without your written consent, and in any case, will disclose disease, the control of public health hazards,
responsible for your care; such information solely for medical or treatment purposes, enforcement of sanitary laws, investigation of
(d) a member, inspector, agent, or investigator of the including: reportable diseases, certification and licensure of
(a) the continuation or modification of medical care or health professionals and facilities, and review of
state board of pharmacy or any federal, state, health care such as that required by the federal
county, or municipal officer whose duty is to treatment; government and other governmental agencies;
enforce the laws of this state or the United States (b) prevention or quality control purposes; or (i) to the state medical examiner in the event of a
relating to drugs and who is engaged in a specific (c) regarding payment for medical health care services. fatality that comes under his or her jurisdiction;
investigation involving a designated person or (j) in relation to information that is directly related to a
drug; RHODE ISLAND current claim for workers’ compensation benefits or
(e) an agent of the state medical board when to any proceeding before the workers’ compensation
enforcing the statutes governing physicians and Disclosure – Pharmacist-Specific: We will only disclose commission or before any court proceeding relating
limited practitioners; your prescription information to our agents and persons to workers’ compensation;
(f) an agency of government charged with the directly involved in your care. (k) to our attorneys whenever we consider the release of
responsibility of providing medical care for you, Disclosure – Health Care Provider: We will not information to be necessary in order to receive
upon a written request by an authorized disclose your confidential health care information adequate legal representation;
representative of the agency requesting such without your consent, except in the following situations: (l) to a law enforcement authority to protect the legal
information; (a) to a physician, dentist, or other medical personnel interest of an insurance institution, agent, or
(g) an agent of a medical insurance company who insurance-support organization in preventing and
provides prescription insurance coverage to you, who believe in good faith that the information is prosecuting the perpetration of fraud upon them;
upon authorization and proof of insurance by you necessary to diagnose or treat you in a medical or (m) to a grand jury or to a court of competent jurisdiction
or proof of payment by the insurance company for dental emergency; pursuant to a subpoena or subpoena duces tecum
those medications whose information is requested; (b) to qualified personnel for the purpose of conducting when that information is required for the investigation
(h) an agent who contracts with the pharmacy as a scientific research, management audits, financial or prosecution of criminal wrongdoing by a health
“business associate” in accordance with the audits, program evaluations, actuarial, insurance care provider relating to his or her or its provisions of
regulations promulgated by the secretary of the underwriting, or similar studies, provided that health care services and that information is
United States department of health and human personnel does not identify, directly or indirectly, unavailable from any other source; provided, that any
services pursuant to the federal standards for you in any report of that research, audit, or information so obtained is not admissible in any
privacy of individually identifiable health evaluation, or otherwise disclose your identity in criminal proceeding against you;
information; or any manner; (n) to the state board of elections pursuant to a
(i) in emergency situations, when it is in your best (c) to appropriate law enforcement personnel, or to a
interest. person if the pharmacist believes that you may
pose a danger to that person or his or her family; or
OKLAHOMA to appropriate law enforcement personnel if you
have attempted or are attempting to obtain narcotic

subpoena or subpoena duces tecum when the (e) information whereby the release is mandated by (e) a government agency charged with the responsibility
information is required to determine your eligibility other state or federal laws, court order, or of providing medical care for you upon written
to vote by mail ballot and/or the legitimacy of a subpoena or regulations (e.g., accreditation or request by an authorized representative of the
certification by a physician attesting to a voter’s licensure requirements); agency requesting the information.
illness or disability;
(o) to certify the nature and permanency of your illness (f) information necessary to adjudicate or process SOUTH DAKOTA
or disability, the date when you were last examined payment claims for health care, if the recipient
and that it would be an undue hardship for you to makes no further use or disclosure of the Social Services - We will only use your information for
vote at the polls so that you may obtain a mail information; purposes directly connected to the administration of the
ballot; medical assistance program. We will not disclose your
(p) to the Medicaid fraud control unit of the attorney (g) information voluntarily disclosed by you to entities information without obtaining your approval.
general’s office for the investigation or prosecution outside of the provider-patient relationship;
of criminal or civil wrongdoing by a health care TENNESSEE
provider relating to his or her or its provision of (h) information used in clinical research monitored by
health care services to then Medicaid eligible an institutional review board, with your written Disclosure –
recipients or patients, residents, or former patients authorization; • We will not disclose your name and address or other
or residents of long term residential care facilities;
provided, that any information obtained is not (i) information which does not identify you by name, identifying information, except to:
admissible in any criminal proceeding against you; or that is encoded so that identifying you by name (a) a health or government authority pursuant to any
(q) to the state department of children, youth, and or address is generally not possible, and that is
families pertaining to the disclosure of health care used for epidemiological studies, research, reporting required by law;
records of children in the custody of the statistical analysis, medical outcomes, or (b) an interested third-party payor for the purpose of
department; pharmacoeconomic research;
(r) to the foster parent or parents pertaining to the utilization review, case management, peer
disclosure of health care records of children in the (j) information transferred in connection with the sale reviews, or other administrative functions; or
custody of the foster parent or parents; provided, of a business; (c) in response to a subpoena issued by a court of
that the foster parent or parents receive competent jurisdiction.
appropriate training and have ongoing availability (k) information necessary to disclose to third parties in • We will obtain your authorization before we disclose
of supervisory assistance in the use of sensitive order to perform quality assurance programs, your patient records for any reason, except where:
information that may be the source of distress to medical records review, internal audits or similar (a) the disclosure is in your best interest;
these children; or programs, if the third party makes no other use or (b) the law requires the disclosure; or
(s) to the workers’ compensation fraud prevention unit disclosure of the information; (c) the disclosure is to an authorized prescriber or
for purposes of investigation. to communicate a prescription order where
(l) information that may be revealed to a party who necessary to:
SOUTH CAROLINA obtains a dispensed prescription on your behalf; or
1. carry out prospective drug use review
Disclosure-Prescription Information Privacy Act: We (m) information necessary in order for a health plan as required by law;
will not disclose your prescription drug information licensed by the South Carolina Department of
without first obtaining your consent, except in the Insurance to perform case management, utilization 2. assist prescribers in obtaining a
following circumstances: management, and disease management for comprehensive drug history on you; or
(a) the lawful transmission of a prescription drug order individuals enrolled in the health plan, if the third
party makes no other use or disclosure of the 3. prevent abuse or misuse of a drug or
in accordance with state and federal laws information. device and the diversion of controlled
pertaining to the practice of pharmacy; substances.
(b) communications among licensed practitioners, Disclosure – Pharmacist-Specific: We will not disclose
pharmacists and other health care professionals your information or the nature of professional pharmacy Sale of Information - We will not sell your name and
who are providing or have provided services to services rendered to you, without your express consent address or other identifying information for any purpose.
you; or the order or direction of a court, except to:
(c) information gained as a result of a person (a) you, or your agent, or another pharmacist acting on TEXAS
requesting informational material from a
prescription drug or device manufacturer or your behalf; Disclosure - We will only release your confidential record
vendor; (b) the practitioner who issued the prescription drug to you, your agent, or to:
(d) information necessary to effect the recall of a (a) a practitioner or another pharmacist if, in the
defective drug or device or protect the health and order;
welfare of an individual or the public; (c) certified/licensed health care personnel who are pharmacist’s professional judgment, the release is
necessary to protect your health and well-being;
responsible for your care; (b) the pharmacy board or another state or federal
(d) an inspector, agent or investigator from the Board agency authorized by law to receive the record;
(c) a law enforcement agency engaged in investigation
of Pharmacy or any federal, state, county, or of a suspected violation of the controlled substances
municipal officer whose duty is to enforce the laws laws, or the Comprehensive Drug Abuse Prevent
of South Carolina or the United States relating to Control Act of 1970;
drugs or devices and who is engaged in a specific
investigation involving a designated person or
drug; and

(d) a person employed by a state agency that licenses believes is providing health care to you; Mental Health - We will not disclose confidential
a practitioner, if the person is performing the (b) to any other person who requires health care information relating to an individual who is obtaining or
person’s official duties; or has obtained treatment for a mental illness, without the
information for health care education, or to provide individual’s written consent, except in the following
(e) an insurance carrier or other third party payor planning, quality assurance, peer review, or circumstances:
authorized by the patient to receive the information. administrative, legal, financial, or actuarial services (a) with the signed, written consent of the individual or
to the pharmacy; or for assisting the pharmacy in
UTAH the delivery of health care and the pharmacist his legal guardian;
reasonably believes that the person will not use or (b) in certain proceedings involving involuntary
Disclosure – We will not release or discuss information disclose the health care information for any other
in your prescription or medication profile to anyone purpose and will take appropriate steps to protect examinations;
except: the health care information; (c) pursuant to a court order in which the court found the
(a) you or your legal guardian or designee; (c) to any other health care provider reasonably
(b) a lawfully authorized federal, state, or local drug believed to have previously provided health care to relevance of the information to outweigh the
you, to the extent necessary to provide health care importance of maintaining the confidentiality of the
enforcement officer; to you, unless you have instructed the pharmacy in information;
(c) a third party payment program authorized by you; writing not to make the disclosure; (d) to protect against clear and substantial danger of
(d) another pharmacist, pharmacy intern, pharmacy (d) to any person if the pharmacist reasonably believes imminent injury by the individual to himself or
that disclosure will avoid or minimize an imminent another; or to staff of the mental health facility where
technician, or prescribing practitioner providing danger to your or another individual’s health or the individual is being cared for or to other health
services to you or to whom you have requested us safety, however there is no obligation on the part of professionals involved in treatment of the individual,
to transfer a prescription; the pharmacist to so disclose; for treatment or internal review purposes.
(e) your attorney, with a written authorization signed (e) oral, and made to your immediate family members,
by: or any other individual with whom you have a close WISCONSIN
personal relationship, if made in accordance with
1. you before a notary public; good medical or other professional practice, unless Disclosure - We will not disclose your prescription
2. your parent or lawful guardian, if you are a you have instructed us in writing not to make the records to anyone other than you or someone authorized
disclosure; by you without first obtaining your written informed
minor; (f) to a health care provider who is the successor in consent.
3. your lawful guardian, if you are incompetent; interest to the pharmacy;
(g) to a person who obtains information for purposes of WYOMING
or an audit, if that person agrees in writing to remove
4. your personal representative, in the case of or destroy, at the earliest opportunity consistent Disclosure - Unless we have received an authorization
with the purpose of the audit, information that from you, we will only disclose your confidential
deceased patients. would enable you to be identified and not to information to:
disclose the information further, except to (a) you, or as you direct;
VERMONT accomplish the audit or report unlawful or improper (b) to those practitioners and other pharmacists where,
conduct involving fraud in payment for health care
Unprofessional Conduct - Unless we have your by a health care provider or patient, or other in the pharmacist’s professional judgment such
consent or a court order, we will not disclose your unlawful conduct by the pharmacy; release is necessary for treatment or to protect your
information or the nature of services rendered to you, (h) to an official of a penal or other custodial institution health and well being;
except to the following persons: in which you are detained; or (c) to such other persons or governmental agencies
(a) you, your agent, or another pharmacist acting on (i) to provide directory information, unless you have authorized by law to investigate controlled substance
instructed the pharmacy not to make the disclosure law violations;
your behalf; Sexually Transmitted Diseases - We will not disclose (d) a minor’s parent or guardian;
(b) the practitioner who issued the prescription drug any information regarding an individual’s treatment for a (e) your third party payor; or
sexually transmitted diseases, except in situations (f) your agent.
order; where the subject of the information has provided us
(c) certified or licensed health care personnel who with a written authorization allowing the release or
where we are authorized or required by state or federal
are responsible for your care; law to make the disclosure.
(d) a Board of Pharmacy or federal, state, county, or
WEST VIRGINIA
municipal officer that enforces state or federal
law relating to drugs or devices, pursuant to an
investigation of a designated drug or person; or
(e) a government agency responsible for providing
medical care for you, upon a written request by
an authorized agency representative.

WASHINGTON

Disclosure - Unless authorized by you, we will not
disclose your health care information, except if the
recipient needs to know the information and the
disclosure is:
(a) to a person who the pharmacist reasonably