HIPAA Notice of Privacy Practices

Effective Date: [April 1st, 2026]

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.

Myerlee Pharmacy is required by law to maintain the privacy of your protected health information (“PHI”), to provide you with notice of our legal duties and privacy practices, and to notify affected individuals following a breach of unsecured PHI.

This Notice describes how Myerlee Pharmacy may use and disclose your PHI, your rights regarding that information, and how you can file a complaint if you believe your privacy rights have been violated.

Who This Notice Applies To

This Notice applies to Myerlee Pharmacy and our pharmacists, employees, staff, and other personnel who are authorized to access your PHI in connection with our services.

How We May Use and Disclose Your PHI

For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your care and pharmacy services.
For example, we may use your prescription information to dispense medication, review potential drug interactions, compound medication, or communicate with your prescriber regarding your therapy.

For Payment

We may use and disclose your PHI to obtain payment for products and services we provide.
For example, we may send prescription or claim information to your health plan, pharmacy benefit manager, or other payer to process payment.

For Health Care Operations

We may use and disclose your PHI for our health care operations.
For example, we may use your information for quality improvement, patient safety activities, credentialing, licensing, staff training, auditing, compliance, and business management.

Other Uses and Disclosures Permitted or Required Without Your Written Authorization

We may also use or disclose your PHI without your written authorization when permitted or required by law, including:

to business associates performing services for us where permitted by law;
to individuals involved in your care or payment for your care, when appropriate;
for public health activities;
for health oversight activities;
as required by law;
in response to certain court orders, subpoenas, or administrative requests when legally permitted;
for law enforcement purposes when legally permitted;
to coroners, medical examiners, or funeral directors, when applicable;
for research when legally permitted;
to avert a serious threat to health or safety;
for workers’ compensation or similar programs, where applicable;
for certain specialized government functions, where applicable.

Uses and Disclosures Requiring Your Written Authorization

Most uses and disclosures of PHI not described in this Notice will be made only with your written authorization.

We will obtain your written authorization for uses and disclosures of PHI for marketing when required by law, for any sale of PHI, and for other uses or disclosures that require authorization under applicable law.

You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Special Protection for Reproductive Health Information

We may not use or disclose your PHI to investigate or impose criminal, civil, or administrative liability on any person for the mere act of seeking, obtaining, providing, or facilitating lawful reproductive health care, or to identify any person for such purposes, where prohibited by applicable law.

For example, if we receive a request for PHI that may relate to lawful reproductive health care, we will not disclose the information for a prohibited purpose.

For certain requests involving health oversight activities, judicial or administrative proceedings, law enforcement purposes, and disclosures to coroners or medical examiners that may involve reproductive health information, we are required to obtain a signed attestation that the request is not for a prohibited purpose before making the disclosure, when required by law.

Potential Redisclosure

Information disclosed under HIPAA may be subject to redisclosure by the recipient and may no longer be protected by HIPAA if the recipient is not otherwise required to protect it under applicable law.

[Include Only If Applicable] Substance Use Disorder Records

Only include this section if Myerlee Pharmacy creates or maintains records subject to 42 CFR Part 2.
Substance use disorder treatment records received from programs subject to 42 CFR Part 2, or testimony relaying the content of such records, may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent or a court order after notice and an opportunity to be heard, as provided in applicable law.

Your Rights Regarding Your PHI

You have the following rights, subject to certain legal limitations:

Right to Request Restrictions

You may request restrictions on certain uses and disclosures of your PHI. We are not required to agree to every requested restriction, except where the law requires us to do so.

If you pay for a product or service out of pocket in full, you may request that we not disclose information about that item or service to your health plan for payment or health care operations purposes, and we will honor that request unless disclosure is otherwise required by law.

Right to Request Confidential Communications

You may request that we communicate with you in a certain way or at a certain location. For example, you may ask us to contact you only at a specific phone number or mailing address.

Right to Inspect and Obtain a Copy

You may request access to or a copy of PHI maintained by Myerlee Pharmacy, as permitted by law.

Right to Request Amendment

If you believe information we maintain about you is incorrect or incomplete, you may request an amendment.

Right to Receive an Accounting of Disclosures

You may request an accounting of certain disclosures of your PHI made by us, as permitted by law.

Right to Obtain a Paper Copy of This Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Our Duties

We are required by law to:

maintain the privacy and security of your PHI;
provide you with this Notice of our legal duties and privacy practices;
abide by the terms of the Notice currently in effect;
notify affected individuals following a breach of unsecured PHI when required by law.

We reserve the right to change the terms of this Notice and to make the revised Notice effective for all PHI we maintain. If we make a material change, we will post the revised Notice on our website and make it available at our pharmacy location.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Myerlee Pharmacy and/or with the U.S. Department of Health and Human Services, Office for Civil Rights.

You will not be retaliated against for filing a complaint.

To file a complaint with Myerlee Pharmacy, contact:

Privacy Officer
Myerlee Pharmacy
1826 Boy Scout Drive
Fort Myers, FL 33907
Phone: (239) 482-3022
Email: contact@myerleepharmacy.com

This draft tracks the HIPAA notice elements HHS and 45 CFR 164.520 currently require, including the newer notice concepts around prohibited reproductive-health disclosures, required attestation situations, the breach-notification duty, paper-copy rights, and website posting. If Myerlee maintains records subject to 42 CFR Part 2, the SUD/Part 2 language must be added in the final notice.