Lark Drugs Pharmacy, Inc.

NOTICE OF PRIVACY Practices

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 pharmacy has created this Notice of Privacy Practices (Notice). This Notice describes the pharmacy'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 pharmacy protect the privacy of your PHI that the pharmacy has received or created.

This pharmacy will abide by the terms presented within this Notice. For any uses or disclosures that are not listed below, the pharmacy 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 pharmacy reserves the right to change the pharmacy's privacy practices and this Notice. Revisions to the Notice will be posted in the pharmacy and upon your request, provided to you in a paper format

HOW THE PHARMACY MAY USE AND DISCLOSE YOUR PHI

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

For Treatment: We will use the PHI that we receive from you to fill your prescription and coordinate or manage your health care.

For Payment: The pharmacy will disclose your PHI to obtain payment or reimbursement from insurers for your health care services.

*****

The following is an accounting of additional ways in which the pharmacy is permitted or required to use or disclose PHI about you

without your written authorization.

As required by law: The pharmacy is required to use or disclose PHI about you as required and as limited by law.

For Public Health Activities: The pharmacy may use or disclose PHI about you to a public health authority that is authorized by law

to collect for the purpose of preventing or controlling disease, injury, or disability.

About victims of abuse, neglect or domestic violence: The pharmacy may use or disclose PHI about you to a government authority

if it is reasonably believed you are a victim of abuse, neglect or domestic violence.

For judicial and administrative proceedings: The pharmacy may disclose PHI about you in the course of any judicial or

administrative proceedings, provided that proper documentation is presented to the pharmacy.

To avert a serious threat to health or safety: The pharmacy may use or disclose PHI about you, if it believed in good faith, and is

consistent with any applicable law and standards of ethical conduct, to avert a serious threat to health or safety.

For workers' compensation: The pharmacy may disclose PHI about you as authorized by and to the extent necessary to comply with

workers' compensation laws or programs established by law.

For disaster relief purposes: The pharmacy may disclose PHI about you as authorized by law to a public or private entity to assist in

disaster relief efforts.

To business associates: The pharmacy may disclose PHI about you to the pharmacy's business associates for services that they may

provide to or for the pharmacy.

OTHER USES AND DISCLOSURES

The pharmacy may contact you for the following purposes:

Refill reminders: The pharmacy may contact you to remind you of your prescription upon such time they are ready to be refilled. Information about treatment alternatives: The pharmacy may contact you to notify you of alternative treatments and/or products. Health related benefits or services: The pharmacy may use your PHI to notify you of benefits and services the pharmacy provides.

FOR ALL OTHER USES AND DISCLOSURES

The pharmacy will obtain a written authorization from you for all other uses and disclosures of PHI, and the pharmacy will only use or disclose pursuant to such an authorization, hi addition, you may revoke such an authorization in writing at any time. To revoke a previously authorized use or disclosure, please contact the pharmacy.

YOUR HEALTH INFORMATION RIGHTS

The following are a list of your rights in respect to your PHI.

Request restrictions on certain uses and disclosures of your PHI: You have the right to request additional restrictions of the

pharmacy's uses and disclosures of your PHI; however, the pharmacy is not required to accommodate a request. If you wish to request additional restrictions, please obtain the form, Request for Restriction of Uses & Disclosures, from the pharmacy and return the completed form to the pharmacy.

The right to have your PHI communicated to you by alternate means or locations: You have the right to request that the

pharmacy communicate confidentially with you using an address or phone number other than your residence. However, state and federal laws require the pharmacy to have an accurate address and home phone number in case of emergencies. The pharmacy will consider all reasonable requests. If you wish to request a change in your communicating address and/or phone number, please obtain a form, Request for Alternative Arrangements for Confidential Communication, from the pharmacy and return the completed form to

the pharmacy. The right to inspect and/or obtain a copy of your PHI: You have the right to request access and/or obtain a copy of your PHI that is contained in the pharmacy for the duration the pharmacy maintains PHI about you. If you wish to inspect or obtain a copy of your PHI, please obtain a form, Request for Access to Records, from the pharmacy and return the completed form to the pharmacy. There may be a reasonable cost-based charge for photocppying documents. You will be notified in advance of incurring such charges, if any.

The right to amend your PHI: You have the right to request an amendment of the PHI the pharmacy maintains about you, if you feel that the PHI the pharmacy has maintained about you is incorrect or otherwise incomplete. Under certain circumstances we may deny your request for amendment If we do deny the request, you will have the right to have the denial reviewed by someone we designate who was not involved in the initial review. You may also ask the Secretary, United States Department of Health and Human Services, or their appropriate designee, to review such a denial. If you wish to amend your PHI files, please obtain a form, Request for Amendment to PHI, from the pharmacy and return the completed form to the pharmacy. The right to receive an accounting of disclosures of your PHI: You have the right to receive an accounting of certain disclosures of your PHI made by the pharmacy. If you wish to receive an accounting of disclosures of your PHI, please obtain a form, Request for Accounting of Disclosures, from the pharmacy and return the completed form to the pharmacy. You should be aware, however, that such an accounting excludes uses and disclosures made for treatment, payment, or health care operations purposes. The right to receive additional copies of the Pharmacy's Notice of Privacy Practices: You have the right to receive additional paper copies of this Notice upon request To receive a copy please ask a pharmacy staff member.

REVISIONS TO THE NOTICE OF PRIVACY PRACTICES

The pharmacy 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 revised Notice will be available upon request. The pharmacy will also post the revised version in the pharmacy.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the pharmacy and/or to the Secretary of HHS, or their designee. If you wish to file a complaint with the pharmacy, please contact James B Gafihey, c/o Lark Drugs. If you wish to file a complaint with the Secretary, please write to:

The U.S Department of Health and Human Services 200 Independence Ave, S.W.

Washington, D.C. 20201

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

CONTACT INFORMATION

If you have any questions on the pharmacy's privacy practices or for clarification on anything contained within the Notice, please contact:

Lark Drugs Pharmacy, Inc. Attn: James B Gaffney, 16251 Main Street, Guerneville, Ca 95446, Phone 707 869-9055