Notice of Privacy Practices | Guy Park Pharmacy

Effective date: May 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.

Guy Park Pharmacy LLC ("the Pharmacy") is required by federal law (HIPAA) and applicable state law to maintain the privacy of your protected health information ("PHI"), provide you with this Notice describing our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

How we may use and disclose your PHI

For treatment

We use and disclose PHI to provide pharmacy services, including filling and refilling prescriptions, performing drug-utilization reviews, counseling you about your medications, and coordinating with your prescribers, other pharmacies, or other healthcare providers involved in your care.

For payment

We use and disclose PHI to bill and obtain payment from you, your insurance plan, or a third party responsible for your care. This may include sharing information with your insurer to confirm coverage, obtain prior authorizations, process claims, and pursue payment for services rendered.

For healthcare operations

We use and disclose PHI for routine pharmacy operations, including quality assessment, staff training, licensing, accreditation, audits, and management of the Pharmacy.

Appointment, refill, and prescription pickup reminders

We may contact you by phone, voicemail, text message, mail, or email to remind you about prescription refills, vaccinations, scheduled appointments, or to let you know an order is ready for pickup or delivery.

Family members and others involved in your care

Unless you tell us otherwise, we may share relevant PHI with a family member, friend, caregiver, or other person you identify as involved in your care or in payment for your care (for example, when they pick up a prescription on your behalf).

Other permitted or required uses

Federal law permits or requires us to use or disclose PHI without your authorization in certain situations, including:

Public-health activities, such as reporting adverse drug events to the FDA
Reporting suspected abuse, neglect, or domestic violence
Health-oversight activities, audits, and investigations
Judicial and administrative proceedings, in response to a court order or subpoena
Law-enforcement purposes as permitted by law
Coroners, medical examiners, and funeral directors
Organ, eye, and tissue donation
Research, subject to appropriate review and protections
To avert a serious threat to health or safety
Workers' compensation as authorized by state law
Military, veteran, national-security, and protective-services activities
Inmates and law-enforcement custody

Uses and disclosures requiring your written authorization

Other uses and disclosures of PHI, including most uses and disclosures of psychotherapy notes, marketing communications, and any sale of PHI, require your written authorization. You may revoke an authorization at any time, in writing, except to the extent we have already acted on it.

Your rights regarding your PHI

You have the following rights regarding the PHI we maintain about you:

Right to inspect and copy. You may request to inspect or obtain a copy of your PHI. We may charge a reasonable cost-based fee.
Right to request an amendment. If you believe PHI we maintain is incorrect or incomplete, you may request that we amend it.
Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your PHI.
Right to request restrictions. You may ask us to restrict how we use or disclose your PHI for treatment, payment, or operations. We are not required to agree, except where the disclosure is to a health plan for a service paid in full by you out of pocket.
Right to request confidential communications. You may ask us to communicate with you in a specific way or at a specific location (for example, by mail only, or only at a particular phone number).
Right to a paper copy of this Notice. You may request a paper copy at any time, even if you have received this Notice electronically.
Right to be notified of a breach. We will notify you if a breach occurs that may have compromised the privacy or security of your PHI.

Our duties

We are required by law to maintain the privacy of your PHI, provide you with this Notice, and abide by the terms of the Notice currently in effect. We reserve the right to change this Notice at any time. Any change will apply to PHI we already have as well as PHI we receive in the future. The most current Notice is posted in the Pharmacy and on this website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

To file a complaint with us, please contact our Privacy Officer:

Guy Park Pharmacy LLC, Attn: Privacy Officer
151 Guy Park Ave, Amsterdam, NY 12010
Phone: (518) 212-6020
Fax: (518) 212-6062

To file a complaint with the federal government, visit hhs.gov/ocr/privacy/hipaa/complaints.

Template notice, please review with counsel. This Notice of Privacy Practices is a generic template designed for an independent community pharmacy. Before publishing publicly, have it reviewed and customized by qualified healthcare counsel familiar with HIPAA, the HITECH Act, and applicable New York State law (including the SHIELD Act). Date it appropriately and post a paper copy in the pharmacy as required.