HIPAA

PATIENT BILL OF RIGHTS AND RESPONSIBILITIES

Patients have the right to:

1. Be fully informed in advance about services or care to be provided.
2. Be treated with dignity, courtesy and respect as a unique person.
3. Be able to identify or ask any company representatives for their name and job title. Patients also have the right to speak with a pharmacist, manager or supervisor.
4. Choose a healthcare provider.
5. Receive information about the services that are provided by the company as well as any limitations to the company’s services.
6. You may request evidence-based practice information for clinical decisions. These may include manufacturer package inserts, published practice guidelines, peer-reviewed journals, etc. This info can include the level of evidence or consensus describing the process for intervention. This is important in instances where there is no evidence-based research, conflicting evidence, or no level of evidence.
7. Timely response when care, treatment, services or equipment is
   needed or requested. You will be informed in a timely manner of impending discharge.
8. Before services are provided, you can receive verbal or written explanations of expected payments. These payments may come from Medicare or a third-party payer. You can also find out what charges you are asked to pay. Plus, we can explain forms you are requested to sign.
9. Receive medications and services that meet or exceed industry standards. You can expect this regardless of your race, religion, political belief, sex, social or economic status. This should be done regardless of your age, disease process, DNR status or disability. All of this will be done in accordance with your doctor’s orders.
10. Receive medications and services from qualified staff. You can expect to receive instructions on safely handling and taking medications.
11. Receive information regarding your order status. Patients or caregivers can call Hy-Vee Pharmacy Solutions at 877-794-9833 and speak
    with pharmacy staff.
12. Receive notification if a prescription or order is processed or filled by another pharmacy within the Hy-Vee Pharmacy Solutions network of pharmacies.
13. Participate in decisions about technical procedures, who will perform it, any possible alternatives and the risks involved. Please know you have the right to refuse all or part of the services. You can also be informed of expected consequences. Hy-Vee Pharmacy Solutions will explain this according to the current body of knowledge.
14. Privacy of all information contained in your records and of Protected Health Information. This may change with the law or third-party contracts. Your information shared within the Patient Care Management Program will be shared when the law allows.
15. If you want, you can be referred to other providers within an external healthcare system. This includes dietitians, pain specialists, mental health services, etc. You may also be referred back to their own prescriber for follow up.
16. Receive information about to whom and when your health information was disclosed. Hy-Vee Pharmacy Solutions will follow the law and company policies and procedures.
17. You can share concerns or complaints for lack of respect. You can also submit complaints for treatment or service. You may also suggest changes in policy, staff or services. This will be received without discrimination, restraint, reprisal, coercion, or unreasonable interruption of services. Patients or caregivers can call the Company, ask for an employee’s name, job title, and speak with a supervisor, pharmacist, or pharmacy manager.
18. Have concerns or complaints about services that are (or fail to be) furnished in a timely manner.
19. Be informed of any financial relationships of the pharmacy.
20. Be provided with information about the Patient Care Management Program. You can receive info about the philosophy and changes to the program. If the program is terminated you may be involved as well.
21. Be offered assistance with any eligible internal programs that help with patient management services. These may be manufacturer co pay, patient assistance programs and health plan programs. This includes tobacco cessation programs, disease management, pain management, suicide prevention or behavioral health programs.
22. Be advised of pharmacy number, for after hours as well as normal business hours: Hy-Vee Pharmacy Solutions: (877) 794-9833 Monday through Friday: 7 AM to 7 PM CST; Saturday: 8 AM to 2 PM CST
23. Be advised of any change in the plan of service before the changeis made.
24. Participate in the development of your care plan. You can also participate in revisions of that plan.
25. Receive information in a manner, format or language that you can easily understand.
26. Give permission (when the law allows) for a family member to be involved in your treatment. The member(s) of your family can serve as a surrogate decision maker.
27. Be fully informed of your responsibilities.
28. Have the right to say no to participation, revoke consent or dis-enroll from any services at any point in time.
29. To be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse. This includes injuries of unknown source, and misappropriation of patient property.
30. Be informed of patient’s rights under state law to formulate an Advanced Directive, if applicable.

Patients have the Responsibility to:

1. Adhere to the treatment plan or services made by your physician. Also, you should notify him or her of your participation in the Patient Management Program.
2. Adhere to company policies and procedures.
3. Submit any forms necessary to participate in the program, to the extent required by law.
4. Participate in the development of an effective plan of care/treatment/services.
5. Provide, to the best of your knowledge, accurate and complete medical and personal information necessary to plan and provide care/services.
6. Ask questions about your care, treatment and/or services.
7. Have clarified any instructions provided by company representatives.
8. Communicate any information, concerns and/or questions related to perceived risks in your services, and unexpected changes in your condition.
9. Be available to receive medication deliveries and coordinate with the company during times you will be available.
10. Treat pharmacy personnel with respect and dignity without discrimination as to color, religion, sex, or national or ethnic origin.
11. Provide a safe environment for the organization’s representatives to provide services.
12. Use medications according to instructions provided, for the purpose it was prescribed, and only for/on the individual to whom
    it was prescribed.
13. Communicate any concerns on ability to follow instructions provided.
14. Promptly settle unpaid balances except where contrary to federal or state law.
15. Notify pharmacy of change in prescription or insurance coverage.
16. Notify pharmacy immediately of address or telephone changes, temporary or permanent.

After-Hour Services:
The normal business number will direct you to a live operator for after-hours emergency questions or situations. A pharmacist will return your call 24 hours/7 days a week. You may leave a message for non-urgent matters or refill requests at the normal business number at any time by following designated prompts.

Complaint Procedure:

1. You have the right and responsibility to express concerns, complaints or dissatisfaction about services you receive or fail to receive without fear of reprisal, discrimination or unreasonable interruption of services. Call, mail or email the Company and ask to speak with a Pharmacist, Pharmacy Manager or the Vice President of Pharmacy Operations during regular business hours or the company representative if you are calling outside of regular business hours, including weekends and holidays.
2. The formal grievance procedure of the company ensures that your concerns/complaints will be reviewed and an investigation started within five business days of receipt of the concern/complaint. Every attempt shall be made to resolve all grievances within 14 days. You will be informed in writing of the resolution of the complaint/grievance. If more time is needed to resolve the concern/complaint, you will also be informed verbally and in writing.
3. If you feel the need to discuss your concerns, dissatisfaction or complaints with a party other than company staff, please file a complaint with the Board of Pharmacy or through the Company’s accreditation organizations – URAC or Accreditation Commission for Healthcare (ACHC). Complaints can be made by phone, mail or online depending on the state’s specific recommendations. For specific guidelines, check the state’s website.

Iowa Board of Pharmacy
Forward pharmacy concerns to:
[email protected]
pharmacy.iowa.gov/online-services/file-complaint
400 SW 8th St. Suite E,
Des Moines, IA 50309-4688
(515) 281-6674

Nebraska Department of Health and Human Services
dhhs.ne.gov/Pages/Complaints.aspx
402.741.2118
P.O. Box 95026
Lincoln, NE 68509-5026
(402) 471-3121

Accreditation Commission for Healthcare
855.937.2242; 222.achc.org

URAC
202.216.9006; www.urac.org