Your Privacy Is Important to Us
At Tango Pharmacy, we are committed to protecting your privacy and ensuring the confidentiality of your health information. This Privacy Statement describes how we use, disclose, safeguard your Protected Health Information (PHI) and how you can get access to this information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review this notice carefully.
Your Rights:
As a Tango pharmacy patient, you have the right to:
- Obtain an electronic or paper copy of this Notice upon request.
- Request confidential communication. We will make reasonable effort to comply with you request to be contacted via a specific channel of communication.
- Request to correct health information about you that you think is incomplete or incorrect. Should we decline to fulfill your request, we will explain why in writing within 60 days.
- Ask us to limit what we use or share about you
- You can ask us not to use or share certain health information for treatment or payment. However, we deserve the right to not comply if it would affect your care
- If you pay for a health care service out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will comply with the request unless a law requires us to share that information.
- Choose someone to act on your behalf. A legal guardian or someone you have given power of attorney to can make choices about your health information. We will make sure the person has the authority to act for you before we take any action.
- Obtain an electronic or paper copy of your medical record. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable Fee.
- Get a list of those with whom we have shared your information
- You can request for an accounting of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment and healthcare operations, and certain other disclosures. We will provide one accounting per year at no cost, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
- File a complain for inappropriate use or disclosure of your information by contacting Tango Pharmacy manager at (702) 636-2054
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C.
20201, calling 1-877-696-6775, or visiting
www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you for filing a complaint.
Your Choices:
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
For instances where you are not able to tell us your preferences, such as unconsciousness, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures:
We typically use or share your health information in the following ways:
- TREAT YOU
We can use your health information and share it with other professionals who are treating you
Example: A doctor treating you for an injury asks another doctor about your overall health condition. - RUN OUR ORGANIZATION
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services. - BILL FOR YOUR SERVICES
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
DO RESEARCH
– We can use or share your information for health research.
HELP WITH PUBLIC HEALTH AND SAFETY ISSUES
– We can share health information about you for certain situations such as:
- Preventing disease
- Reporting adverse reactions to medications
- Helping with product recall
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
RESPOND TO ORGAN AND TISSUE DONATION REQUESTS
– We can share health information about you with organ procurement organizations you with organ procurement organizations
COMPLY WITH THE LAW
– We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
WORK WITH A MEDICAL EXAMINER OR FUNERAL DIRECTOR
– We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
ADDRESS WORKERS’ COMPENSATION, LAW ENFORCEMENT, AND OTHER GOVERNMENT REQUESTS
– We can use or share information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services.
RESPOND TO LAWSUITS AND LEGAL ACTIONS
– We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities:
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information, visit:
https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Contact Information for Questions or Complaints
If you have any questions, or would like additional information about Tango Pharmacy’s privacy practice, please let us know immediately by emailing us at privacy@tangopharmacy.com or call 702-636-2054 and leave a message for a manager.
You may also send a letter to:
Tango, Inc
Attn: Privacy office
4090 W. Craig Rd Ste 101
North Las Vegas, NV 89032
4090 W. Craig Road Suite 101, North Las Vegas, NV 89032 | www.tangopharmacy.com | p 702-636-2054 | f 702-636-2028