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JOSEPH PHARMACY 216 WEST 72ND STREET NEW YORK, NY 10023 TEL (212) 875-1718 FAX (212) 875-0921 E-Mail: [email protected] PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. COM 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. JOSEPH PHARMACY is required by law to maintain the privacy of Protected Health Information ('PHI') and to provide individuals with notice of our legal duties and privacy practices with respect to PHI.The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations.To request an accounting, you must submit a request in to the Privacy Officer or e-mail it to [email protected] Your request must specify the time period, but may not be longer than six years.This Notice of Privacy Practices ('Notice') describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law.

Upon request, we will provide any revised Notice to you.The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for cost of providing additional accountings.We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.We will bill you or third-party payer for the cost of prescription medications dispensed to you.The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking. Example: JOSEPH PHARMACY may use information in your health record to monitor the performance of the pharmacists providing treatment to you.

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JOSEPH PHARMACY is required to follow the terms of this Notice.

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