Notice of Privacy Practices

Quisenberry Pharmacies, 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.

Quisenberry Pharmacies uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Quisenberry Pharmacies.

How Quisenberry Pharmacies May Use Or Disclose Your Health Information

For Treatment. Quisenberry Pharmacies may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.

For Payment. Quisenberry Pharmacies may use and disclose your health information to others for purposes of obtaining payment for treatment and services that we provide you. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operation. Quisenberry Pharmacies may use and disclose health information about you in order to support the business activities of this office and your physician’s practice. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:

  • evaluate the performance of our staff;
  • assess the quality of care and outcomes in your case and similar cases;
  • learn how to improve our facilities and services; and
  • determine how to continually improve the quality and effectiveness of the health care we provide.

Appointments. Quisenberry Pharmacies may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.

Fund Raising. Quisenberry Pharmacies may use your information to contact you to raise funds for activities supported by our office; or a group health plan, health insurance issuer, or HMO with respect to a group health plan may disclose health information to the sponsor of the plan.

Required by Law. Quisenberry Pharmacies may use and disclose information about you as required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. For example, our office may disclose information for the following purposes:

  • for judicial and administrative proceedings pursuant to legal authority;
  • to report information related to victims of abuse, neglect or domestic violence; and
  • to assist law enforcement officials in their law enforcement duties;

Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

Decedents, Organ/Tissue Donation. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties including identification and determining cause of death. We may disclose Health Information to funeral directors or coroners in reasonable anticipation of death. Your Health Information also may be used or disclosed for cadaveric organ, eye or tissue donation purposes.

Research. Quisenberry Pharmacies may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.

Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

Government Functions. Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.

Workers Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers Compensation.


Other uses and disclosures of your Health Information will be made only after we receive written authorization from you. You may revoke any authorization given at any time, in writing, unless your physician or Quisenberry Pharmacies has taken action in reliance on the authorization.

Your Health Information Rights

You have the right to:

  • request a restriction on certain uses and disclosures or your information as provided by 45 CFR § 164.522; however, our office is not required to agree to a requested restriction;
  • obtain a paper copy of the notice of information practices upon request;
  • inspect and obtain a copy of all or part of your health record as provided for in 45 CFR § 164.524, in some circumstances; we may deny access to your health record, and you may have the right to have a denial reviewed by another health professional;
  • amend your health record as provided in 45 CFR § 164.526; in certain cases we may deny your request, but you have the right to have a formal statement of disagreement included in your health record;
  • request communications of your health information by alternative means or at alternative locations;
  • revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
  • receive an accounting of disclosures made of your health information as provided by 45 CFR § 164.528.

Any of the requests above must be made in writing, and directed to our Privacy Officer. Forms for making a request are available from our Privacy Officer.

Obligations of Quisenberry Pharmacies

Quisenberry Pharmacies is required to:

  • maintain the privacy of protected health information;
  • provide you with this notice of its legal duties and privacy practices with respect to your health information;
  • abide by the terms of this notice;
  • notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
  • accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
  • obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.

We reserve the right to change our information practices and to make the new provisions effective for all protected health information that we maintain. Revised notices will be made available to you.

Contact Information

If you have any questions or complaints, please contact our Privacy Officer at:

Steve Quisenberry
Quisenberry Pharmacies
150 Liberty St SE
Salem, OR 97301

Copyright 1998 – 2009 by Quisenberry Pharmacies Inc.