DEPARTMENT OF HEALTH 5: HUMAN SERVICES OFFICE OF THE SECRETARY Volce- (215) 861-4441 TDD - (215) 861-4440 FAX - {215) 361?4431 Of?ce for Civil Rights, Region 150 S. Irdependence Mall West Public Ledger Building, Suite - hh Philadelphia. PA 19106-3499 Reference: 12-141 17'4 Investigator: Amy Kaplarl Contact Telephone: 215-361-4446 June 13, 2013 {bli?llbl?ltcl Deal- {bii?liblil?lici On February 2012, the U.S. Department of Health and Human Services Of?ce for Civil Rights (OCR) received a complaint from you alleging a violation of the Federal Standards for Privacy of Individually Identi?able Health Information andi?or the Security Standards for the Protection of Electronic Protected Health Information (45 C.F.R. Parts 160 and 164, Subparts A, C, and E, the Privacy and Security Rules) by CVS Pharmacy on Colonial Road in Roanoke, VA. Speci?cally, you alleged that when you peeled your prescription label off your bottle, there was another person?s prescription label underneath. These allegations could re?ect a violation of 45 C.F.R. 164.530(c] (safeguards) and or, impermissible disclosures of protected health information under 45 CPR Thank you for bringing this matter to attention. Your complaint plays an integral part in enforcement efforts. OCR enforces the Privacy, Security, and Breach Noti?cation Rules, and also enforces Federal civil rights laws which prohibit discrimination in the delivery of health and human services because of race, color, national origin, disability, age, and under certain circumstances, sex and religion. The Privacy Rule permits certain incidental uses and disclosures of protected health information (PHI) that occur as a lily-product of another permissible or required use or disclosure of PHI, as long as the covered entity has applied reasonable safeguards and implemented the minimum necessary standard, where applicable, with respect to the primary use or disclosure. See 45 C.F.R. For example, the Privacy Rule permits covered health care providers to share PHI for treatment purposes without patient authorization as long as they use reasonable safeguards when doing so. These safeguards may vary depending on the mode of communication used. For example, when discussing patient health information orally with another provider in proximity of others, a doctor may be able to reasonably safeguard the information by lowering hisfher voice. We have carefully reviewed your complaint against CVS Pharmacy and have determined to resolve this matter informally through the provision of technical assistance to CVS. Should OCR receive a similar allegation of noncompliance against CVS Pharmacy in the future, OCR may initiate a formal investigation of that matter. Based on the foregoing, OCR is closing this case without further action, effective the date of this letter. determination as stated in this letter applies only to the allegations in this complaint that were reviewed by OCR. Under the Freedom of Information Act, we may be required to release this letter and other information about this case upon request by the public. In the event OCR receives such a request, we will make every effort, as permitted bylaw, to protect information that identi?es individuals or that, if released, could constitute a clearly unwarranted invasion of personal privacy. If you have any questions regarding this matter, please contact Amy Kaplan, Investigator at 215-861-4446. Thank you for bringing this matter to cm attention Sincerely, Barbara J. Hollan Regional Manager Ema? DEPARTMENT OF HEALTH 8: HUMAN SERWCES OFFICE OF THE SECRETARY a voice- (215) 361-4441 Of?ce for Civil Rights, aegien e, TDD (215} 361-4440 150 S. Independence Mall West he. FAX - (215} 361-4431 Public Ledger Building, Suite 372 Philadelphia, PA 19106-3499 Reference: 12-141174 Investigator: Amy Kaplan Contact Telephone: 215-361?4446 June 12, 2013 CVS Pharmacy Illilililiminim Pharmacy Supervisor 2001 Colonial Avenue Roanoke, VA 2401 5 Deaf On February 21, 2012 the us; Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR) received a complaint from alleging that CVS Pharmacy on Colonial Avenue in Roanoke, VA has violated the Federal Standards for Privacy of Individually Identi?able Health Information (45 CPR. Parts 160 and 164, Subparts A and E, the Privacy Rule). Speci?cally, the complainant alleges that she peeled off her prescription label only to discover the protected health information of another patient. These allegations could re?ect a violation of 45 C.F.R. 164.530(c) (safeguards) and or, impermissible disclosures of protected health information under 45 C.F.R OCR enforces the Privacy, Security, and Breach Noti?cation Rules, and also enforces Federal civil rights laws which prohibit discrimination in the delivery of health and human services because of race, color, national origin, disability, age, and under certain circumstances, sex and religion The Privacy Rule permits certain incidental uses and disclosures of protected health information (PHI) that occur as a by-product of another permissible or required use or disclosure of PHI, as long as the covered entity has applied reasonable safeguards and implemented the minimum necessary standard, where applicable, with respect to the primary use or disclosure. See 45 C.F.R. For example, the Privacy Rule permits covered health care providers to share PHI for treatment purposes without patient authorization as long as they use reasonable safeguards when doing so. These safeguards may vary depending on the mode of communication used. For example, when discussing patient health information orally with another provider in proximity of others, a doctor may be able to reasonably safeguard the information by lowering hisfher voice. In this matter, the complainant alleges the incidental use or disclosure of PHI was not permissible, either because reasonable safeguards were not in place to prevent the use or disclosure andfor because the minimum necessary standard was not implemented when it should have been. Pursuant to its authority under 45 C.F.R. 160.304(a) and OCR has determined to resolve this matter informally through the provision of technical assistance to CVS Pharmacy. To that end, OCR has enclosed material explaining the Privacy Rule provisions related to Incidental Uses and Disclosures, Reasonable Safeguards, and the Minimum Necessary requirement. You are encouraged to review these materials closely and to share them with your staff as part of the Health Insurance Portability and Accountability Act (HIPAA) training you provide to your workforce. You are also encouraged to assess and determine whether there may have been an incident of noncompliance as alleged by the complainant in this matter, and, if so, to take the steps necessary to ensure such noncompliance does not occur in the future. Please contact OCR if you need further information regarding the allegations in this matter. Should OCR receive a similar allegation of noncompliance against CVS Pharmacy in the future, OCR may initiate a formal investigation of that matter. Based on the foregoing, OCR is closing this case without ?lrther action, effective the date of this letter. determination as stated in this letter applies only to the allegations in this complaint that were reviewed by OCR. Under the Freedom of Information Act, we may be required to release this letter and other information about this case upon request by the public. In the event OCR receives such a request, we will make every effort, as permitted by law, to protect information that identi?es individuals or that, if released, could constitute a clearly unwarranted invasion of personal privacy. If you have any questions regarding this matter, please contact Amy Kaplan, Investigator at 215-861-4446. Thank you for bringing this matter to our attention. Barbara J. Holland Regional Manager Enclosures: Incidental Disclosures Reasonable Safeguards Minimum Necessary