?lm: DEPARTMENT OF HEALTH 3: HUMAN SERVICES OFFICE OF THE SECRETARY Voice . {214) rev?4056, (soc) ass-1019 TDD - {214) 167-3940 Of?ce for Civil Rights, Region VI FAX - (214] Eff-0432 WM 1301 Young Street. Suite 1169 ?am cameraman: JUN132012 CVS Caremark Attention: Privacy Of?cer One CV3 Place Woonsocket, RI 02895 Our Transaction Number: 11-132069 Dear Privacy Of?cer: On September 12, 2011, the U.S. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR), Region VI received a complaint alleging that CVS Caremaric, the covered entity, has violated the Federal Standards for Privacy of Individually Identi?able Health Information (45 C.F.R. Parts 160 and 164, Subparts A and E, the PrivaCy Rule). Speci?cally, the complaint alleges that, on April 4, 2011, June 8, 2011, August 12, 2011, and August 22, 2011, CVS Caremark sent a drug utilization review form (the ?form?) to a physician at Texas Scottish Rite Hospital. The form is for an individual who is not a patient of the physician. This allegation could re?ect a violation of 45 CPR. 164.502(a) and 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 CPR. 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 Caremark. 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 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 Caremark in the future, OCR may initiate a formal investigation of that matter. Based on the foregoing, OCR is closing this case without ?thher 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 Vaniaey Nwigwe, Investigator, at 214-767-4054 (Voice), 214?767-8940 (TDD). Sincerely, Ralph D. Rouse Regional Manager Region VI Regional Manager Enclosures: Incidental Disclosures Reasonable Safeguards Minimum Necessary ?lial-Hf. at: a" DEPARTMENT on HE ALTH a mutant SERVICES OFFICE or THE SEcatETnur voice - {21a res-sass, (soot 363-101? Tun - (214} Tar-sale Of?ce for-Civil Rights, Region? a FAX- (214) Tar-M32 1301 Young Street. stir: 1169 . Dallas, TX r5202 JUN 1 3 2012 Our Transaction Number: 11-132069 Deal- On September 12, 2011, the US. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR), Region VI received your complaint alleging that CVS Carernark, the covered entity, has violated the Federal Standards for Privacy of Individually Identi?able Health Information (45 GER. Parts 16f! and 164, Subparts A and E, the Privacy Rule)- Speci?cally, you allege that, on April 4, 20] l, June 8, 201], August 12, 2011, and August 22, 2011, CVS Caremark sent a drug utilization review form [the onn?) to a physician at Texas Scottish Rite Hospital. The form is for an individual who is not a patient of the physician. This allegation could re?ect a violation of4S C.F.R. 164.502(a) and 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 byproduct of another pennissible 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 coveted 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 hisfh'er voice. We have carefully reviewed your complaint against CVS Caremark and have determined to resolve this matter informally through the provision of technical assistance to CVS Caremark. Should OCR receive a similar allegation of noncompliance against CVS Caremark in the futm?e, 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 he 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 Venice),r Nwigwe, Investigator, at 214-767-4054 (Voice), 214-767-8940 (TDD). Sincerely, 6L Ralph D. Rouse Regional Manager Region VI - Regional Manager