DEPARTMENT OF HEALTH SERVICES OFFICE OF THE SECRETARY voice - war-toss, (see)- res?rots TDD - (no T613940 Of?ce for can Rights, Region VI FAX- (214) res-c432 WM 1301 Young Street, suite 1159 Dallas, Tx mos JUN 1 a 2012 CV Caremark Attention: Privacy Of?cer One CVS Place Woonsocket, RI 02895 Our Transaction Number: 12-13695!) Dear Privacy Officer: On December 22, 2011, the US. Department of Health and Human Services (HI-IS), Of?ce for Civil Rights (OCR), Region VI received a complaint alleging that CV5 Carernark, 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 September, 20, 2011, CVS Caremark faxed a ?Medication Non- adherence Th - Advisory" form (the ?form?) to ltbli?ilibliil'ici I place of employment. ?bli?libliilicl is a workforce member, as well as, a patient at her place of employment. It is averred that the form went to the wrong department. This allegation could re?ect a violation of45 C.F.R. 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 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 his?her 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. 160.3 04(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 ?iture, 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 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 Vaniecy 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 OFFICE OF THE SECRETARY Of?ce for lCivil Rights, Region VI film.? 3 DEPARTMENT OF HEALTH HUMAN SERWCES "i voice - (214) rat-sass, (sea) 363-11319 TDD (21o res-sass 5% Fax. (214} room he not Young Street, Suite new mm Dallas, T317520: JUN 3 2012 {bil?llbimlci Our Transaction Number: 12-13695?) Dear On December 22, 2011, the US. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR), Region VI received your complaint alleging that CVS Caremarlt, the {bll?lt?llili?ll . covered entity, 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, you allege that, on September 20, 2011, CVS Caremark faxed 3. ?Medication Non-adherence Therapy Advisory? form (the ?form"} to the department you work at; instead of the physician outpatient department. This allegation could re?ect a violation of 45 C.F.R. 16450201) 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 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 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 These safeguards may vary depending on the mode of communication used. For example, when discussing patient health information orally with religion. necessary standard, where applicable, with respect to the primary use or disclosure. See 45 another provider in proximity of others, a doctor may be able to reasonably safeguard the safeguards when doing so. information by lowering hisfher voice. We have care?tlly 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 Caremarlt 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. OCR's detennination 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 ever}r 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 Vaniecy Nwigwe, Investigator, at 214-?67-4054 (Voice), 214-767r8940 (TDD). Sincerely, Ralph D. Rouse Regional Manager Region VI Regional Manager