Last Updated: March 1, 2019
THIS NOTICE DESCRIBES HOW MEDICAL AND PHARMACEUTICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices addresses the legal duties and privacy practices of Schraft’s 2.0,
LLC (“Schraft’s,” “we,” “us,” or “our”) regarding the protected health information (“PHI”) of
individuals that use our services as an online pharmacy focused on fertility drugs (“patients,”
“you,” or “your”), and their rights under the Health Insurance Portability and Accountability Act,
as amended (“HIPAA”).
I. Uses and Disclosures of PHI. PHI is information about a patient, including demographic
information, that may identify the patient and is related to the patient’s past, present or future
physical or mental health or condition and related health care services. There are circumstances
where we are not required to a receive patient’s written authorization to use or disclose patient
PHI, outlined in Section (A) below, and Section (B) provides circumstances when patient written
authorization is required to use or disclose the patient’s PHI.
1) Business Associates. There are some services provided by us through contracts with HIPAA
business associates. When these services are contracted for, we may disclose our patients’ PHI to
our business associates so that they can perform the job we have asked them to do and bill the
applicable patient or your third-party payor for services rendered. To protect our patients’ PHI,
we require the business associate to appropriately safeguard the PHI and sign a business
associate agreement with us.
2) Treatment. We are permitted to use and disclose our patients’ PHI in connection with their
medical treatment in situations such as allowing a family member, other relative, close personal
friend or other person involved in the patient’s health care to pick up the patient’s prescriptions
and to receive PHI that is directly related to the patient’s care. In doing so, we are to use our
professional judgment and experience with common practice in determining what is in the
patient’s best interest. Other examples include sending information about a patient’s
prescriptions to the patient’s family doctor or to a specialist who is treating the patient or to a
hospital where the patient is receiving care, particularly if the patient has suffered a health
3) Payment. If a patient is covered by a pharmacy benefit plan, we are entitled to send PHI to
the plan or to another business entity involved in our billing system describing the medication or
health care equipment we have dispensed so that we can receive payment.
4) Health Care Operations. In addition, we can provide PHI for health care operations such as
evaluations of the quality of our patients’ health care in order to improve the success of treatment
programs. Other examples include reviews of health care professionals, insurance premium
rating, legal and auditing functions, and business planning and management.
Additional Disclosures of Our Patient’s PHI Without Written Authorization are Permitted
under the Following Circumstances:
a) When requires by law to do so, such as reporting patients’ health information to state, federal,
or local law enforcement officials, court officials, or government agencies, such as the FDA.
b) When ordered by authorized public health officials for the purpose of carrying out public
health activities, such as to report product problems, or exposure to a communicable disease.
c) When the use/disclosure relates to victims of abuse, neglect or domestic violence.
d) When the use/disclosure is for health oversight activities, such as by written request of a
state/federal government agency performing management audits, financial audits, and program
e) When the use/disclosure is for judicial and administrative proceedings, such as in response to
an order of a court.
f) When the use/disclosure is to provide notification and reporting of an unsecured breach as
required by law.
g) When the use/disclosure is for law enforcement purposes, such as reporting certain types of
wounds or injuries, or if there is a good faith belief the disclosure is necessary to prevent or
lessen a serious, imminent threat to the safety of a person or the public.
h) When the use/disclosure is related to death, such as disclosing a patient’s health information to
coroners, medical examiner and funeral directors so they can carry out their duties related to such
i) When the use/disclosure is related to cadaveric organ, eye, or tissue donation purposes.
j) We may disclose information about our patients for military activities, national security and
intelligence activities, and for protective services to the President of the United States.
k) We may disclose information about our patients to a correctional institution having lawful
custody of such patients.
l) We may disclose your health information as authorized by and to the extent necessary to
comply with the laws related to workers’ compensation or other similar programs established by
m) When the use/disclosure relates to certain research purposes. For example, in limited
circumstances, we may disclose your information to researchers preparing a research protocol or
if an institutional review board determines authorization is not necessary.
For purposes other than those mentioned above, we are required to ask for our patients’ written
authorizations before using or disclosing any of their PHI. If we request an authorization, any of
our patients may decline to agree, and if a patient gives us an authorization, the patient has the
right to revoke the authorization at any time and by doing so, stop any future uses and
disclosures of the patient’s health information that the authorization covered. An example of a
situation where the patient’s prior authorization would be required would be if we wish to
conduct a marketing program that would involve the use of PHI, or disclosures that constitute
sale of PHI, explained in further detail below.
Marketing. We must obtain our patients’ written authorization prior to using patients’ PHI for
purposes that are marketing under the HIPAA privacy rules. For example, we will not accept any
payments from other organizations or individuals in exchange for making communications to our
patients about treatments, therapies, health care providers, settings of care, case management,
care coordination, products, or services unless the patient has given us his or her authorization to
do so or the communication is permitted by law. We may communicate with patients about a
product that is currently prescribed so long as any payment we receive in relation to making the
communication is reasonably related to the cost of making the communication. In addition, we
may market to patients in a face-to-face encounter and give patients promotional gifts of nominal
value without obtaining patients’ written authorization
Sale of Protected Health Information. We will not make any disclosure of PHI that is a sale of
Protected Health Information without our patients’ written authorization.
II. Patients’ Rights. HIPAA (and associated regulations) provide our patients with rights
concerning their PHI. With limited exceptions (which are subject to review) each patient has the
right to the following:
1) Patient’s Record. Each patient has the right to access and copy the patient’s PHI contained in
a designated record set upon written request. The designated record set usually will include
prescription and billing records. We may charge patients a fee as authorized by law to fulfill such
requests. Upon receiving a patient’s request to access his or her PHI, we are required to respond
to the patient no later than thirty (30) days after the receipt of the request. We may deny the
request to inspect and copy in certain limited circumstances. If a patient is denied access to his or
her PHI, the patient may request that the denial be reviewed. Patients may request access to their
health information in a certain electronic form and format, if readily producible, or, if not readily
producible, in a mutually agreeable electronic form and format. Further, patients may request in
writing that we transmit such a copy to any person or entity they designate. The written, signed
patient request must clearly identify such designated person or entity and where we should send
the copy. To inspect or copy PHI, patients should email us at firstname.lastname@example.org.
2) Accounting for Disclosures. Each patient can, upon written request, obtain a list of the
disclosures of the patient’s PHI by us that have occurred within the 6 years preceding the
request, except for disclosures made for the purposes of treatment, payment or health care
operations and certain others. We will provide patients with an accounting no later than sixty
(60) days after receipt of such request, with an option to extend for an additional thirty (30) days
if we are unable to provide the accounting within the time required. There will be no charge for
the first request in any twelve (12) month period, but we are entitled to charge a reasonable cost
based fee for additional requests made in the same period of time. Patients should submit
requests for an accounting of disclosures to email@example.com.
3) Amendments. Each patient may ask to change the record of his or her own PHI upon written
request explaining why the change should be made. We will review the request, but may decline
to make the change if in our professional judgment we conclude that the record should not be
changed. If we deny your request for amendment, you have the right to file a statement of
disagreement with the decision and we give a rebuttal to your statement. We will respond to
patient requests no later than sixty (60) days after receipt of such request, with an option to
extend for an additional thirty (30) days if we are unable to provide the accounting within the
time required. Patients should submit requests for an amendment to firstname.lastname@example.org.
4) Confidential Communications. Upon written request, each patient can ask us to
communicate with him or her about their own PHI in a confidential manner such as by sending
mail to an address other than the home address or using a particular telephone number. Patient
requests must state how or where the patient would like to be contacted. We will attempt to
accommodate all reasonable requests, and will not request an explanation for the basis for the
request. Patients should submit requests for confidential communication to email@example.com.
5) Special Restrictions. Upon written request, each patient can ask us to adopt special
restrictions that further limit our use and disclosure of the patient’s PHI (except where use and
disclosure are required of us by law or in emergency circumstances). You may also request that
any part of your PHI not be disclosed to family members or friends who may be involved in your
care or for your notification purposes. We will consider the request, but in accordance with
HIPAA we are not required to agree to with the request. Patients also have to right to request
restriction with regards to disclosure of health information to a patient’s health insurance
company if: (1) the disclosure is for the purpose of carrying out payment or health care
operations and is not otherwise required by law; and (2) the health information pertains solely to
a health care item or service for which we have been paid in full (other than by your health
insurance company). We will accommodate such a request, except where we are required by law
to make a disclosure. If we agree to your requested restriction, we will comply with your request
unless the information is needed to provide you emergency treatment. Patients should submit
requests for restriction to firstname.lastname@example.org.
6) Revoking Authorization. If a patient has signed an authorization to disclose information, the
patient can later revoke that authorization, in writing, to stop future uses and disclosures.
Revocation will not apply to disclosures or uses already made or taken in reliance on the
authorization. Patients should submit revocations to email@example.com.
7) Complaints. If a patient believes that we have violated the patient’s rights as to the patient’s
PHI under HIPAA or if a patient disagrees with a decision we made about access to the patient’s
PHI, the patient has the right to file a written complaint with our Contact Person listed below.
Our Contact Person is required to investigate, and if possible, to resolve each such complaint,
and to advise the patient accordingly. The patient also has the right to send a written complaint to
the U.S. Department of Health and Human Services at the address listed below. Under no
circumstances will we permit any retaliation against any patient for filing a complaint.
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
We are required by law to protect the privacy of our patients’ PHI, to provide this notice about
our privacy practices, and follow the privacy practices that are described in this notice. We
reserve the right to make changes in our privacy practices that will apply to all PHI that we
maintain. If or when we change our notice, we will post the new notice on our website.
Corporate Compliance Officer
3 Wing Drive, Suite 102
Cedar Knolls NJ 07927
Copyright 2019 Schraft’s 2.0, LLC. All rights reserved.
I acknowledge that I have received the HIPAA Notice of Privacy Practices (the “Notice”) from
Shcraft’s 2.0, LLC (“Schraft’s 2.0”). I have been provided an opportunity to review the Notice and
consent to its terms. I understand that:
• I have certain rights to privacy regarding my protected health information.
• Schraft’s 2.0 can and will use my health information for purposes of my treatment, payment for
treatment, and health care operations.
• The Notice explains in more detail how Schraft’s 2.0 may use and share my protected health
information for other purposes.
• I have the rights regarding my protected health information listed in the Notice.
• Schraft’s 2.0 has the right to change the Notice from time to time and I can obtain a current copy of
the Notice by contacting the person listed in the Notice.
Date: September 18, 2021
Date of Birth:
Relationship to Patient :
FOR OFFICE USE ONLY:
Good Faith Effort to Obtain Acknowledgment Form
Name of Patient:
I attempted to obtain the patient’s (or the representative of the patient) signature on the HIPAA Notice of
Privacy Practices Acknowledgment Form, but was unable to do so, as documented below:
1. I hereby authorize Schraft’s 2.0, LLC (“Schraft’s 2.0) to use and/or disclose the protected health
information about me described below (“PHI”) to:
2. The PHI that may be used and/or disclosed is:
All of my health information
My health information relating to the following treatment or condition:
My health information covering the period of healthcare from September 18, 2021 to
Medications taken by patient:
3. The PHI may be used and/or disclosed for the following purpose(s):
Patient Services and Patient-related Treatment
4. Schraft’s 2.0 may disclose this health information to the following recipient(s):
My health information may be disclosed to the recipients identified above by the following methods:
Email and Regular Mail
5. This authorization shall remain in effect until:
6. Schraft’s 2.0 will not receive direct or indirect remuneration in exchange for disclosing the health
information to the above recipients.
1. I understand that my treatment, payment, enrollment, or eligibility for benefits will not be conditioned
on whether I sign this form.
2. I understand that this medical information may be used by the person(s) I authorize to receive this
information for my medical treatment or consultation, billing or claims payment, or other purposes as I may
3. I understand that, as set forth in the notice of privacy practices, I have the right to revoke this
authorization, in writing, at any time, except to the extent that Schraft’s 2.0 has acted in reliance upon it on
my authorization, or if my authorization was obtained as a condition of obtaining insurance coverage and
the insurer has a legal right to contest a claim.
4. I understand that I have the right to refuse to sign this authorization.
5. I understand that PHI used or disclosed pursuant to this authorization may be redisclosed by the recipient
and its confidentiality may no longer be protected by federal or state law.
Relationship to the Individual:
We are grateful for the opportunity to assist you with all of your pharmacy needs.
Our mission at Schraft’s 2.0 is to be a specialty pharmacy offering superior patient care and specialty medications in a cost-effective manner with the ultimate objective to secure the best possible outcome for patients.
The staff at Schraft’s 2.0 understands that your medical and medication needs are unique and require special knowledge to effectively collaborate with your medical provider and insurance company. We are dedicated to providing you the personal service necessary to ensure that you achieve the maximum benefit. Schraft’s 2.0 offers all patients:
Schraft’s 2.0 is located at:
3 Wing Dr, Suite 102
Cedar Knolls, NJ 07927
Our business hours are:
Monday-Friday: 8am to 8pm Eastern*
Saturday: 8am to 3pm Eastern*
Phone: 855-SCHRAFT (855-724-7238)
After Hours Phone: 862-217-3598
*Closed on all major holidays, including New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day
We look forward to providing you with the best service possible. We know you have many options and we thank you for choosing Schraft’s 2.0.
The Schraft’s 2.0 Team
What to expect:
We recognize that your medical needs are unique and complex and possibly overwhelming. We are an independently owned pharmacy and are here for you. At Schraft’s 2.0, our staff is dedicated to working with you, your doctor(s) and nurse(s), as well as your family to achieve a fully integrated health care team. Our primary goal is to provide you quality care.
You can expect:
Our trained staff members will work with you to discuss your treatment plan and we will address any questions or concerns you may have.
We work directly with your medical team to ensure any difficulties you may have with your treatment are addressed efficiently.
Getting your medications and medical supplies quickly and efficiently is important. We will be in close contact with you during your treatment and will be your healthcare advocate.
Treatment can be costly. We will help you navigate through the complexities of the healthcare system to explore every option available to you. Our relationships with insurers will help provide you with information and explanations of your prescription and medical insurance benefits.
We offer fast and convenient delivery to your home, workplace, or the location you prefer throughout all of the Unites States of America. A staff member will contact you the same day we receive your order to coordinate the medications you need, update your medical and insurance records, and to set up and confirm a delivery date and address.
Our Pharmacy staff is available 24 hours a day, 7 days a week. We are always here to answer any questions or address any concerns you may have.
Upon receipt of your package, please open it immediately and double-check that your order is complete. If you have any questions, please contact us within 24 hours of receipt of your package at (855) 724-7238. We are unable to address any issues regarding the contents of your package if it is brought to our attention more than 24 hours after receipt.
In accordance with both Federal and State regulations, Schraft’s 2.0 cannot accept returns on medications once they have been dispensed. If an order is canceled prior to you receiving your package credit will be issued less a restocking fee. If you have any questions, please call us at (855) 724-7238.
When to contact us at (855) 724-7238:
Before your care begins, a staff member will inform you of your financial obligations that are not covered by your insurance or other third-party sources. These obligations include but are not limited to: out-of-pocket costs such as deductibles, co-pays, co-insurance, annual out of pocket limits, and life time out of pocket limits. We will also provide this information if there is a change in your insurance plan.
Schraft’s 2.0 will submit claims to your pharmacy insurance carrier on the date your prescription is filled. If the claim is rejected, a staff member will notify you, as necessary, so that we can work together to resolve the issue.
You may be required to pay a part of your medication cost, called a copayment. If you have a co-payment, it must be paid at the time of shipping or pick-up. We accept Visa®, MasterCard®, American Express®, and Discover®. We can maintain your credit card information on file in a secure environment.
We have access to financial assistance programs for some medications to help with high co-payments or out-of-pocket costs. These programs include discount coupons, programs from drug manufacturers, and assistance from various disease management foundations. We will assist you in enrollment into such programs.
How to Place an Order
To place a new order, after your doctor has submitted your prescription, please call us at (855) 724-7238 with the following information: Which medications ordered by your doctor you would like to receive, your insurance information, a shipping address for us to deliver to, and payment information. Please contact us as early as possible so we can ensure you will receive your medications on time.
PATIENT BILL OF RIGHTS AND RESPONSIBILITIES
Schraft’s 2.0 recognizes that patients have inherent rights. Patients who feel their rights have not been respected, or who have questions or concerns, should talk to the pharmacist on duty.
Patients and their families also have responsibilities while under the care of Schraft’s 2.0 in order to facilitate the provision of safe, high-quality health care for themselves and others. The following patient rights and responsibilities shall be provided to, and expected from, patients or legally authorized individuals.
To ensure the finest care possible, as a patient receiving our pharmacy services, you should understand your role, rights and responsibilities involved in your own plan of care.
As our patient, you have the right:
Patients have the responsibility:
Specialty Pharmacy Patients have additional rights and responsibilities:
For additional information regarding your condition or diagnosis, you can visit the following websites OR DOWNLOAD APPLICATIONS ON YOUR SMART PHONE:
Please sign and return this form at your earliest convenience via fax or email:
I confirm that I have received Schraft’s 2.0 Welcome packet, which includes Hours of Operation, Contact Information, Patient Bill of Rights and Responsibilities, Financial Obligation, Complaint Process, and Return Policy.
Thank you for choosing Schraft’s 2.0 to service all your specialty pharmacy needs.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: HIPAA Policy
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