Country Name: USA

Pharmacy - HIPAA Notice of Privacy Practices (rev 12.18.21) vAST 10-27-2021

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.

In the course of receiving services from AHF Pharmacies, we will be provided with health information about you. We have a duty under the law to maintain the privacy of this information, and to inform you of our legal obligations. This notice may change from time to time, and we will inform you of any changes. We will abide by this Notice or the most recent Notice. AHF will use this information, and/or disclose it to other people, for the following purposes:

determines that that there is a low probability that your medical information has been compromised.

If you have any questions or complaints about this Notice or about your health information, please call our Privacy Officer at 323-860-5200. You may also contact the Secretary of the United States Department of Health and Human Services. You will not be retaliated against in any way for asking questions or making a complaint.

The effective date of this Notice is                    , and lasts for as long as you are a client of AHF.


ACCEPTANCE:  I certify that I have read, understand, and agree to the terms of this Notice, and authorize the release of the above information


                Dated:                                            By:                                                                                     



Print Name                                  



 If client declines to sign, Staff sign here:                                    

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