Your Rights

1. Your Rights as a Patient/Consumer

At Bloom Pharmacy, we prepare and dispense patient-specific compounded therapies for the prescribers, telehealth platforms, medspas, and clinics we partner with, and we ship directly to patients pursuant to a valid prescription. You have the following rights as a patient or consumer of our services:

Right to Receive Accurate Information

You have the right to receive complete, accurate, and understandable information about your medications, including their intended use, potential side effects, drug interactions, proper storage, and administration instructions. You also have the right to receive clear information about the services Bloom Pharmacy provides and any associated costs.

Right to Privacy and Confidentiality (HIPAA)

You have the right to have your protected health information (PHI) kept private and confidential in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and applicable state laws. Bloom Pharmacy maintains administrative, technical, and physical safeguards to protect the confidentiality, integrity, and availability of your health information.

Right to Access Your Health Records

You have the right to inspect and obtain a copy of your health records and prescription history maintained by Bloom Pharmacy. You may submit a written request to access your records, and we will respond within 30 days (or as otherwise required by applicable state law). Reasonable, cost-based fees may apply for copies.

Right to Request Amendments

You have the right to request an amendment to your health records if you believe the information is inaccurate or incomplete. Requests must be submitted in writing and include the reason for the amendment. Bloom Pharmacy will respond within 60 days. We may deny your request under certain circumstances as permitted by law, but you will be informed of the reason and your right to submit a written statement of disagreement.

Right to an Accounting of Disclosures

You have the right to receive an accounting of certain disclosures of your protected health information made by Bloom Pharmacy during the six years prior to your request (or a shorter period if you specify). This accounting does not include disclosures made for treatment, payment, or healthcare operations, or disclosures you authorized in writing.

Right to Request Restrictions

You have the right to request restrictions on how Bloom Pharmacy uses or discloses your health information for treatment, payment, or healthcare operations. You also have the right to request restrictions on disclosures to individuals involved in your care or payment for your care. While Bloom Pharmacy is not required to agree to all restriction requests, we are required to comply with a request to restrict disclosures to a health plan for services you have paid for in full out of pocket.

Right to Receive Confidential Communications

You have the right to request that Bloom Pharmacy communicate with you about your health information in a specific way or at a specific location. For example, you may request that we contact you only at a particular phone number or send correspondence to an alternate address. We will accommodate reasonable requests.

Right to Choose Your Pharmacy

You have the right to choose the pharmacy that fills your prescriptions, subject to the terms of your insurance plan and applicable laws and regulations. You are not required to use Bloom Pharmacy and may transfer your prescriptions to another pharmacy at any time.

Right to Be Treated with Respect and Dignity

You have the right to be treated with courtesy, respect, and dignity by all Bloom Pharmacy staff. You have the right to receive care that is considerate of your personal values, beliefs, and cultural background, free from any form of abuse, neglect, or harassment.

Right to Informed Consent

You have the right to receive sufficient information to make informed decisions about your care, including information about proposed treatments, alternatives, and the risks and benefits associated with each option. You have the right to participate in decisions about your pharmacy services and treatment plan.

Right to Refuse Treatment

You have the right to refuse any medication or pharmacy service. If you choose to refuse, you will be informed of the potential consequences of that decision. Your refusal will not affect your right to receive future care or services from Bloom Pharmacy.

2. Your Responsibilities as a Patient/Consumer

To help us provide you with the highest quality of care, we ask that you fulfill the following responsibilities:

Provide Accurate Health Information

You are responsible for providing Bloom Pharmacy with complete and accurate information about your health history, including current medications (prescription, over-the-counter, and supplements), known allergies, adverse drug reactions, and any other relevant medical conditions. Accurate information is essential for us to compound and dispense your medications safely.

Follow Prescribed Treatment Plans

You are responsible for following the treatment plan agreed upon with your healthcare provider, including taking medications as directed. If you have questions or concerns about your treatment plan, contact your prescriber or speak with a Bloom Pharmacy pharmacist before making changes.

Notify Providers of Changes in Health Status

You are responsible for informing your healthcare providers and Bloom Pharmacy of any changes in your health condition, including new diagnoses, hospitalizations, or changes to your medication regimen. Timely communication helps prevent medication errors and adverse interactions.

Keep Appointments and Communicate Cancellations

If you have scheduled consultations or medication therapy management sessions with Bloom Pharmacy, you are responsible for keeping those appointments or notifying us in advance if you need to cancel or reschedule.

Understand Your Financial Obligations

You are responsible for understanding your insurance coverage, copayments, deductibles, and any other financial obligations related to your pharmacy services. If you have questions about costs, contact Bloom Pharmacy or your insurance plan before services are rendered.

Report Suspected Medication Errors

You are responsible for promptly reporting any suspected medication errors, adverse reactions, or concerns about your medications to Bloom Pharmacy and your healthcare provider. Early reporting helps us investigate and resolve issues quickly and prevent future occurrences.

3. HIPAA Notice of Privacy Practices Summary

How Your Health Information Is Used and Disclosed

Bloom Pharmacy may use and disclose your protected health information (PHI) for the following purposes without your written authorization:

• Treatment: To provide and coordinate your pharmacy care, including compounding and dispensing medications, consulting with your healthcare providers, and providing drug utilization review.
• Payment: To bill and collect payment for pharmacy services, including submitting claims to your health insurance plan.
• Healthcare Operations: To support our business activities, including quality improvement, staff training, compliance audits, and customer service.
• As Required by Law: To comply with federal, state, and local laws, including public health reporting, law enforcement requests pursuant to valid legal process, and regulatory oversight.
• Health and Safety: To prevent or lessen a serious and imminent threat to your health or safety or that of the public.

Bloom Pharmacy will not use or disclose your PHI for marketing purposes or sell your PHI without your prior written authorization, except as permitted by law.

Breach Notification

If a breach of your unsecured PHI occurs, Bloom Pharmacy will notify you without unreasonable delay and no later than 60 calendar days after discovery. We will provide information about the nature of the breach, the PHI involved, steps you can take to protect yourself, and what we are doing to investigate, mitigate harm, and prevent future breaches.

Your Right to the Full Notice

You have the right to receive a complete copy of the Bloom Pharmacy Notice of Privacy Practices at any time. To request a copy, contact us at:

• Email: info@bloomrx.health

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with Bloom Pharmacy and/or with the U.S. Department of Health and Human Services (HHS).

To file a complaint with Bloom Pharmacy:

Contact our Privacy Officer at:

• Email: info@bloomrx.health

To file a complaint with HHS Office for Civil Rights:

• Online: www.hhs.gov/hipaa/filing-a-complaint
• Phone: 1-800-368-1019, TDD: 1-800-537-7697
• Mail: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201

You will not be penalized or retaliated against for filing a complaint.

4. Non-Discrimination Notice

Bloom Pharmacy complies with applicable federal and state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, religion, or any other characteristic protected by law.

Bloom Pharmacy complies with Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in healthcare programs and activities receiving federal financial assistance. This includes, but is not limited to:

• Providing equal access to pharmacy services regardless of race, color, national origin, sex, age, or disability.
• Providing meaningful access to individuals with limited English proficiency, including interpreter services and translated materials, at no cost to the patient.
• Providing appropriate auxiliary aids and services to individuals with disabilities, including accessible formats and communication methods, at no cost to the patient.

How to File a Discrimination Complaint

If you believe Bloom Pharmacy has failed to provide these services or has discriminated in any way, you may file a complaint:

With Bloom Pharmacy:

• Email: info@bloomrx.health

With the U.S. Department of Health and Human Services, Office for Civil Rights:

• Online: ocrportal.hhs.gov/ocr/portal/lobby.jsf
• Phone: 1-800-368-1019, TDD: 1-800-537-7697
• Mail: U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201

Complaints must be filed within 180 days of the date of the alleged discrimination. Complaints may be filed in any language.

5. How to Exercise Your Rights

To exercise any of the rights described in this document, or if you have questions about your rights, please contact Bloom Pharmacy:

Requesting Your Records

To request access to or copies of your health records or prescription history, submit a written request using the contact details above. Please include your full name, date of birth, and a description of the records you are requesting. We will respond to your request within 30 days.

Requesting an Amendment

To request an amendment to your health records, submit a written request using the contact details above. Include your full name, date of birth, a description of the information you believe is inaccurate or incomplete, and the reason for the requested amendment. We will respond within 60 days.

Filing a Complaint

If you have a concern or complaint about the services you received from Bloom Pharmacy, your privacy, or any rights described in this document, you may contact us directly using the information above. We take all complaints seriously and will investigate and respond promptly.

You also have the right to file a complaint with the appropriate state board of pharmacy in any state where Bloom Pharmacy is licensed, or with the federal agencies identified in this document.