Warren's Drug Store Prescription Refill Form

Warren's Drug Store Privacy Policy:

Health Insurance Portability and Accountability Act (HIPAA) regulations require organizations to enforce security controls that promote the confidentiality, integrity and availability of all personal health information.

Privacy challenges influence the daily reactions between patients and healthcare organizations, businesses and their customers, and government agencies and their constituents. With privacy breaches making headlines and tighter compliance regulations on the horizon, organizations must be prepared to ensure the quality, accuracy and security of data about individuals. Protecting the privacy of medical records and consumer data is no longer a choice, but a necessity.

This is a necessary statement that we must we read and comply by. If you have any question about this please call or stop by, thank you.

The Staff at Warren’s Drug Store

Prescription :	Delivery Pick-Up Mailed
First Name:
Last Name:
Rx # or Medications Name: (You may enter up to 10 precrptions to be refilled. Please leave field as "XXXXX" if you're done entering in RX numbers)









Date of Birth :	MM-DD-YYYY
Phone:
Address:
City:
State:
Zip Code:
Store Location:
Type Additional Information Below:
Warren's Drug Store Privacy Policy: Health Insurance Portability and Accountability Act (HIPAA) regulations require organizations to enforce security controls that promote the confidentiality, integrity and availability of all personal health information. Privacy challenges influence the daily reactions between patients and healthcare organizations, businesses and their customers, and government agencies and their constituents. With privacy breaches making headlines and tighter compliance regulations on the horizon, organizations must be prepared to ensure the quality, accuracy and security of data about individuals. Protecting the privacy of medical records and consumer data is no longer a choice, but a necessity. This is a necessary statement that we must we read and comply by. If you have any question about this please call or stop by, thank you. The Staff at Warren’s Drug Store