Notice of privacy practices
This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you the patient significant new rights to understand and control how your health information is used.
This Notice describes how we may use and disclose your protected health information to provide treatment, obtain payment and conduct health care operations and for other purposed permitted or required by law. It also describes your rights concerning your protected health information. “Protected health information” is information about your, including demographic information that may identify your and relates to your past, present or future or mental health or condition and related health care services.
We are required by law to follow the practices described in this Notice. We may change the terms of this Notice at any time. The new Notice will be effective for the protected health information we maintain at the time including health information we created or received before we made the changes. You may obtain a copy of our Notice of Privacy Practices at any time by calling our office or requesting on at our next appointment
Uses and Disclosures of Health Information
• Treatment: We will use and disclose your health information to provide, coordinate and manage health care and related services for you. For example we will disclose information to a specialist to whom you have been referred to ensure the provider has enough information to diagnose and/ or treat you. We may also disclose information to a laboratory that, at our request, becomes involved in your treatment.
• Payment: We may use and disclose your information to obtain payment for services we provide to you. For example we will send the necessary information to your health or dental insurance company to obtain payment for the treatment provided.
• Healthcare Operations: We will use and disclose your health information to conduct the business activities of this office. These activities include, but are not limited to, quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also you by name in the waiting room when we are ready to begin your treatment. We will send reminder postcards to your residences that contain your name, date, and time of scheduled appointments. We may call your residence or place of employment to confirm appointments. We may use intra-oral cameras, during your appointment, to display and print images of your mouth for diagnosis, patient education or insurance purposes.
• Other Involved in Your Health Care: We must disclose your health information to you as described in the Patient Rights section of the Notice. We may disclose your health information to a family member or other person to the extent necessary to help with your health care or with payment for your health care, but only if you agree.
• Emergencies: In the event of your incapacity or in emergency circumstances, we may use or disclose your protected health information to treat you.
• Uses and Disclosures of Protected Health Information Based upon Your Written Authorization: Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that an action has already been taken in reliance on the authorization.
Your Rights
Your rights with respect to your protected health information and how your may exercise those rights are outlined below.
• You have a right to obtain a copy and/or inspect your information: Health information includes treatment records, billing records and any other records used by us to make decision about your treatment.
• You have a right to request a restriction on the use and disclosure of tour protected health information: You may ask us not to use or disclose some part of your protected health information for the purposes of treatment, payment or operations. You may also request that we not disclose some part of your information to family and others who may be involved in tour care or for nomination purposes as otherwise described in this Notice. We are not required to agree to the restrictions but if we do, we are obligated to abide by the agreement except in cases of emergency. You may request a restriction by sending your request in writing to our Privacy Contact.
• You have the right to receive confidential communications by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for your request. Please make this request in writing to our Privacy Contact. You may have the right to request an amendment to your protected health information. You may request that we amend protected health information about you. Your request must be in writing with an explanation as to when the information should be amended. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your stamen and will provide you with a copy of any such rebuttal.
• You have the right to receive an accounting of certain disclosure we have made by our Business Associates or us. It excludes disclosers for treatment, payment or healthcare operations as described in this Notice of Privacy Practices, to you, to family member members or friends involved in your care, for notification purposes or as a result of an authorization signed by you.
