Privacy Policy
This Privacy Policy covers services provided to you by this dental office. By law, we are required to maintain the privacy of protected health information and to provide you with this Policy outlining our legal duties and privacy practices with respect to protected health information. Protected health information consists of information about you (including demographic information) that may identify you and that relates to your past, present, or future physical or mental health or condition. It also includes related health care services.
This Policy describes how this dental office may use and disclose your protected health information to carry out treatment, payment, or health care operations. Other uses and disclosures of your information will be made only with your written authorization (unless otherwise permitted or required by law). The Policy also describes your rights to access and control your protected health information and informs you of your rights to make a complaint to either this dental office or to the Secretary of Health and Human Services if you believe we have violated your rights.
We are required to abide by the terms of this Policy. We may change the terms of the Policy at any time. The new notice will be effective for all protected health information that we maintain at the time of the change. We can provide you with any revised Policy upon request. You may contact our office by calling our Office Manager and requesting that a revised copy be sent to you in the mail or asking for one at your next appointment.
Please read this Policy carefully.
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.
If you have any questions about this Notice, please contact the Office Manager.
We are required by law to maintain the privacy of our patients’ health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. Protected health information consists of information about you—including demographic information—that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.
1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Uses and Disclosures of Protected Health Information for Treatment, Payment, or Operations
Your protected health information may be used by your doctor for treatment, payment, and health care operations as described here without authorization from you. It may be used and disclosed by your doctor, the office staff, and others outside our office who are involved in your care and treatment for the purpose of providing health care services to you and to pay your health care bills, which are used to support the operation of the doctor’s practice.
Examples of uses and disclosures of your protected healthcare information include:
- Treatment: Your protected health information may be used and disclosed to provide, coordinate, or manage your health care and any related services, including services rendered from another doctor, consultation with another doctor, or the management of your health care with a third party.
- Payment: Your information may be used, as needed, to obtain or provide payment for your medical services. This includes disclosures to other entities, such as your health insurance provider, in order to determine eligibility, coverage, or to review services provided.
- Operations: Your protected health information may be used or disclosed, as needed, to support the business activities of the dental office. These activities include—but are not limited to—quality assessment, reviewing the competence or qualifications of professionals, business planning, and development.
We may also use a sign-in sheet at the registration desk, call you by name in the waiting room, and use or disclose your protected health information to contact you for appointment reminders.
Whenever your protected health information is used or disclosed in an arrangement between our office and a business associate, we will have a written contract that contains terms that will protect the privacy of your information.
We may also use or disclose your protected health information as necessary to provide you with information about a product or service that may be relevant to your care.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will only be made with your written authorization unless otherwise permitted or required by law. You may revoke this authorization at any time in writing, except to the extent that your doctor or the practice has taken action in reliance on the use or disclosure indicated in the authorization.
2. YOUR RIGHTS
You have several rights with respect to your protected health information:
- Right to Inspect and Copy: You may inspect and obtain a copy of your protected health information that is contained in your chart, including medical and billing records.
- Right to Request Restrictions: You may request that we restrict the use or disclosure of any part of your protected health information. While we are not required to agree to a requested restriction, if we do agree, we will comply with the restriction unless needed for emergency treatment.
- Right to Confidential Communications: You may request confidential communications from us by alternative means or at an alternative location; we will accommodate reasonable requests.
- Right to Amend: You may request an amendment to your protected health information if you believe it is incorrect or incomplete. We reserve the right to deny this request under certain circumstances, but you have the right to file a statement of disagreement.
- Right to an Accounting of Disclosures: You may request a list of certain disclosures of your protected health information that were made for purposes other than treatment, payment, or health care operations.
3. COMPLAINTS
You may make a complaint to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Office Manager. We will not retaliate against you for filing a complaint.
For further information about the complaint process, contact the Office Manager.
This Policy was published and becomes effective on March 21, 2019.