This notice describes how medical information about you may bee used and disclosed and how you can get access to this information. Please review it carefully.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (phi) to carry out treatment, payment or health care option (tpo) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and relates to your past, present or future physical or mental condition and related to health care services.
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your dentist, our office staff and other outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay our healthcare bills, to support the operation of the physicians practice, and any other use by law.
We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination of management of your health care with a third party. for example, your protected health information may be provided to a physician/dentist to whom you have been referred to ensure that the physician/den-tist has necessary information to diagnose or treat you.
Your protected health information will be used, as needed, to obtain payment for your health care services. For example, we may contact your health insurer to certify your eligibility of benefit and obtain payment from other third parties, your rel-evant protected health information may be disclosed to the health plan.
We may use or disclose, as needed, your protected information in order to support the business activities of your dentist’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your pro-tected health information to students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your dentist is ready see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
Persons Involved In Care
We may use or disclose your protected health information in the following situations without your authorization. These situ-ations include as required by law public health issues as required by law, Communicable Diseases; Health Oversight; Abuse or Neglect; Food and Drug Administration requirements; Legal Proceedings; Law Enforcement; Coroners, Funeral Directors, Organ Donation Research; Criminal Activity; Military Activity; National Security; Workers Compensation; Inmates; Required Uses and Disclosures. Under the law, we must make disclosures to you and when required by the Secretary f the Department of Health and Human Services to investigate or determine our compliance with requirements of Section 164.500
Other permitted and required uses and disclosures will be made only with your consent. Authorization or opportunity to ob-ject, unless required b law. You may revoke this authorization, at any time, in writing, except to the extent that your dentist‘s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Although your health records are the physical property of the health care provider who completed it, you have certain rights with regards to the information contained therein. Following is a statement of your rights with respect to your protected health information.
Questions and Complaints
If you need more information about our privacy practices or have questions or concerns, please contact us. We support your right to the privacy of your protected health information. You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may cay file a complaint with us by notifying your privacy contact of your complaint. We will not retaliate against you for filing a complaint.
This notice was published and becomes effective on/before April 14, 2003.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with resect to protected health information. If you have any objections to this form, please ask to speak with our hipaa compliance officer in person or by phone at our main phone number.