Notice of Privacy Practices

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 operations, 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 that relates to your past, present, or future physical or mental health condition and related 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 others outside of our office involved in your care and treatment for the purpose of providing health care services to you, paying your health care bills, supporting the operation of our practice, and any other use required by law.

Treatment

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician or specialist to whom you have been referred to ensure they have the necessary information to diagnose or treat you.

Payment

Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a dental procedure may require that your relevant protected health information be disclosed to the health plan to obtain approval.

Health Care Operations

We may use or disclose your protected health information in order to support the business activities of our practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training, licensing, and conducting other business activities.

Other Permitted Uses and Disclosures

We may use or disclose your protected health information without your authorization in the following situations:

• As required by law
• For public health activities
• Health oversight activities
• In cases of abuse, neglect, or domestic violence
• For judicial and administrative proceedings
• For law enforcement purposes
• For research purposes (with safeguards)
• To avert a serious threat to health or safety
• For workers' compensation purposes

Your Rights

You have the following rights regarding your protected health information:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your protected health information that may be used to make decisions about your care. To inspect and copy your health information, you must submit your request in writing.

Right to Request Restrictions

You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. We are not required to agree to your request, except in certain circumstances.

Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

Right to Amend

If you believe that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by our office.

Right to an Accounting of Disclosures

You have the right to request an accounting of disclosures. This is a list of the disclosures we made of your health information for purposes other than treatment, payment, or health care operations.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information

If you have any questions about this notice or would like to exercise any of your rights, please contact us: