|Notice of HIPAA Privacy
|Effective as of
This notice is not meant to alarm you. Quite the opposite! It is our desire
to communicate to you that we are taking seriously Federal law (HIPAA-
Health Insurance Portability And Accountability Act) enacted to protect
the confidentiality of your health information . We do not ever want you
to delay treatment because you are afraid your personal health history
might be unnecessarily made available to others outside our office.
|Protecting Your Confidential
Health Information is Important to us!
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 and if you have
any questions about this notice, please contact us. This is effective
until further notice.
|Why do you have a privacy
policy? Very good question!
The Federal government legally
enforces the importance of the privacy of health information largely in
response to the rapid evolution of computer technology and its use in
healthcare. The government has appropriately sought to standardize and
protect the privacy of the electronic exchange of your health
information. This has challenged us to review not only how your health
information is used within our computers but also with the Internet,
phone, faxes, copy machines, and charts. We believe this has been an
important exercise for us because it has disciplined us to put in
writing the policies and procedures we follow to protect your health
information when we use it.
We want you to know about these
policies and procedures which we developed to make sure your health
information will not be shared with anyone who does not require it. Our
office is subject to State and Federal law regarding the confidentiality
of your health information and in keeping with these laws, we want you
to understand our procedures and your rights as our valuable patient.
We will use and communicate your HEALTH INFORMATION only for the
purposes of providing your treatment, obtaining payment, conducting
health care operations, and as otherwise described in this notice.
|How your HEALTH INFORMATION may
be used To Provide Treatment
We will use your HEALTH
INFORMATION within our office to provide you with medical care. This may
include administrative and clinical office procedures designed to
optimize scheduling and coordination of care between health care
providers and business office staff. In addition, we may share your
health information with other health care personnel providing you
|To Obtain Payment
may include your health information with an invoice used to collect
payment for treatment you receive in our office. We may do this with
insurance forms filed for you in the mail or sent electronically. We
will be sure to only work with companies with a similar commitment to
the security of your health information.
|To Conduct Health Care
Your health information may be used during
performance evaluations of our staff. Some of our best teaching
opportunities use clinical situations experienced by patients receiving
care at our office. As a result, health information may be included in
training programs for students, interns, associates, and business and
It is also possible that health information
will be disclosed during audits by insurance companies or government
appointed agencies as part of their quality assurance and compliance
reviews. Your health information may be reviewed during the routine
processes of certification, licensing or credentialing activities.
|In Patient Reminders
Because we believe regular care is very important to your oral and
general health, we will remind you of a scheduled appointment or that it
is time for you to contact us and make an appointment. Additionally, we
may contact you to follow up on your care and inform you of treatment
options or services that may be of interest to you or your family.
These communications are an important part of our philosophy of
partnering with our patients to be sure they receive the best preventive
and restorative care modern healthcare can provide. They may include
postcards, folding postcards, letters, telephone reminders or electronic
reminders such as email or text message (unless you tell us that you do
not want to receive these reminders).
|To Business Associates
We may have contracted with third parties (referred to as a
business associate) to use and disclose your health information to
perform services for us, such as billing services. We will obtain each
business associate's written agreement to safeguard your health
|NOTICE OF PRIVACY PRACTICES
|Federal law generally permits us to make
certain uses or disclosures of health information without your
permission. Federal law also requires us to list in the Notice each of
these categories of uses or disclosures. The listing is below.
|As Required By Law
We may use or disclose your health information as required by any
statute, regulation, court order or other mandate enforceable in a court
|Abuse or Neglect
may disclose your health information to the responsible government
(a) the Privacy Official reasonably believes that you are
a victim of abuse, neglect, or domestic violence, and
(b) we are
required or permitted by law to make the disclosure. We will promptly
inform you that such a disclosure has been made unless the Privacy
Official determines that informing you would not be in your best
|Public Health and National
We may be required to disclose to Federal officials
or military authorities health information necessary to complete an
investigation related to public health or national security. Health
information could be important when the government believes that the
public safety could benefit when the information could lead to the
control or prevention of an epidemic or the understanding of new side
effects of a drug treatment or medical device.
|For Law Enforcement
As permitted or required by State or Federal law, we may disclose your
health information to a law enforcement official for certain law
enforcement purposes, including, under certain limited circumstances, if
you are a victim of a crime or in order to report a crime.
|Family, Friends and Caregivers
We may share your health information with those you tell us will be
helping you with your home hygiene, treatment, medications or payment.
We will be sure to ask your permission first. In the case of an
emergency, where you are unable to tell us what you want, we will use
our best judgment when sharing your health information only when it will
be important to those participating in providing your care.
|Workers' Compensation Purposes
We may disclose your health information as required or permitted by
State or Federal workers' compensation laws.
|Judicial and Administrative
We may disclose your health information in an
administrative or judicial proceeding in response to a subpoena or a
request to produce documents. We will disclose your health information
in these circumstances only if the requesting party first provides
written documentation that the privacy of your health information will
|Incidental Uses and Disclosures
We may use or disclose your health information in a manner which is
incidental to the uses and disclosures described in this Notice.
|Health Oversight Activities
We may disclose your health information to a government agency
responsible for overseeing the health care system or health-related
government benefit program.
|To Avert A Serious Threat To
Health or Safety
We may use or disclose your health
information to reduce a risk of serious and imminent harm to another
person or to the public.
|To The U.S. Department of Health
and Human Services (HHS)
We may disclose your health
information to HHS, the government agency responsible for overseeing
compliance with federal privacy law and regulation s regulating the
privacy and security of health information.
use or disclose your health information for research, subject to
conditions. "Research" means systemic investigation designed to
contribute to generalized knowledge.
|In Connection With Your Death Or
We may disclose your health information to a
coroner for identification purposes, to a funeral director for funeral
purposes, or to an organ procurement organization to facilitate
transplantation of on e of your organs.
If applicable State law
does not permit the disclosure described above, we will comply with the
stricter State law.
|Authorization to Use or Disclose
Other than is stated above or where
Federal, State or Local law requires us, we will not disclose your
health information other than with your written authorization. You may
revoke that authorization in writing at any time.
|You have the following rights related to
your health information.
have the right to request restrictions on the use or disclosure of your
health information for treatment, payment, or health care operations in
addition to the Patient Acknowledgment restrictions imposed by federal
law. Our office is not required to agree to your request, but we will
endeavor to honor reasonable requests. We generally are not required to
agree to a requested restriction. Our office will honor your request
that we not disclose your health information to a health plan for
payment or healthcare operation purposes if the health information
relates solely to a health care item or service for which you have paid
us out-of-pocket in full.
You have the right to request that we communicate with you by
alternative means or at an alternative location. You may, for example,
request that we communicate your health information only privately with
no other family members present or through mailed communications that
are sealed. We will honor your reasonable requests for confidential
|Inspect and Copy Your Health
You have the right to read, review, and copy
your health information, including your complete chart, x-rays and
billing records. If you would like a copy of your health information,
please let us know. We may need to charge you a reasonable, cost-based
fee to duplicate and assemble your copy. If there will be a charge, we
will first contact you to determine whether you wish to modify or
withdraw your request.
|Amend Your Health Information
You have the right to ask us to update or modify your records if you
believe your health information records are incorrect or incomplete. We
will be happy to accommodate you as long as our office maintains this
information. In order to standardize our process, please provide us with
your request in writing and describe the information to be changed and
your reason for the change.
Your request may be denied if the
health information record in question was not created by our office, is
not part of our records or if the records containing your health
information are determined to be accurate and complete. If we deny your
request, we will provide you with a written explanation of the denial.
|Accounting of Disclosures of
Your Health Information
You have the right to ask us for a
description of how and where your health information was disclosed. Our
documentation procedures will enable us to provide information on health
information disclosures that we are required to disclose to you. Please
let us know in writing the time period for which you are interested.
Thank you for limiting your request to no more than six years at a time.
We will provide the first accounting during any 12 month period without
charge. We may charge a reasonable, cost-based fee for each additional
accounting during the same 12 month period. If there will be a charge,
the Privacy Official will first contact you to determine whether you
wish to modify or withdraw your request.
|Request a Paper Copy of this
You have the right to obtain a copy of this Notice of
Privacy Practices directly from our office at any time. Stop by or give
us a call and we will mail or email a copy to you.
required by law to maintain the privacy of your health information and
to provide to you or your personal representative with this Notice of
our Privacy Practices. We are required to practice the policies and
procedures described in this notice but we do reserve the right to
change the terms of our Notice. If we change our privacy practices we
will be sure all of our patients receive a copy of the revised Notice
when requested. You have the right to express complaints to us or to the
Secretary of Health and Human Services if you believe your privacy
rights have been compromised. We encourage you to express any concerns
you may have regarding the privacy of your information. We will not
retaliate against you for submitting a complaint. Please let us know of
your concerns or complaints in writing by submitting your complaint to
our Privacy Officer.