Privacy Policy

This Privacy Policy covers services provided to you by our office. By law, we are required to maintain the privacy of protected health information and to provide you with the Policy of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Policy as currently in effect. We reserve the right to change the terms of our Policy and to make the new Policy provisions effective for all protected health information we maintain. If we make a material change to our Policy, we will provide a copy of the revised Policy to you by mail or at the time of your next visit to our office. You have the right to receive a paper copy of this Policy at any time, even if you have previously agreed to receive it electronically. To obtain a paper copy, please contact our office.

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.

We understand that your health information is personal and we are committed to protecting it. We create a record of the care and services you receive at our office. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share the health information in your record. It also describes your rights and certain duties we have regarding the use and disclosure of your health information.

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

The following categories describe the different ways we may use and disclose your protected health information. Not every use or disclosure will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following categories.

Treatment

We may use your health information to provide you with dental treatment or services. We may disclose your health information to dentists, hygienists, dental assistants, and other health care providers who are involved in providing your care. For example, a dentist treating you for a dental condition may need to know about your medical history to determine the best course of treatment. Different dental professionals in our office may share information about you in order to coordinate your treatment, such as prescriptions, lab work, and X-rays.

Payment

We may use and disclose your health information so that the treatment and services you receive at our office may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your insurance company information about dental services provided to you so that your insurance company will pay us or reimburse you for the services. We may also tell your insurance company about a treatment you are going to receive to obtain prior approval or to determine whether your insurance plan will cover the treatment. We may also share portions of your health information with the following: billing companies, insurance companies, health plans, collection agencies, and other third-party payers.

Health Care Operations

We may use and disclose your health information for our health care operations. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services

We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or services at our office. We may also use and disclose your health information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care

When appropriate, we may share your health information with a person who is involved in your dental care or payment for your care, such as a family member or guardian. We may also notify your family about your location, general condition, or death.

Research

Under certain circumstances, we may use and disclose your health information for research purposes. All research projects are subject to a special approval process that evaluates a proposed research project and its use of health information. Before we use or disclose health information for research, the project will have been approved through this process.

As Required by Law

We will disclose your health information when required to do so by federal, state, or local law.

To Avert a Serious Threat to Health or Safety

We may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat.

Workers' Compensation

We may release your health information for workers' compensation or similar programs that provide benefits for work-related injuries or illness.

Public Health Activities

We may disclose your health information for public health activities, including:

• To prevent or control disease, injury, or disability
• To report births and deaths
• To report reactions to medications or problems with products
• To notify people of recalls of products they may be using
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition

Health Oversight Activities

We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes

If you are involved in a lawsuit or dispute, we may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement

We may release your health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process, subject to all applicable legal requirements.

Military and Veterans

If you are a member of the armed forces, we may release your health information as required by military command authorities.

Coroners, Medical Examiners, and Funeral Directors

We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities

We may release your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

2. YOUR RIGHTS

You have the following rights regarding your health information:

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your dental care. This includes dental and billing records but does not include psychotherapy notes. To inspect and copy your health information, you must submit your request in writing to our Privacy Officer. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request in certain limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed.

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. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. To request restrictions, you must make your request in writing to our Privacy Officer. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure, or both, and to whom you want the limits to apply. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

Right to Request Confidential Communications

You have the right to request that we communicate with you about dental matters in a certain way or at a certain location. For example, you may ask that we contact you only at work or only by mail. To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Request Amendment

If you feel that the 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 or for our office. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that was not created by us, is not part of the health information kept by or for our office, is not part of the information which you would be permitted to inspect and copy, or is accurate and complete.

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, health care operations, and certain other activities. To request this list, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

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. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact our front desk.

3. 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. To file a complaint with our office, contact our Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

For further information about this notice or our privacy practices, please contact our office at any of our locations.

This Policy was published and becomes effective on March 21, 2019.