Responsible Party Information
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 have put in writing the policies and procedures we follow to protect your information. We are required to give you notice about our privacy practices that are described in this notice while it is in effect. This notice will take effect on date signed and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request
USES AND DISCLOSURES OF HEALTH INFORMAITON
Treatment: We will use your Health Information within our office for payment and healthcare operations. We may share your health information with physicians, referring dentists, clinical and dental laboratories, and other health care personnel providing you treatment.
Payment: We may use and disclose your health information to collect payment for treatment you receive in our office, and when we are filing insurance claims on your behalf whether filed by mail or electronically. We may disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Patient Reminders: We will remind you of a scheduled appointment or that it is time for you to contact us to make an appointment. Additionally, we my contact you to follow up on care and inform you of treatment options. These may include postcards, folding postcards, letters, telephone reminders, or electronic reminders such as email or texts (unless you tell us you don’t want them).
Persons Involved in Care: We may use or disclose health information to notify, or assist in the notification (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition or death. If your are present, then prior to use or disclosure of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare.
Marketing Health Related Services: We will not use your health information for marketing communications or posting of photographs without your written authorization.
Required by Law: We will disclose your heath information when we are required by law to do so. Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that possible abuse, neglect or domestic violence or you are the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
Judicial and Administrative Proceedings: 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 be protected.
Patient RightsAccess: You have the right to look at or get copies of your health information, with limited exceptions, You may request that we provide copies in a format other than photocopies. We will use the format you requested unless we cannot practicably do so. (You must make a request in writing to obtain access to your health information). We will charge you a reasonable cost-based fee for expenses such as copies and staff time. If we make copies we will charge you $1.00 per black and white and $3.00 per page for color and $30./hour (minimum 1 hour) for staff time to locate and copy your health information plus the cost of postage if you need the copies mailed If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If a report is required and we prepare a summary or an explanation of your health information this is at an additional fee, beginning at $100/hour to write and prepare such report.
Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
Confidential Communication: You have the right to request that we communicate with you by alternative means or to an alternative location. (You must make your request in writing). Your 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 request.
Amendment: You have the right to request that we amend your health information. (Your request must be in writing and you must explain why the information should be amended). We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice on our web site or by electronic mail, you are entitled to receive this notice in written form. Please request a written copy.
We are required by law to maintain the privacy of your health information and to provide you or your personal representative with this Notice of 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. 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.