Your protected health information (i.e., individually identifiable information, such as names, dates, phone/fax numbers, email addresses, home addresses, social security numbers, and demographic data) may be used or disclosed by us in one or more of the following respects:
- To other health care providers (i.e., your general dentist, oral surgeon, etcin connection with our rendering orthodontic treatment to you (i.e., to determine the results of cleanings, surgery, etc;
- To third party payors or spouses (i.e., insurance companies, employers with direct reimbursements, administrators of flexible spending accounts, etc
- To certifying, licensing, and accrediting bodies (i.e., the American Board of Orthodontics, state dental boards, etc in connection with obtaining certification, licensure, or accreditation; Internally, to all staff members who have any role in your treatment;
- To other patients and third parties who may see or overhear incidental disclosures about your treatment, scheduling, etc.;
- To your family and close friends involved in your treatment.
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Any other uses or disclosures of your protected health information will be made only after obtaining your written authorization, which you have the right to revoke.
Under the privacy rules you have the right to:
- Request restrictions on the use and disclosure of your protected health information;
- Request confidential communication of your protected health information;
- Inspect and obtain copies of your protected health information;
- Amend or modify your protected health information in certain circumstances;
- Receive an accounting of certain disclosures made by us of your protected health information; and
- You may without risk of retaliation, file a complaint as to any violation by us for your privacy rights with us (by submitting inquiries to our Privacy Contact Person, Yvonne, at 2333 Knob Creek Rd Suite 10 Johnson City, TN 37604) or the United States Secretary of Health and Human Services (which must be filed within 180 days of the violation).
Please note that we are not obligated to:
- Honor any request by you to restrict the use or disclosure of your protected health information;
- Amend your protected health information if, for example, it is accurate and complete; or,
- Provide an atmosphere that is totally free of the possibility that your health information may be incidentally overheard by other patients or third parties.
This privacy notice is effective as of the date of your signature. If you have any questions about the information in this notice, please ask for our Privacy Contact Person or direct your questions to this person at our office address. Thank you.