Chambers Family Dentistry Notice of Privacy Practices
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to provide you with this Notice of Privacy Practices (“Notice”) which describes our privacy practices and legal duties, as well as your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect. We will not use or share your health information other than as described in this Notice, unless you notify us in writing at the address provided below. This Notice takes effect April 1st, 2003, 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, includinghealth 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.
A. Uses and Disclosures for Treatment, Payment, and Health Care Operations
We must disclose your health information to you, as described in this Notice. We also use your health information and share it with others, in electronic or other formats, to help treat your condition, coordinate payment for that treatment, and run our business operations.
Treatment: We may use your health information to provide treatment to you. We disclose your health information to our employees and others who are involved in providing the care you need. We may disclose your health information to a physician or other health care provider providing treatment to you. We may also share your health information with a pharmacist in order to provide you with a prescription or with a laboratory that performs tests or fabricates dental prostheses or orthodontic appliances.
Payment: We may use and disclose your health information to obtain payment for services we provide to you, unless you request that we restrict such disclosure to your health plan when you have paid out-of-pocket and in full for services rendered.
Health Care Operations: We may use and disclose your health information in connection with our health care operations, including quality assessment and improvement activities, evaluation of practitioner and provider performance, training programs, accreditation, certification, and licensing and credentialing activities.
Disclosures to Your Family or Friends Involved in Your Care: Unless you object, we may disclose your health information to a family member, friend, or other person identified by you as being involved in your treatment or payment for your health care. If you are not present to agree or object, we may exercise our professional judgment to determine whether the disclosure is in your best interest and will limit such disclosures to information necessary to help with your treatment or with payment for your health care. We may also notify a family member, personal representative, or another person responsible for your care about your location or general condition. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
Business Associates: We may disclose your health information to a “business associate” who needs the information to perform a function or service for our business operations. We will do so only if the business associate signs an agreement to protect the privacy of your health information. For example, we may share your health information with a billing company that helps us to obtain payment from your insurance company.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services: We may use and disclose your health information to provide you with appointment reminders (such as voicemails, postcards, letters, emails, texts, or similar mobile device communications). If you are not home, we may leave reminder information on your answering machine or with the person who answers the telephone. We may also use your health information in order to recommend possible treatment alternatives or health-related benefits and services, such as disease awareness or case management, that may be of interest to you.
Patient-Related Communications: We may use or disclose your health information to provide patient-related communications such as intraoral photography, “no cavity club” for children, and telephoned-in prescriptions. We may send treatment plans, statements, newsletters, and other information to you.
Miscellaneous: If any part of the practice is transferred, your patient record will become the property of the new owner.
Emergencies: In an emergency, we may disclose your health information to a family member or another person responsible for your care.
B. Uses and Disclosures for the Public Need
We may use your health information and share it with others in order to comply with the law or meet important public needs described below.
Required by Law: We may use or disclose your health information when we are required by law to do so.
Public Health Activities: We may disclose your health information to authorized public health officials so they may carry out their public health activities. For example, we may share your health information with government officials that are responsible for controlling disease, injury, or disability.
Health Oversight Activities: We may release your health information to government agencies authorized to conduct audits, investigations, and inspections, as well as civil, administrative or criminal investigations, proceedings, or actions. This includes those agencies that monitor programs such as Medicaid.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence, or the possible victim of other crimes.
Product Monitoring, Repair and Recall: We may disclose your health information to a person or company that is regulated by the Food and Drug Administration for the purpose of: (1) reporting or tracking product defects or problems; (2) repairing, replacing, or recalling defective or dangerous products; or (3) monitoring the performance of a product after it has been approved for use by the general public. We may also disclose your health information to report adverse reactions to medications.
Lawsuits and Disputes: We may disclose your health information if we are ordered to do so by a court or administrative tribunal that is handling a lawsuit or other dispute. We may also disclose your health information in response to a subpoena, discovery request, or other lawful request by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain a court order protecting the information from further disclosure.
Law Enforcement: We may disclose your health information to law enforcement officials for certain reasons, including to comply with court orders or laws that we are required to follow and to assist law enforcement officers with identifying or locating a suspect, fugitive, witness, missing person or victims of a crime.
To Avert a Serious and Imminent Threat to Health or Safety: We may disclose your health information to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others. If we do, we will only share your information with someone able to help prevent the threat.
Workers’ Compensation: We may disclose your health information to the extent necessary to comply with workers’ compensation or other programs established by law that provide benefits for work-related injuries or illness without regard to fraud.
National Security: We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may also disclose to military authorities the health information of Armed Forces personnel under certain circumstances. If you are an inmate or you are detained by a law enforcement officer, we may disclose your health information to the prison officers or law enforcement officers if necessary to provide you with health care, or to maintain safety, security and good order at the place where you are confined.
Coroners, Medical Examiners, and Funeral Directors: In the unfortunate event of your death, we may disclose your health information to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death. We may also release this information to funeral directors as necessary to carry out their duties and to organizations that procure or store organs, eyes, or other tissues so that these organizations may investigate whether donation or transplantation is possible under the law.
Research: We can use or share your information for health research.
C. Completely De-Identified and Partially De-Identified Health Information
We may use and disclose your health information if we have removed any information that has the potential to identify you so that the health information is “completely de-identified.” We may also use and disclose “partially de-identified” health information about you. Partially de-identified health information will not contain any information that would directly identify you (such as your name, street address, social security number, phone number, fax number, electronic mail address, website address, or license number).
YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION
Access: You have the right to inspect or obtain copies of your health information, with limited exceptions. If we maintain your health information in electronic format, you have the right to obtain a copy of your health information in the form and format you request if the information is readily producible in that format, or, if not, a mutually agreeable alternative format. You also have the right to direct us to send a copy of your health information to a third party you clearly designate. We may charge you a reasonable, cost-based fee to cover copy costs and postage. If you request a copy of your electronic health information, we will not charge you any more than our labor costs in preparing the materials. You must make a request in writing to obtain access to your health information.
Disclosure Accounting: You have the right to receive a report of who we have disclosed your information to.
Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. If we agree to do so, we will put these restrictions in place except in an emergency situation or as required by law. We do not need to agree to the restriction unless (i) the disclosure is for the purpose of carrying our payment or health care operations and is not otherwise required by law, and (ii) the health information relates only to a health care item or service that you or someone on your behalf has paid for out of pocket and in full. You have the right to revoke the restriction at any time. You may obtain a form to request additional restrictions by using the contact information at the end of this Notice.
Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You may obtain a form to request additional alternative communications by using the contact information at the end of this Notice. Your request must specify how or where you wish to be contacted, and provide a satisfactory explanation regarding how payments will be handled if we communicate with you through the alternative means or location you request.
Amendment of Health Information: If you believe we have health information about you that is incorrect or incomplete, you may request in writing an amendment to your health information. You may obtain a form to request an amendment by using the contact information at the end of this Notice.
Notification of Breach of Unsecured Health Information: We are required by law to maintain the privacy of your health information, and to provide you with this Notice containing our legal duties and privacy practices with respect to your protected health information. Our policy is to encrypt our electronic files containing your health information so as to protect the information from those who should not have access to it. If, however, for some reason, we experience a breach of your unencrypted health information, we will notify you of the breach.
Paper Notice: You have the right at any time to obtain a paper copy of this Notice, even if you receive this Notice electronically. You may make such a request by writing to the address provided at the end of this Notice.
Choose Someone to Act for You: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
CONTACT INFORMATION
If you have any questions about this Notice, you may contact us at (410) 224-2660, or write us at:
Chambers Family Dentistry
621 Ridgely Ave Ste 206
Annapolis, MD 21401
If you want more information about our Privacy Policy or have questions or concerns, please contact us. If you have concerns relating to a perceived violation of your privacy rights, to access to your health information, to amending or restricting the use or disclosure of your health information, or to requesting alternative means of communication, you may contact us using the contact information listed at the end of this Notice. You also may submit a written complaint to the Department of Health and Human Services (HHS). We will provide you with the HHS address upon request.