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.
This Notice of Privacy Practices describes how we may use and disclose your "Protected Health Information" (PHI) to carry out Treatment, Payment or Healthcare Operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected Health Information" (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information
Your protected health information (PHI) may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.
TREATMENT - We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose PHI as necessary to a home health agency that provides care to you. For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
PAYMENT - Your PHI will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
HEALTH CARE OPERATIONS - We may use or disclose as needed, your PHI in order to support the business activities of your physician's practice. These activities include but are not limited to, quality assessment activities, employee review activities, training of dental students, licensing, marketing, and fundraising activities, and conducting or arranging for other business activities. For example, we may disclose your PHI to dental school students that see patients in our office. In addition, we may utilize a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also ca ll you by name in the waiting room when your physician is ready to see you. We may use or disclose your PHI as necessary to contact you to remind you of our appointment. We may use or disclose your PHI in the following sit uations without your authorization. These situations include public health issues as required by law, communicable diseases, health oversight, abuse or neglect, Food and Drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, and organ donation, research, criminal activity, national security, worker's compensation, inmates, required uses and disclosures, under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law. You may revoke thi s authorization at any time in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights - The following is a statement of your rights with respect to your PHI.
*You have the right to inspect and copy your PHI. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to protected PHI.
*You have the right to request a restriction of your PHI. This means that you may ask us not to disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
*Your physician is not required to agree to a restriction that you may request. If a physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another Healthcare professional.
*You have the right to request and receive confidential communications from us by alternative means or at an alternative location.
*You have the right to obtain a copy of this notice from us upon request, even if you have agreed to accept this notice alternatively, I.E. electronically.
*You may have the right to have your physician amend to your PHI. If we deny your request for amendment, you then have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and we will provide you with a copy of any such rebuttal.
*You have the right to change the terms of this notice and we will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice.
You may complain to us or the Secretary of Health and Human Services if you believe you privacy rights have been violated by us. You may file a complaint with us or by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.
If you have any comments regarding this notice please contact our office.
RECEIPT OF ACKNOWLEDGEMENT
We are required by law to maintain the privacy of and provide individuals with this notice of our legal duties and privacy practices with respect to Protected Health Information.