Notice of Privacy Practices
This notice is to inform you that your personal health information will only be used for purposes of treatment in our facility and will not be misused or disclosed by/to anyone outside of our practice. You may gain access to this information if you desire.
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Please review it carefully. The privacy of your health information is important to us.
Our Legal Duty
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We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect.
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 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 Information
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We use and disclose health information about you for treatment, payment, and healthcare operations.
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Treatment: We may use or disclose your health information to a physician or other healthcare provider who is currently providing treatment to you.
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Payment: We may use and disclose your health information to obtain payment for services we provided to you (i.e., insurance companies).
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Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations, including quality assessment and improvement activities, reviewing the competency or qualification of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
Your Authorization
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You may give us written authorization to use your health information or to disclose it to anyone for any purpose (e.g., a family member picking up records, referral to a dental specialist, etc.). If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
To Your Family and Friends
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We must disclose your health information to you, as described in the Patient Rights section of this notice. We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or payment for your healthcare, but only if you agree that we may do so.
ation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
Persons Involved in Care
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We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your representative, or another person responsible for your care, your location, your general condition, or death.
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If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information that is directly relevant to that person’s involvement in your healthcare.
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We will also use our professional judgment and experiences with common practices to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other forms of health information.
Marketing Health-Related Services
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Our dental office does not use patient information for any marketing purposes without the written consent of the patient.
Required by Law
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We may use or disclose your health information when it is required by law to do so (i.e., missing persons, etc.).
Abuse or Neglect
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We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence, or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your safety or the health or safety of others.
National Security
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We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.
We may disclose to lawfully authorized Federal Officials health information required by lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmates or patients under certain circumstances.
Appointment Reminders
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We may use or disclose health information to provide you with appointment reminders.
Patient Rights
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Access: You have the right to look at or get copies of your health information with limited exceptions. You may request that we provide copies. You must make a request in writing to obtain access to your health information. We may charge you a reasonable cost-based fee for expenses such as copies and staff time. You may request access by sending us a letter to the address at the top of this notice.
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Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for any purpose other than treatment, payment, healthcare operations, and certain other activities for the last six years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to those requests.
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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 your agreement except in an emergency.
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Amendment: You have the right to request that we amend your health information. Your request must be in writing and must explain why the information should be amended. We may deny your request under certain circumstances.
Questions and Complaints
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If you desire further information about our privacy practices or have any questions, please contact us.
If you are concerned that:
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We may have violated your privacy rights,
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You disagree with a decision we made about access to your health information, or
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You made a request to amend/restrict the use or disclosure of your health information and disagree with our response,
you may complain to the U.S. Department of Health and Human Services.