Privacy Practices - Web Edition
(Click on the "Patient Forms" link for
a printable version.)
This notice describes how health information about
you may be used and disclosed and how you can get access to this
information. It is our desire to communicate to you that we are
taking the new Federal (HIPAA – Health Insurance Portability
And accountability Act) laws written to protect the confidentiality
of your health information seriously. We do not ever want you to
delay treatment because you are afraid your personal health history
might be unnecessarily made available to others outside of our office.
Please review it carefully.
How Your Health Information
May Be Used
now? Very good questions!
The most significant variable that has motivated
the Federal government to legally enforce the importance of the
privacy of health information is 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, phones, faxes, copy machines, and charts.
We believe this has been an important exercise for us because it
has disciplined us to put in writing the policies and procedures
we use to ensure the protection of your health information everywhere
it is used.
We want you to know about these policies and procedures
which we developed to make sure your health information will not
be shared with anyone who does not require it. Our office is subject
to State and Federal law regarding the confidentiality of your health
information and in keeping with these laws, we want you to understand
our procedures and your rights as our valuable patient.
We will use and communicate your health information
only for the purposes of providing your treatment, obtaining payment
and conducting health care operations. Your health information will
not be used for other purposes unless we have asked for and been
voluntarily given your written permission.
How your health information may be used
We will use your health information within our office
to provide you with the best dental care possible. This may include
administrative and clinical office procedures designed to optimize
scheduling and coordination of care between hygienist, dental assistant,
dentist and business office staff. In addition, we may share your
health information with physicians, referring dentists, clinical
and dental laboratories, pharmacies or other health care personnel
providing you treatment.
To Obtain Payment
We may include your health information with an invoice
used to collect payment for treatment you receive in our office.
We may do this with insurance forms filed for you in the mail or
sent electronically. We will be sure to only work with companies
with a similar commitment to the security of your health information.
To Conduct Health Care Operations
Your health information may be used during performance
evaluations of our staff. Some of our best teaching opportunities
use clinical situations experienced by patients receiving care at
our office. As a result, health information may be included in training
programs for students, interns, associates, and business and clinical
employees. It is also possible that heath information will be disclosed
during audits by insurance companies or government appointed agencies
as part of their quality assurance and compliance reviews. Your
health information may be reviewed during the routine processes
of certification, licensing or credentialing activities.
In Patient Reminders
Because we believe regular care is very important
to your oral and general heath, we will remind you of a scheduled
appointment or that it is time for you to contact us and make an
appointment. Additionally, we may contact you to follow up on your
care and inform you of treatment options or services that may be
of interest to you or your family.
These communications are an important part of our
philosophy of partnering with our patients to be sure they receive
the best preventive and restorative care modern dentistry can provide.
They may include postcards, folding postcards, letters, telephone
reminders or electronic reminders such as email (unless you tell
us that you do not want to receive these reminders).
Abuse or Neglect
We will notify government authorities if we believe
a patient is the victim of abuse, neglect or domestic violence.
We will make this disclosure only when we are compelled by our ethical
judgment, when we believe we are specifically required or authorized
by law or with the patient’s agreement.
Public Health and National Security
We may be required to disclose to Federal officials
or military authorities health information necessary to complete
an investigation related to public health or national security.
Health information could be important when the government believes
that public safety could benefit when the information could lead
to the control or prevention of an epidemic or the understating
of new side effects of a drug treatment or medical device.
For Law Enforcement
As permitted or required by State or Federal law,
we may disclose your health information to a law enforcement official
for certain law enforcement purposes, including, under certain limited
circumstances, if you are a victim of a crime or in order to report
Family, Friends and Caregivers
We may share your health information with those
you tell us will be helping you with your home hygiene, treatment,
medications, or payment. We will be sure to ask your permission
first. In the case of an emergency, where you are unable to tell
us what you want we will use our very best judgment when sharing
your health information only when it will be important to those
participating in providing your care.
Authorization to Use or Disclose Health
Other than is stated above or where Federal, State
or Local law requires us, we will not disclose your health information
other then with your written authorization. You may revoke that
authorization in writing at any time.
This new law is careful to describe that you have
the following rights related to your health information.
You have the right to request restrictions on certain
uses and disclosures of your health information. Our office will
make every effort to honor reasonable restriction preferences.
You have the right to request that we communicate
with you in a certain way. You may request that we only communicate
your health information privately with to other family members present
or through mailed communications that are sealed. We will make every
effort to honor your reasonable requests for confidential communications.
Inspect and Copy Your Health Information
You have the right to read, review, and copy your
health information, including your complete chart, x-rays and billing
records. If you would like a copy of your health information please
let us know. We may need to charge you a reasonable fee to duplicate
and assemble your copy.
Amend Your Health Information
You have the right to ask you to update or modify
your records if you believe your health information records are
incorrect or incomplete. We will be happy to accommodate you as
long as our office maintains this information. In order to standardize
our process, please provide us with your request in writing and
describe your reason for the change.
Your request may be denied if the health information
record in question was not created by or office, is not part of
our records or if the records containing your health information
are determined to be accurate and complete.
Documentation of Health Information
You have the right to ask us for a description of
how and where your health information was used by our office for
any reason other than for treatment, payment or health operations.
Our documentation procedures will enable us to provide information
on health information usage from April 14, 2003 and forward. Please
let us know in writing the time period for which you are interested.
Thank you for limiting your request to no more than six years at
a time. We may need to charge you a reasonable fee for your request.
Request a Paper Copy of this Notice
You have a right to obtain a copy of this Notice
of Privacy Practices directly from our office at any time. Stop
by or give us a call and we will mail, or email a copy to you.
We are required by law to maintain the privacy of
your health information and to provide to you and your representative
the Notice of our Privacy Practices. We are required to practice
the policies and procedures described in the Notice but we do reserve
the right to change the terms of our Notice. If we change our privacy
practices we will be sure all of our patients receive a copy of
the revised Notice.
Your have the right to express complaints to us
or to the Secretary of Health of 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.
Please let us know of your concerns or complaints in writing.