Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this notice while it is in effect. This Notice takes effect 05/13/2015 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, and to make new Notice provisions effective to all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice Clearly and prominently at our practice location, and we will provide copies of the new Notice upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for a copy of this Notice, please contact us using the information listed at the end of this Notice.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description. Some information such as HIV-related information, alcohol and/or substance abuse and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.
- We may use and disclose your health information for your treatment. For example, we may disclose your health information to your general dentist or treating physician when applicable.
- We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with our care. Payment activities include billing, collections, claims management and determination of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your dental or medical health plans containing certain health information.
Healthcare Operations. We may use and disclose your health information in connection with our healthcare operations. For example, healthcare operations include quality assessment and improvement activities, conducting training programs, and licensing activities.
Individuals Involved in Your Care or Payment of Your Care. We may disclose your health information to your family or friends or any other individual identified by you when they are involved in your care or in the payment of your care. Additionally, we may disclose information about you to a patient representative. If a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information. In the event of your incapacity or emergency circumstances, we will disclose health information based on determination using our professional judgement, disclosing only health information that is directly relevant to the person’s involvement in your healthcare.
Disaster Relief. We may use or disclose your information to assist in disaster relief efforts when authorized by law.
Required by law. We may use or disclose your health information when we are required to do so by law.
Public Health Activities. We may use or disclose your health information for public health activities, including disclosures to:
- Prevent or control disease, injury, or disability
- Report child abuse or neglect
- Report reactions to medication or problems with products/devices
- Notify a person of a recall, repair, or replacement of products/devices
- Notify a person who may have been exposed to a disease or condition; or
- Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
National Security. We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorize federal officials health information required for lawful intelligence, counterintelligence, or other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient.
Secretary of Health and Human Services (HHS). We will disclose your information to the Secretary of the U.S. Department of Health and Human Services when required to investigate to determine compliance with HIPAA.
Worker’s Compensation. We may disclose your protected health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Payment. We may use or disclose your protected health information to obtain payment for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your dental health plan containing certain health information.
Law Enforcement. We may disclose your protected health information for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Health Oversight Activities. We may disclose your protected health information to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing as necessary for licensure and for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings. If you are involved in a lawsuit or dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.
- We may disclose your protected health information to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and establish protocols to ensure the privacy of your information.
Medical Coroners, Medical Examiners, and Funeral Directors. We may release your protected health information to a coroner or medical examiner. This may be necessary, for example to identify the deceased or determine a cause of death. We may also disclose your protected health information to funeral directors consistent with applicable law to enable them to carry out their duties.
Fundraising. We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving such communications.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your authorization is required, with a few exceptions, for disclosures of psychotherapy notes, use or disclosure of protected health information for marketing, and for the sale of protected health information. We will also obtain your written authorization before using or disclosing your protected health information for purposes other than those provided in the Notice (or as otherwise permitted or required by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your protected health information, except to the extent that we have already taken action in reliance on the authorization.
YOUR HEALTH INFORMATION RIGHTS
- You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may obtain a form to request access by using the email, fax, or physical address listed at the end of this Notice. You may also request access by sending us a letter. If you request information we maintain on paper, we may provide you photocopies. If you request information we maintain electronically, you may have an electronic copy. We will use the form and format that you request if readily producible. We may charge you a reasonable cost based fee for the cost of the supplies and/or labor. If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.
Disclosure Accounting. With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations. You must submit your request in writing. 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 the additional requests.
Right to Request a Restriction. You have the right to request additional restrictions of use or disclosures of your protected health information by submitting a written request. Your written request must include (1) what information you would like limited, (2) whether you’re limiting our use, disclosure, or both and (3) to whom you would like the limits to apply. We are not required to agree to your request except in the case where the disclosure is to a health plan for the purposes of carrying out payment or healthcare operations, and the information pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan), has paid our practice in full.
Alternative Communication. You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing, specifying the alternative means or location requested, and provide a satisfactory explanation of how payments will be handled under the alternative means or location you request. We will accommodate reasonable requests. However, if we are unable to contact you using the means or locations requested, we may contact you using the information we have.
- You have the right to request that we amend your health information. Your request must be submitted in writing with explanation as to why the information should be amended. We may deny your request under certain circumstances. IF we agree to your request, we will amend your record(s) and notify you of such. If we deny your request for amendment, we will provide you with a written explanation for the denial and explain your rights.
Right to Notification of a Breach. You will receive notifications of breaches of your unsecured protected health information as required by law.
Electronic Notice. You may receive a paper copy of this Notice up on request, even if you have agreed to receive this Notice electronically on our website.
We may provide you with appointment reminders such as voicemail messages, email messages, text messages, postcards or letters.
We support your right to the privacy of your health information. We will not retaliate if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.