Advanced Family Dentistry’s Privacy Practices
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.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information (protected health information) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your personal health information.
- We are permitted to use and disclose your personal health information for the purposes of providing, coordinating, and managing your treatment, to obtain payment for health care services that we provide to you or your dependents/guarantees, and for health care operations. This includes sharing information with other healthcare providers regarding your treatment and coordinating and managing your healthcare.
- Payment for health care services includes, but is not limited to, such activities as obtaining payments from insurance payors or from you for services provided to you or your dependents (in person or by phone, text, email or mail), confirming insurance coverage, billing or collection activities, claims management, and other related functions. An example of this would be us billing your dental plan for your dental services.
- Health care operations include the business aspects of running our practice. These activities include, but are not limited to, quality assessment and improvement activities, employee review activities and training programs, auditing functions, cost-management analysis, ensuring compliance with legal and regulatory requirements, and customer service.
Certain health information we maintain, specifically records regarding substance use disorder (SUD) diagnosis, treatment, or referral, is protected by federal law under 42 CRF Part 2. These records receive a higher level of protection than other types of health information. We will not use or disclose these records without your written consent, except as permitted by 42 CRF Part 2.
In addition, we may use your personal health information to remind you of an appointment (by phone, text, email or mail), provide you with information about treatment options or other health-related services, and disclose relevant information to your family members and friends that are directly involved in your dental care or payment of your dental care, including those listed on your family account and those designated as your guarantor of payment.
We will use and disclose your protected health information when we are required to do so by federal, state or local law. We may use and disclose your protected health information in response to legal proceedings, to health authorities that are authorized to collect such information, and to a health oversight agency for activities authorized by law, including but not limited to response to a court or administrative order if you are involved in a lawsuit or similar proceeding, or in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute.
We will release your protected health information if requested by a law enforcement official for any circumstance required by law. We may release your protected health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs. We may release protected health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor. We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or to the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat. We may disclose your protected health information to report abuse, neglect, or domestic violence.
We may disclose your protected health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities. We may disclose your protected health information to federal officials for intelligence and national security activities authorized by law.
We may disclose your protected health information to correctional institutions or law enforcement HIPAA officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals or the public.
We may release your protected health information for workers’ compensation and similar programs.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have certain rights in regard to your protected health information, which you can exercise by presenting a written request:
- The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
- The right to request to receive confidential communications of your protected health information from us.
- The right to inspect your protected health information.
- The right to request an amendment to your protected health information.
- The right to receive an accounting of disclosures of protected health information outside of treatment, payment and health care operations.
- The right to obtain a paper copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices.
We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from this office. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (tollfree)