DENTAL CARE DESIGNNotice of Privacy Policies |
The information providedbelow illustrates the manner your protected health information could beaccessed and released and what you need to know about this process. Thisimportant document should be reviewed thoroughly. Managing the privacy of yourprotected health information is extremely important to Dental Care Design.
Legal Responsibilities of Dental Care Design: As mandated by Federal and State legal requirementsyour protected health information must be protected. As part of theseregulations we are required to ensure you are aware of privacy policies, legalduties and your rights to your protected health information. This notice ofprivacy policies, outlined below, will be in effect for the duration and mustbe followed by our practice. This notice will be in effect until it is replacedand becomes effective January 1, 2003.
We reserve the right tomodify our privacy policies and the terms of this notice at any time, and willmake such modifications within the guidelines of the law. We reserve the rightto make the modifications effective for all protected health information thatwe maintain, including protected health information we created or receivedbefore the changes were made. Changing this notice will precede all significantmodifications.
PROTECTED HEALTH INFORMATION USE AND DISCLOSURE: Information regarding your health may be used anddisclosed for the purpose of treatment, payment and other healthcareoperations.
Treatment: Use and disclosure of your protected healthinformation may be provided to a physician or other healthcare providerproviding treatment to you.
Payment: Your protected health information may be used anddisclosed to obtain payment for services we provided to you.
Healthcare Processes: We may use and disclose your protected healthcareinformation in relations with our healthcare process. These processes includean assessment, improvement activities, reviewing the competence orqualifications of healthcare professionals, provider performances andevaluating practitioner, conducting training programs, accreditation,certification, licensing or credentialing activities.
Your Authorization: At any time you may provide in writing yourauthorization for use and disclosure of your protected health information forany purpose. You may choose to revoke your written permission at any time. The revocation must be in writing. If yourevoke your written authorization it will not affect any use or disclosureprior to the revocation.
Your protected health careinformation may be used and disclosed to you, as described in the patientrights section of this notice. In addition, your protected health informationmay be used and disclosed to a family member, friend, or other person to theextent necessary to assist you with your healthcare, but only with yourauthorization.
Person Involved in Care: In order to accommodate the notification of yourlocation, your general condition, or death, your protected health informationmay be used or disclosed to a family member, your personal representative oranother person responsible for your care. If you are present and wish to objectto such disclosures of your protected health information you may do so. To theextent you are incapacitated or emergency circumstances exist, we will discloseprotected health information using our professional judgment disclosing onlyprotected health information that is directly relevant to the person'sinvolvement in your healthcare. We will use our professional judgment and ourexperience with common practices to make reasonable inferences of your bestinterest in allowing a person to pick up filled prescriptions, medicalsupplies, x-rays, or other similar forms of protected health information.
Marketing Health-Related Services: The use of your protected health information for thepurpose of marketing communications is prohibited without you're writtenauthorization.
Required by Law: Your protected health information may be used or disclosed if requiredby law.
Abuse or Neglect: As required by law, if we have reason to believe that you are thevictim of possible abuse, neglect or domestic violence or other possiblecrimes, your protected health information may be disclosed to the appropriateauthorities. If we have reason to believe the use or disclosure of yourprotected health information will prevent a serious threat to your health orsafety or the health or safety of others we may have to provide the necessaryprotected health information.
National Security: Under some circumstances the military may require disclosure of healthcare information for armed forces personnel. For the purpose of nationalsecurities activities, counter intelligence and lawful intelligence, authorizedfederal authorities may require disclosure of protected health information.Protected health care information disclosure may be made to correctionalfacilities or law enforcement authorities with the lawful authority requiringcustody of such information.
Appointment Reminders: Your protected health care information may be usedto assist you with appointment reminders in the form of voicemail messages,postcards, or letters.
PATIENT RIGHTS
Access: Atall times you have the right to review your protected health information, withlimited exceptions. At your request, we will provide your information in a formatother than photocopies. If we are able to do so we will accommodate yourrequest.
Your request to obtainaccess to your information must be in writing. You may obtain a Protected health information Access Formby using the contact information at the end of this notice. We may need tocharge you a reasonable cost-based fee for expenses including copies and stafftime. You may also request access for submitting a letter using the informationat the bottom of this notice. If you request copies, we will charge you $0.83for the first 30 pages and $0.63 per page for all other pages plus $19.00search and handling fee for staff time to locate and copy your protected healthinformation. Copies of x-rays are charged a minimum of $10.00 per film. Postagewill be included if you wish to have your information mailed. If you request aformat option, which is different, we will charge a cost based fee for thatformat. An explanation of fees can be made available.
Disclosure Accounting: Your rights include the choice to receive a reviewof every time we or our business associates disclosed your protected healthinformation for reasons other than treatment, payment, healthcare informationand certain other activities for the last six years but not before April 14,2003. Additional reasonable cost based fees may be extended if your requestsfor such information are more than one time per year.
Restrictions: You may request we apply additional restrictions to any disclosure ofyour health care information. We are not required to respond to the applicationof these additional restrictions. If we agree to follow your request regardingadditional restrictions we will follow the agreed restrictions unless anemergency situation dictates otherwise.
Alternative Communication: Your rights include the instruction to request howyou are communicated to regarding your protected health information. Yourrequest must be in writing and can spell out other ways or others locationsregarding your protected health information communication. You must identifyagreed upon explanations of payment arrangements under alternativecommunications.
Amendment:You can initiate a written request to amend your protected healthinformation. Included in the amendmentmust be an explanation why information should be amended. Certain conditionsmay exist where we may reject you request.
Electronic Notice: If you receive a notice electronically, you are entitled to receive the noticein writing as well.
QUESTIONS AND COMPLAINTS
If at any time you areunsure or concerned that your protected health information has not beenprotected or if you believe an error was made in the decision we made aboutaccessing your protected health information; or in the response to a requestyou made to amend the use or disclosure of your protected health information;or to have us communicate to you by an alternative means or at an alternativelocations, you have the right to bring this issue forward. You may make acomplaint to the U.S. Department of Health and Human Services. We will provideyou with the address to file your complaint with the U. S. Department of Healthand Human Service at your request.
Privacy of your protectedhealth information remains extremely important; we are committed to ensure yourprivacy. If you file a concern with the U.S. Department of Health and HumanResources we will not retaliate in anyway. We are available to assist you withany questions, concerns or complaints.
