HIPAA NOTICE OF PRIVACY PRACTICES
Pediatric Dentistry and Orthodontics
7400 NW 5th Street
Plantation, FL 33317 (954-581-7883)
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.
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This notice describes how we protect your health information and what rights you have regarding it.
Treatment, Payment, and Health Care Operations
The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; examining your teeth; prescribing medications and faxing them to be filled; referring you to another doctor or clinic for other health care or services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or dental care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.
Our Use and Disclosure of Your Health Information Without Your Written Authorization. Common Reasons for Our Use and Disclosure of Patient Health Information
Appointment Reminders. We may use or disclose your health information when contacting you to remind you of your dental appointment. We may contact you by using a postcard, letter, phone call, voice message, text, or e-mail.
Treatment Alternatives and Health-Related Benefits and Services. We may use and disclose your health information to tell you about treatment options or alternatives, or health- related benefits and services that may be of interest to you.
Disclosure to Family Members and Friends. We may disclose your health information to a family member or friend who is involved with your care or payment for your care if you do not object or, if you are not present, we believe it is in your best interest to do so.
Payment. We may use and disclose your health information to obtain payment from health plans and insurers for the care that we provide for you.
Health Care Operations. We may use and disclose health information about you in connection with health care operations necessary to run our office, including review of our treatment and services, training, evaluating the performance of our staff and health care professionals, quality assurance, financial or billing audits, legal matters, and business planning and development.
Disclosure to Business Associates. We may disclose your protected health information to our third party service providers (called, “business associates”) that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use a business associate to assist us in maintaining our practice management software. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Less Common Reasons for Use and Disclosure of Patient Health Information
Disclosures Required by Law. We may use or disclose patient health information to the extent we are required by law to do so. For example, we are required to disclose patient health information to the U.S. Department of Health and Human Services so that it can investigate complaints or determine our compliance with HIPAA.
Public Health Activities. We may disclose patient health information for public health activities and purposes, which include: preventing or controlling disease, injury or disability; reporting births or deaths; reporting child abuse or neglect; reporting adverse reactions to medications or foods; reporting product defects; enabling product recalls; and notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Victims of Abuse, Neglect or Domestic Violence. We may disclose health information to the appropriate government authority about a patient whom we believe is a victim of abuse, neglect or domestic violence.
Health Oversight Activities. We may disclose patient health information to a health oversight agency for activities necessary for the government to provide appropriate oversight of the health care system, certain government benefit programs, and compliance with certain civil rights laws.
Lawsuits and Legal Actions. We may disclose patient health information in response to (i) a court or administrative order or (ii) a subpoena, discovery request, or other lawful process that is not ordered by a court if efforts have been made to notify the patient or to obtain an order protecting the information requested.
Law Enforcement Purposes. We may disclose patient health information to a law enforcement official for law enforcement purposes, such as to identify or locate a suspect, material witness or missing person; or to alert law enforcement of a crime.
Coroners, Medical Examiners and Funeral Directors. We may disclose patient health information to a coroner, medical examiner or funeral director to allow them to carry out their duties.
Organ, Eye and Tissue Donation. We may use or disclose patient health information to organ procurement organizations or others that obtain, bank or transplant cadaveric organs, eyes or tissue for donation and transplant.
Research Purposes. We may use or disclose patient health information for research purposes pursuant to patient authorization waiver approval by an Institutional Review Board or Privacy Board.
The following uses and disclosures occur infrequently and may never apply to you.
Serious Threat to Health or Safety. We may use or disclose patient health information if we believe it is necessary to do so to prevent or lessen a serious threat to anyone’s health or safety.
Specialized Government Functions. We may disclose patient health information to the military (domestic or foreign) about its members or veterans, for national security and protective services for the President or other heads of state, to the government for security clearance reviews, and to a jail or prison about its inmates.
Workers’ Compensation. We may disclose patient health information to comply with workers’ compensation laws or similar programs that provide benefits for work-related injuries or illness.
Forwarding of Records. We may forward your records to contain any of the following information: dates of last services rendered, current radiographs, and any outstanding treatment plans, with your verbal or written consent to another dental practice.
Your Written Authorization for Any Other Use or Disclosure of Your Health Information.
We will make other uses and disclosures of health information not discussed in this notice only with your written authorization. You may revoke that authorization at any time in writing. Upon receipt of the written revocation, we will stop using or disclosing your health information for the reasons covered by the authorization going forward.
Your Rights
You have a number of rights when it comes to your health information. This section explains your rights and some of our responsibilities to help you.
Your Medical Record. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. You may ask us how to do this. We will provide a copy or a summary of your health information, usually within thirty days of your request. We may charge a reasonable, cost-based, fee.
Medical Record Corrections. You can ask us to correct health information about you that you think is incorrect or incompatible.
Confidential Communications. You can ask us to contact you in a specific way, such as at your home or office phone, or to send mail to a different address.
Limitations as to What We Use or Share. You can ask us not to use or share certain health information for treatment, payment, or our operations. Please note that we are not required to agree to your request and that we may decline to do so if it will affect your care.
Obtaining a List of Those with Whom We Shared Information. You can ask for a list of the times we shared your health information, within a period of six years prior to the date of your request, who we shared the information with, and why we shared that information. We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another within twelve months.
Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian or parent, that person can exercise your rights and make choices about your healthcare information. We will make sure the person has this authority and can act for you before we take any action.
Our Notice of Privacy Practices
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our Website.
Complaints
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, please let us know. Tell us what you want us to do and we will follow your instructions.
In such cases, you have both the right and choice to tell us to: i) share information with your family, close friends, or others involved in your care, or ii) share information in a disaster relief situation. If you are a not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In the following cases, we will never share your information unless you give us written permission: i) marketing purposes, or ii) the sale of your information.
Pediatric Dentistry and Orthodontics
7400 NW 5th Street
Plantation, Florida 33317