NOTICE OF PRIVACY PRACTICES Hipaa policy
This notice describes how medical/dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Click here to download this document.
Our Legal Duty to Protect Medical/Dental Information About You
We understand that your medical/dental information is personal and we are committed to protecting your medical/dental information. We create a record of the care and services you receive at Arnold Dental Arts, LLC, to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Arnold Dental Arts, LLC. This Notice describes how we may use and disclose your medical/dental information, and provides examples where necessary. This Notice also describes your rights regarding our use and disclosure of your medical/dental information.
We are required by law to make sure that:
- Medical/dental information that identifies you is kept private
- Give you this Notice of our legal duties and privacy practices with respect to your medical/dental information
- Follow the terms of the Notice currently in effect.
We reserve the right to change our privacy practices and this Notice at any time.
Disclosure of Information
We may use and disclose your medical/dental without your written permission in the following circumstances:
- We may use and disclose your medical/dental information to provide medical/dental treatment to you, and to coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. For example, we may disclose your medical/dental information when you need a prescription, lab work, an x-ray, or other health care services. Also, we may use and disclose your medical/dental information when referring you to another health care provider.
- We may use and disclose your medical/dental information to bill and receive payment. For example, a bill may be sent to you or your insurance company. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used, so that your benefit plan will pay for the medical/dental bill. We may also tell your benefit plan about a treatment you’re expected to receive to obtain prior approval or to determine if your benefit plan will pay for the treatment.
- We may use and disclose your medical/dental information for health care operations. We will use your health information for regular operations of the clinic to ensure that all of our patients receive quality care. For example, members of the staff may use information in your dental record to assess the care and outcomes in your case and others like it. We may also disclose information to other doctors, staff, and technicians for review and learning purposes.
- We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
- We may use and disclose your medical/dental information to recommend treatment alternatives. We may use and disclose your medical/dental information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- We may use and disclose your medical/dental information to our business associates to carry out treatment, payment, or health care operations. For example, we may disclose information about you to a company to help us obtain payment for services provided.
- We may use and disclose your medical/dental information for research or to collect information in databases used for research. Research projects are reviewed and approved by a Review Board to protect the privacy of your health information.
- We will disclose medical/dental information about you when required by federal, state, or local law. We may release medical/dental information about you to authorized federal officials for national security and intelligence activities.
- We may use and disclose your medical/dental information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- We may use and disclose your medical/dental information to organizations engaged in the procurement, banking, or transplantation of organs for the purpose of organ or tissue donation and transplant.
- We may use and disclose your medical/dental information to release to the extent authorized by laws relating to workers’ compensation or other similar programs established by law, which provide benefits for work-related injuries or illness.
- If you are a member of the armed forces, we may release medical/dental information about you as required by military command authorities. We may also release medical/dental information about foreign military personnel to the appropriate foreign military authority.
- We may use and disclose your medical/dental information as required by law for public health activities. For example, your information may be released in efforts of preventing or controlling disease, injury, or disability. Also for reporting medication reactions or problems, and reporting domestic abuse, neglect, or violence.
- We may use and disclose your medical/dental information to health oversight agencies as required by agencies that enforce compliance with licensure or accreditation requirements. Examples of these situations would be audits, investigations, inspections, and licensure.
- We may use and disclose your medical/dental information in response to a court or administrative order. We may use and disclose your medical/dental information about you in response to a subpoena, discovery request, or other lawful process. We may use and disclose your medical/dental information for law enforcement purposes as required by law. For example, we may use and disclose your medical/dental information about you to comply with laws that require the reporting of certain types of wounds or other physical injuries.
- We may use and disclose your medical/dental information to coroners, medical examiners, or funeral directors consistent with applicable law to carry out their duties.
- We may use and disclose your medical/dental information to a correctional institution having lawful custody of you necessary for your health and the health and safety of other individuals.
Alcohol, Drug Abuse, and Psychiatric Treatment Information may have special privacy protections. We will not disclose any information identifying an individual as being a patient or provide any medical/dental information relating to the patient’s substance abuse or psychiatric treatment unless:
- The patient consents in writing
- A court order requires disclosure of the information
- Medical/dental personnel need information to meet a medical/dental emergency
- Qualified personnel use the information for the purpose of conducting scientific research, management audits, financial audits, or program evaluation
- It is necessary to report a crime or a threat to commit a crime
- To report abuse or neglect as required by law.
Objecting to Certain Uses and Disclosures of Your Medical/Dental Information
Unless you object, we may use and disclose your medical/dental information in the following circumstances:
- Individuals Involved in Your Care or Payment for Your Care: We may use or disclose information to notify or assist in notifying a family member, legal representative or another person responsible for your care.
- Emergency Circumstances and Disaster Relief: We may use and disclose information about you to an entity assisting in a disaster relief effort so that your family can be notified of your location and general condition. Even if you object, we may still share the medical/dental information about you, if necessary for emergency circumstances.
Other Uses of Medical Information
Other uses and disclosures of medical/dental information not covered by this notice or law that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical/dental information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical/dental information about you for the reasons covered by your revocation. You understand that we are unable to take back any disclosures that we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Your Rights Regarding Medical/Dental Information About You
You have the following rights regarding the medical/dental information we maintain about you:
- Right to See and Obtain Copies of Your Medical/Dental Information. You have the right to see and obtain copies of medical/dental information that have been used to make decisions about your care. Usually this includes medical/dental and billing records, but doesn’t include psychotherapy notes. To inspect and copy your medical information you must submit a request in writing on the appropriate form. If you request a copy of the medical/dental information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to see and obtain your medical/dental information in certain, very limited circumstances. If you are denied access to your medical/dental information, you may request that the denial be reviewed. The person who conducts the review will not be the same person who denied your request. We will comply with the outcome of the review.
- Right to Amend. If you think that medical/dental information we have about you is incorrect or incomplete, you may ask us to correct or add to the information. You have the right to request that we make amendments to clinical, billing, and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. We may deny your request if:
- The information was not created by us
- The information is not part of the records used to make decisions about you
- We believe the information is correct and complete
- You would not have the right to see and copy the record as described above.
We will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received information about you and who need the amendment. To request an amendment, your request must be in writing and submitted on the proper form.
- Right to an Accounting of Disclosures. You have the right to request an Accounting of Disclosures. This is a list of the disclosures we have made of medical/dental information about you. The Accounting of Disclosures does not include disclosures made for your treatment, billing and collection of payment for your treatment, health care operations, made to or requested by you, or that you authorized, occurring as a byproduct of permitted uses and disclosures, made to individuals involved in your care, or for other purposes described in the above subsections. To request this list or Accounting of Disclosures, you must submit your request in writing. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. While the first requested Accounting within a twelve month period is free, any request thereafter may have a fee applied to it. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time, before any costs are incurred.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the medical/dental information we use or disclose about you for treatment, payment, or health care operations. We are not required to agree with your request. If we do agree with your request, we will comply with your request unless the information is needed to provide you emergency treatment or the disclosure is required by the Secretary of the Department of Health and Human Services, and/or the uses and other disclosures listed in this notice. To request restrictions, you must make your request in writing and you must tell us:
- What information you want to limit
- Whether you want to limit our use, disclosure, or both
- To whom you want the limits to apply
- Right to Choose How We Communicate With You. You have the right to request that we communicate with you about medical/dental matters in a certain way or at a certain location. Your request must be made in writing and no reason needs to be supplied. We will honor reasonable requests.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may obtain a copy of this notice at the front desk.
Changes to This Notice
We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical/dental information we already have about you as well as any information we receive in the future.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. The address for the Secretary is:
The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201