Gentle Breeze Family Dentistry Notice of 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.
OUR LEGAL DUTY
- MAINTAIN THE PRIVACY AND SECURITY OF YOUR PROTECTED HEALTH INFORMATION (PHI).
- PROVIDE YOU WITH THIS NOTICE EXPLAINING OUR LEGAL DUTIES AND PRIVACY PRACTICES.
- FOLLOW THE TERMS OF THE NOTICE CURRENTLY IN EFFECT.
- NOTIFY YOU IF A BREACH OCCURS THAT MAY HAVE COMPROMISED YOUR INFORMATION.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
- TREATMENT: TO PROVIDE, COORDINATE, OR MANAGE YOUR DENTAL CARE WITH OTHER HEALTHCARE PROVIDERS.
- PAYMENT: TO BILL AND RECEIVE PAYMENT FROM INSURANCE COMPANIES OR OTHER THIRD PARTIES.
- HEALTHCARE OPERATIONS: TO RUN OUR PRACTICE, IMPROVE CARE, TRAIN STAFF, CONDUCT AUDITS, AND FOR ADMINISTRATIVE PURPOSES.
SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER (SUD) RECORDS
- FEDERAL LAW (42 CFR PART 2) PROVIDES ADDITIONAL PRIVACY PROTECTIONS FOR SUBSTANCE USE DISORDER DIAGNOSIS, TREATMENT, OR REFERRAL RECORDS.
- WE MAY USE AND DISCLOSE SUD RECORDS FOR TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS AS PERMITTED BY LAW.
- THESE RECORDS MAY NOT BE RE-DISCLOSED BY A RECIPIENT UNLESS PERMITTED BY LAW
- WE WILL OBTAIN YOUR WRITTEN AUTHORIZATION WHEN REQUIRED FOR OTHER USES AND DISCLOSURES.
USES REQUIRING YOUR WRITTEN AUTHORIZATION
- MARKETING COMMUNICATIONS
- SALE OF PHI
- MOST SHARING OF PSYCHOTHERAPY NOTES
- OTHER USES NOT DESCRIBED IN THIS NOTICE
YOUR RIGHTS
- GET A COPY OF YOUR MEDICAL AND BILLING RECORDS
- REQUEST CORRECTIONS TO YOUR RECORDS
- REQUEST CONFIDENTIAL COMMUNICATIONS
- ASK US TO LIMIT CERTAIN USES OR DISCLOSURES
- GET A LIST OF CERTAIN DISCLOSURES WE MADE
- GET A PAPER COPY OF THIS NOTICE
- CHOOSE SOMEONE TO ACT FOR YOU
- FILE A COMPLAINT IF YOU BELIEVE YOUR RIGHTS HAVE BEEN VIOLATED
CHANGES TO THIS NOTICE
WE MAY CHANGE THIS NOTICE. UPDATED NOTICES WILL BE AVAILABLE IN OUR OFFICE AND ON OUR WEBSITE.
YOU MAY ALSO FILE A COMPLAINT WITH THE OFFICE FOR CIVIL RIGHTS, U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES. WE WILL NOT RETALIATE AGAINST YOU FOR FILING A COMPLAINT.
