THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REIVEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practice, our legal duties, and your rights concerning your health information.
We reserve the right to change our Privacy Practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our Privacy Practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:
TREATMENT: We may use or disclose your health information to a physician, dentist or other provider that may be providing you with treatment or that we may have referred you to.
PAYMENT: We may use and disclose your health information to obtain payment for services we provide to you.
HEALTHCARE OPERATIONS: We may use and disclose your health information in connection with our healthcare operations. For example: Your information may be used by your dentist and staff in this office only, to make quality assessments and improvements to our office procedures. We may also use your information in reviewing the competence and qualifications of other healthcare professionals we may have referred you to. In the process of continuing education and accreditation for the dentists in this office, your information may be used in their case presentation, such as x-rays or description of services rendered. Your name or photo will not be made public in these presentations.
YOUR AUTHORIZATION: Your authorization gives us the authority to use your health information for treatment, payment or healthcare operations. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.
TO YOUR FAMILY AND FRIENDS: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
PERSONS INVOLVED IN CARE: We may use or disclose health information to notify a family member, your personal representative or another person responsible for your care of your general health condition or dental condition. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures to persons other than yourself. In the event of your incapacity or emergency circumstances, we will disclose health information based on our professional judgment of the immediate situation. We will disclose only health information that is directly relevant to the person's involvement in your healthcare. We will also use our professional judgment and reasonable care when we allow any person other than you to pick up filled prescriptions, medical supplies, x-rays or other similar forms of health information.
MARKETING HEALTH-RELATED SERVICES: We will not use your health information for marketing communications.
REQUIRED BY LAW: We may use or disclose your health information when we are required to do so by law.
ABUSE OR NEGLECT: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
NATIONAL SECURITY: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
APPOINTMENT REMINDERS: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters.)
PATIENT RIGHTS ACCESS: You have the right to look at or get copies of your health information. You must make a request in writing to obtain access to your health information. We will charge you a reasonable cost based on expenses such as copies and staff time. You may request access by sending us a letter to the address at the end of this Notice. If you request copies, the charge to you will be $25.00 - $50.00 depending on the size of your chart and the time needed to locate and copy your health information, plus any postage due if you want the copies mailed to you. If you prefer, we will prepare a summary or an explanation of your health information for a fee.
RESTRICTION: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
ALTERNATIVE COMMUNICATION: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. (You must make your request in writing.) Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.
AMENDMENT: You have the right to request that we amend your health information. (Your request must be in writhing, and it must explain why the information should be amended.) We May deny your request under certain circumstances.
ELECTRONIC NOTICE: If you receive this Notice on our Web site or by electronic mail (e-mail), you are entitled to request this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us;
Heritage Dental DDS
Heritage Executive Campus
595 Bethlehem Pike
Suite 302
Montgomeryville, PA 18936
USA
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of health and Human Services upon request.
