Notice of Privacy Practices
It is essential that we provide the following information about privacy practices to our patients.
All information that is obtained from you by this dental office is protected and kept confidential. Every reasonable measure to prevent unauthorized disclosure of your health information is practiced.
Uses and Disclosures
- Your protected health information is accessed and used for healthcare related purposes only.
- Your protected health information is never sold, rented, transferred, exchanged and or used for non-healthcare related purposes including marketing activities without you written authorization.
- Your protected health information is disclosed to third-party entities without your written authorization for the purpose of treatment, to obtain payment for treatment and for healthcare operations.
*Conditions and limitations may apply. Please obtain additional information from the office manager.
Your protected health information can be disclosed by the dentist without your written authorization in certain limited circumstances:
- Medical emergencies
- In situations required by the law
- Individuals involved in your care
- When requested by public health agency
- When requested by a law enforcement agency
For any purpose other than treatment, obtaining payment, healthcare operations or certain limited circumstances, we will ask you for your written authorization before using or disclosing your protected health information. If you choose to sign an authorization to disclose protected health information, you can revoke that authorization in writing at any time.
- You have the right to request in writing to inspect and or receive a copy of your health information.*
- You have the right to request in writing an alternate means or location to receive communications regarding your health information.*
- You have the right to request in writing to amend, correct or delete any recorded health information within our possession.*
- You have the right to request in writing to restrict some of the uses and disclosures of your health information.*
- You have the right to request in writing an accounting of certain disclosures of your health information that were made by this office.*