This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review carefully. The privacy of your health information is important to us.
We are required by law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect. This Notice takes effect June 22, 2009, and will remain in effect until we replace it.
We may change our privacy practices—and the terms of this Notice—at any time, as permitted by law. Any change will apply to all health information we maintain, including information created or received before the change. A current copy of the Notice will be posted in our office and on our website (www.dentalworks.com). The effective date appears at the top of the Notice.
You may request a copy of the Notice at any time. For more information, or for additional copies, contact the Privacy Officer listed at the end of this Notice.
We may use and disclose health information about you for treatment, payment, and health-care operations. For example:
Treatment We may use or disclose your health information to another dentist or health-care provider treating you, or if we refer you to another provider.
Payment We may use and disclose your health information to obtain payment for services. This may include sharing information with our billing department, your insurance company, collection agencies, attorneys assisting with collections, or others responsible for your bills (for example, your spouse). For instance, we may send your insurer information about a dental procedure so it will pay us or reimburse you.
Health-care operations We may use and disclose your health information for our operations, such as quality-assessment activities; reviewing professional competence; evaluating provider performance; conducting training; and handling accreditation, certification, licensing, or credentialing.
To your family, friends, and others involved in your care We may share information directly related to a person’s involvement in your care or payment, or to notify them of your location or general condition—only if you agree, or if we judge you would not object.
Use and disclosure required by law We may use or disclose your health information when required by federal or state law; in court or administrative proceedings; for public-health activities; to oversight agencies; to coroners, medical examiners, and funeral directors; to the military; to federal officials for lawful intelligence and national-security activities; to correctional institutions; to law-enforcement officials; to report abuse, neglect, or domestic violence; to avert serious threats to health or safety; and as allowed by workers’-compensation laws.
Marketing health-related services We will not use your health information for marketing communications without your written authorization.
Contacting you We may use or disclose your health information to contact you about appointments and other matters and to send electronic billing statements. We may contact you by telephone, email, or mail and may leave messages at the number you provide.
Health-related services We may send you information about our health-related products and services, dental-health news, and special offers. We will tell you how to opt out.
Your authorization Except as described in this Notice, we will not use or disclose your health information for any other purpose without your written authorization. You may revoke an authorization in writing at any time; the revocation will not affect any use or disclosure already made.
Right to see and copy your health information You may inspect or receive copies of your health information, with limited exceptions. If we deny your request, we will explain the reason in writing and describe any review rights you have. Requests must be written, signed, and dated. We may charge reasonable fees for copies, staff time, and postage. With your agreement, we can instead provide a summary or explanation for a fee.
Right to an accounting of disclosures You may receive a list of instances—within the past six years (but not before April 14, 2003)—in which we or our business associates disclosed your information for purposes other than treatment, payment, health-care operations, and certain other activities. Additional requests in a 12-month period may incur a reasonable fee. Requests must be written, signed, and dated.
Your request must be mailed to the Privacy Officer, 17300 Dallas Parkway, Suite 1070, Dallas, TX 75248.
Right to request restriction You may ask us to limit certain uses or disclosures of your health information (including to family or friends involved in your care). Requests must be written, signed, and dated. Although we are not required to agree, we will comply with any agreed restriction except in emergencies.
Right to request alternative communication You may request that we contact you by alternative means or at alternative locations (for example, only at work). Requests must be written, signed, dated, and state how/where you wish to be contacted.
Right to request amendment You may ask us to amend your health information. Requests must be written, signed, dated, and state why the amendment is needed. If we deny the request, we will explain why in writing and outline your options.
Right to written notice If you are viewing this Notice electronically, you may request a paper copy.
If you want more information about our privacy practices, or have questions or concerns, please contact us.
If you believe your privacy rights have been violated, you may complain to us (see contact information below) or to the U.S. Department of Health and Human Services. We will not retaliate if you file a complaint.
Privacy Officer
17300 Dallas Parkway, Suite 1070
Dallas, TX 75248
Telephone: 440-684-6940
