The Policy explains how Sirius Dental PLLC may utilize and disclose your protected health information for the purposes of treatment, payment, or healthcare operations. Any other uses and disclosures of your information will require your written authorization, except as permitted or required by law. Additionally, the Policy details your rights regarding accessing and controlling your protected health information, and it informs you of your right to file a complaint with our office or the Secretary of Health and Human Services in the event of a violation of your rights.
We are obligated to adhere to the terms of this Policy, which may be subject to changes. Any modifications to the Policy will apply to all protected health information we maintain at the time of the change. If you wish to obtain a revised copy of the Policy, please contact our Office Manager either by phone or during your next appointment.
We kindly request that you review this Policy carefully.
NOTICE OF PRIVACY PRACTICES
This Notice provides details on how your medical information may be used, disclosed, and accessed, as well as how you can obtain access to this information. We encourage you to thoroughly review this Notice and reach out to our Office Manager if you have any questions.
We are legally required to protect the privacy of our patients’ health information and provide this Notice outlining our legal duties and privacy practices related to protected health information. Protected health information includes information about you, such as demographic details, that can identify you and is connected to your past, present, or future physical or mental health, as well as related healthcare services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Uses and Disclosures of Protected Health Information for Treatment, Payment, or Operations
Your doctor may use your protected health information for treatment, payment, and healthcare operations as described in this Policy, without requiring your explicit authorization. This includes using and disclosing your information to provide you with healthcare services, facilitate payment for those services, and support the operations of the dental practice.
Outlined below are examples of how your protected health information may be used or disclosed by your doctor and the office staff without your specific authorization. Please note that these examples are not exhaustive, but rather serve to illustrate the types of uses and disclosures that may occur in our office.
- Treatment: Your protected health information may be used and disclosed to provide, coordinate, or manage your healthcare, including consultations with other healthcare providers and coordinating services with third parties.
- Payment: Your information may be used, as needed, to obtain or provide payment for your medical services. This may involve sharing your information with entities such as health insurance plans for purposes like eligibility determination, coverage review, and utilization review before approving or paying for services.
- Operations: Your protected health information may be disclosed or used, as necessary, to support the business activities of the dental practice. These activities include quality assessment and improvement, professional competency reviews, business planning and development, and other related operations. During your visit, we may use a sign-in sheet that requires you to provide your name and indicate your treating provider. Additionally, we may call you by name in the waiting room and use or disclose your protected health information to contact you for appointment reminders.
Whenever your protected health information is shared with a business associate as part of an arrangement with our office, we ensure that a written contract is in place to safeguard the privacy of your information.
We may use or disclose your protected health information, as necessary, to provide you with information about a product or service that may be of interest to you. Such communication is limited to specific purposes and kept to a minimum.
For limited operational purposes, your protected health information may be disclosed to another healthcare provider, health plan, or healthcare clearinghouse that has or had a relationship with you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
All other uses and disclosures of your protected health information will only occur with your written authorization, unless permitted or required by law. You have the right to revoke this authorization at any time in writing, except to the extent that your doctor or the practice has taken action based on the use or disclosure indicated in the authorization.
The following section outlines your rights regarding your protected health information and provides a brief description of how you can exercise these rights.
- Right to Inspect and Copy: You have the right to inspect and obtain a copy of your protected health information contained in your medical and billing records, as well as other records that may influence your treatment decisions. However, access may be restricted to information compiled for use in legal proceedings. If you have questions about the extent of your access to your medical record, please contact our Office Manager.
- Right to Request Restrictions: You can request restrictions on the use and disclosure of your protected health information for treatment, payment, or healthcare operations. Additionally, you may request that your information not be disclosed to specific family members or friends involved in your care. Any such request must specify the desired restriction and the individuals to whom it applies. While your doctor is not obligated to agree to the requested restriction, they may accommodate your request if it is deemed in your best interest. If you wish to place any restrictions on your protected health information, please speak with our Office Manager.
- Right to Request Confidential Communications: You have the right to request alternative means or locations for communications from us regarding your protected health information. We will reasonably accommodate such requests without requiring an explanation. However, we may ask for information regarding payment arrangements or specify an alternative address or method of contact. To make this request, please submit it in writing to our Office Manager.
- Right to Request Amendments: You may request amendments to your protected health information, and while we reserve the right to deny such requests, we will consider your request for as long as we maintain the relevant information. If your amendment request is denied, you have the right to include a statement of disagreement, which we will rebut and provide you with a copy.
- Right to Receive an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures of your protected health information made by us, excluding disclosures for treatment, payment, healthcare operations, facility directories, notifications, or those for which you have provided authorization. Please note that there are exceptions, restrictions, and limitations to this right.
If you believe your privacy rights have been violated, you have the right to file a complaint with our office or the Secretary of Health and Human Services. To file a complaint with us, please notify our Office Manager. We assure you that we will not retaliate against you for filing a complaint.
For more information on the complaint process, please contact our Office Manager.
This Policy was published on June 21, 2020, and is effective as of that date.