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.
Whitley Family Dental is required, by law, to maintain the privacy
and confidentiality of your protected health information and
to provide our patients with notice of our legal duties and
privacy practices with respect to your protected health
information.
Disclosure of Your Health Care Information
Treatment
We may disclose your health care information to other
healthcare professionals within our practice for the purpose
of treatment, payment or healthcare operations. (example)
“On occasion, it may be necessary to seek consultation
regarding your condition from other health care providers
associated with Whitley Family Dental.”
“It is our policy to provide a substitute health care
provider, authorized by Whitley Family Dental to provide
assessment and/or treatment to our patients, without
advanced notice, in the event of your primary health care
provider’s absence due to vacation, sickness, or other
emergency situation.”
Payment
We may disclose your health information to your insurance
provider for the purpose of payment or health care
operations.
Workers’ Compensation
We may disclose your health information as necessary to
comply with State Workers’ Compensation Laws.
Emergencies
We may disclose your health information to notify or assist
in notifying a family member, or another person responsible
for your care about your medical condition or in the event
of an emergency or of your death.
Public Health
As required by law, we may disclose your health information
to public health authorities for purposes related to:
preventing or controlling disease, injury or disability,
reporting child abuse or neglect, reporting domestic
violence, reporting to the Food and Drug Administration
problems with products and reactions to medications, and
reporting disease or infection exposure.
Judicial and Administrative Proceedings.
We may disclose your health information in the course of any
administrative or judicial proceeding.
Law Enforcement.
We may disclose your health information to a law enforcement
official for purposes such as identifying or locating a
suspect, fugitive, material witness or missing person,
complying with a court order or subpoena, and other law
enforcement purposes.
Deceased Persons.
We may disclose your health information to coroners or
medical examiners.
Organ Donation.
We may disclose your health information to organizations
involved in procuring, banking, or transplanting organs and
tissues.
Research.
We may disclose your health information to researchers
conducting research that has been approved by an
Institutional Review Board.
Public Safety.
It may be necessary to disclose your health information to
appropriate persons in order to prevent or lessen a serious
and imminent threat to the health or safety of a particular
person or to the general public.
Specialized Government Agencies.
We may disclose your health information for military,
national security, prisoner and government benefits
purposes.
Change of Ownership.
In the event that Whitley Family Dental is sold or merged with
another organization, your health information/record will
become the property of the new owner.
Your Health Information Rights
You have the right to request restrictions on certain uses
and disclosures of your health information. Please be
advised, however, that Whitley Family Dental is not required to
agree to the restriction that you requested.
You have the right to have your health information received
or communicated through an alternative method or sent to an
alternative location other than the usual method of
communication or delivery, upon your request.
You have the right to inspect and copy your health
information.
You have a right to request that Whitley Family Dental amend your
protected health information. Please be advised, however,
that Whitley Family Dental is not required to agree to amend your
protected health information. If your request to amend your
health information has been denied, you will be provided
with an explanation of our denial reason(s)and information
about how you can disagree with the denial.
You have a right to receive an accounting of disclosures of
your protected health information made by Whitley Family
Dental.
You have a right to a paper copy of this Notice of Privacy
Practices at any time upon request.
Changes to this Notice of Privacy Practices Whitley Family
Dental reserves the right to amend this Notice of
Privacy Practices at any time in the future, and will make
the new provisions effective for all information that it
maintains. Until such amendment is made, Whitley Family
Dental is
required by law to comply with this Notice.
If you are not satisfied with the manner in which this
office handles your complaint, you may submit a formal
complaint to:
DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201 |
