Privacy Policy

NOTICE OF PRIVACY PRACTICES  THIS NOTICE EXPLAINS HOW YOUR HEALTH INFORMATION MAY BE UTILIZED AND SHARED, AND HOW YOU CAN ACCESS IT. PLEASE READ IT THOROUGHLY.  WE VALUE THE PRIVACY OF YOUR HEALTH INFORMATION.  OUR LEGAL DUTY  Under relevant federal and state laws, we must protect the privacy of your health information. We are obligated to provide this Notice detailing our privacy practices, legal responsibilities, and your rights related to your health information. We will adhere to the practices outlined in this Notice as long as it remains active. This Notice becomes effective on April 14, 2003, and stays in place until updated.  We retain the ability to modify our privacy practices and this Notice's terms at any point, as long as such modifications comply with applicable laws. These changes will apply to all health information we hold, including data created or obtained prior to the updates.  Prior to implementing a major change in our privacy practices, we will revise this Notice and offer the updated version upon request. For additional details on our privacy practices or to obtain a copy of this Notice, please reach out using the contact details on our website.  USES AND DISCLOSURES OF HEALTH INFORMATION  We utilize and share your health information for purposes of treatment, payment, and healthcare operations. Examples include:  Treatment: We might share or use your health information with a doctor or another provider treating you.  Payment: We could use and share your health information to secure payment for the services delivered to you.  Healthcare Operations: We may use and disclose your health information for our operational needs, such as quality evaluations, assessing professional qualifications, performance reviews, training initiatives, and activities related to accreditation, certification, licensing, or credentialing.  Your Authorization: Beyond using your health information for treatment, payment, or operations, you can provide written permission for us to use or disclose it to any party for any reason. You can withdraw this authorization in writing anytime, though it won't impact prior uses or disclosures allowed under it. Without your written consent, we won't use or disclose your health information except as noted here.  To Your Family and Friends: As outlined in the Patient Rights section, we must share your health information with you. We may also share it with family, friends, or others as needed to assist with your care or payments, but only with your agreement.  Persons Involved In Care: We could use or disclose health information to inform or help notify (including locating or identifying) a family member, personal representative, or another caregiver about your whereabouts, overall status, or passing. If you're available, we'll allow you to object before any such use or disclosure.  In cases of incapacity or emergencies, we'll share health information using professional judgment, limiting it to what's relevant to the person's role in your care.  We'll also apply our judgment and standard practices to reasonably determine your best interests when permitting someone to collect prescriptions, supplies, x-rays, or similar health items.  Marketing Health-Related Services: We won't use your health information for marketing without your written consent.  Required by Law: We may use or disclose your health information if mandated by law.  Abuse or Neglect: If we reasonably suspect you're a victim of abuse, neglect, domestic violence, or other crimes, we may share your health information with authorities. We'll disclose as needed to prevent serious threats to your health, safety, or that of others.  National Security: Under specific conditions, we may share health information of Armed Forces members with military officials. We could disclose to federal authorities for intelligence, counterintelligence, or national security purposes. We may also share with correctional facilities or law enforcement holding custody of an inmate's or patient's protected health information in certain situations.  Appointment Reminders: We might use or disclose your health information for reminders about appointments (like voicemails, postcards, or letters).  PATIENT RIGHTS  Access: With some exceptions, you can review or obtain copies of your health information. You may ask for copies in formats besides photocopies, and we'll comply if feasible. (Requests must be written.) We may apply a reasonable, cost-based fee for copying and staff efforts. For alternative formats, we'll charge accordingly.  Disclosure Accounting: You can request a record of disclosures we or our associates made of your health information, excluding those for treatment, payment, operations, and select activities (not prior to April 14, 2003). Additional requests within 12 months may incur a reasonable, cost-based fee.  Restriction: You can ask us to add restrictions on how we use or disclose your health information. We're not obligated to agree, but if we do, we'll honor it (except in emergencies).  Alternative Communication: You can request alternative methods or locations for communicating about your health information. {Requests must be written.} Specify the alternatives and explain payment handling under them.  Amendment: You may request amendments to your health information. (Requests must be written and justify the change.) We might deny under specific conditions.  Electronic Notice: If you get this Notice via our website or email, you're entitled to a written copy.  QUESTIONS AND COMPLAINTS  For more on our privacy practices, questions, or concerns, contact us via the details on our website. If you believe we've breached your privacy rights or disagree with decisions on access, amendments, restrictions, or alternative communications, complain using our contact info.  You can also file a written complaint with the U.S. Department of Health and Human Services; we'll supply the address upon request. We uphold your health information privacy and won't retaliate for complaints filed with us or HHS.  ©2002, 2009 American Dental Association. All Rights Reserved. Reproduction and use of this form by dentists and their staff is permitted. Any other use, duplication or distribution of this form by any other party requires the prior written approval of the American Dental Association.  This Form is educational only, does not constitute legal advice, and covers only federal, not state, law (August 14, 2002; April 30, 2009).