NOTICE OF PRIVACY PRACTICES
Effective Date: 11.01.2024
This Notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your protected health information (PHI). We must also provide you with this Notice of our legal duties and privacy practices with respect to your health information and follow the terms of this Notice.
We are committed to protecting your health information and maintaining confidentiality.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use and disclose your health information without your written authorization in the following ways:
For Treatment
We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. This may include communication with other healthcare providers regarding your treatment and coordinating your care with third parties.
For Payment
We may use and disclose your health information to obtain payment for the services we provide. This may include contacting your insurance company, billing and collection services, or other third-party payers.
For Healthcare Operations
We may use and disclose your health information for internal operational purposes, such as quality assessment and improvement activities, training programs, licensing, and administrative purposes.
OTHER USES AND DISCLOSURES PERMITTED BY LAW
We may also disclose your information without your written authorization in the following circumstances:
As required by federal, state, or local law
To public health authorities for disease reporting, injury reporting, or other public health purposes
To report abuse, neglect, or domestic violence as permitted by law
For health oversight activities such as audits, inspections, or investigations
In connection with legal proceedings or law enforcement activities
To coroners, medical examiners, and funeral directors
For organ donation and transplant purposes
For workers’ compensation or similar programs
To prevent or lessen a serious threat to health or safety
For specialized government functions such as military or national security activities
DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
All other uses and disclosures of your health information not described in this Notice will be made only with your written authorization. This includes:
Most uses and disclosures of psychotherapy notes
Uses and disclosures for marketing purposes
Sale of your health information
You may revoke any authorization at any time in writing, except to the extent we have already taken action based on your prior authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your protected health information:
Right to Access
You have the right to inspect and obtain a copy of your health information maintained by us, with limited exceptions. We may charge a reasonable fee for copies.
Right to Request Amendment
If you believe your records are inaccurate or incomplete, you may request that we amend your records. Your request must be in writing and explain the reason for the amendment. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures
You have the right to receive a list of disclosures we have made of your health information, other than for treatment, payment, and healthcare operations.
Right to Request Restrictions
You may request that we restrict how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except if you pay for a service out-of-pocket in full and request that the information related to that service not be disclosed to a health plan.
Right to Request Confidential Communications
You have the right to request that we communicate with you in a specific way or at a certain location (e.g., sending mail to a P.O. Box). We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice, even if you have agreed to receive it electronically.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice at any time. Any changes will apply to the health information we already have and any new information we receive. A copy of the current Notice will be posted in our office and on our website (if applicable).COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the Office for Civil Rights at the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.To file a complaint with our office or obtain more information, please contact:
The Dental Retreat LLC
125 Botanical Circle, Travelers Rest, SC 29690
(864) 836-3611
info@thedentalretreat.com