PRIVACY POLICY NOTICE
New Design Dental Associates
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.
Uses and Disclosures: Our office is required
by law to maintain the privacy of your personal health information and to provide you, the patient, a description and at least one
example of the types of uses and disclosures that our office is permitted to make for the purpose of treatment, payment and health-care
operations, which are permitted by law without authorization by the patient. We are bound to abide by the terms of this notice
and reserve the right to make revisions to this policy. Should revisions be made, you will be notified at our next contact and
a copy of the revised policy will be made available at your request. You will be asked to sign a consent form authorizing
us to use and disclose your personal health information only for the following purposes , as defined under the Health Insurance Portability
and Accountability Act of 1996(HIPAA).
Treatment - meaning the provision, coordination, or management of health care and related
services by one or more healthcare providers, including the coordination or management of health care by a healthcare provider with
a third party; consultation between healthcare providers relating to a patient; or the referral of a patient for health care from
one healthcare provider to another. An example of this would be a referral to an Orthodontist.
Payment - meaning obtaining reimbursement
for the provision of health care; determination of eligibility or coverage; billing; claims management; collection activities; justification
of charges; and disclosure to consumer reporting agencies; protected health information relating to the collection of reimbursements(only
certain information may be disclosed). An example of this would be submitting your bill for health care services to your insurance
company.
Health Care Operations - are any activity related to covered functions in which we participate in the function of our offices,
such as conducting quality assessment activities; protocol development; case management and care coordination; auditing functions;
business management and general administrative activities, including implementation of this regulation; customer service evaluations;
resolution of grievances; and marketing for which an authorization is not required. An example of this would be evaluation of
customer service given to patients.
We may, without prior consent use or disclose your personal health information to carry out
treatment, payment or health care operations:
· Directly to you at your request
· In an emergency treatment situation, if we attempt to obtain such consent as soon as reasonably practicable after the delivery of
such treatment, if we are required by law to treat you and attempts to obtain consent are unsuccessful, or if we attempt to obtain
consent but are unable, due to barriers of communication, but we determine in our professional opinion that treatment is clearly inferred
from the circumstances;
· Pursuant to and in compliance with an authorization signed
by you; and
· Provided that you are informed in advance of the use and disclosure and
have the opportunity to agree to or prohibit or restrict the use or disclosure. This may be an oral agreement between us and
may include a directory maintained at our facility containing specific information allowed by this Act.
We may de-identify your
personal health information by using codes or removing all individually identifiable health information. All other uses and
disclosure will be made only upon securing a written authorization form signed by you. You have the right to revoke this authorization,
at any time, upon written notice and we will abide by that request. However, exception would be any actions already taken, relying
on your authorization, prior to revocation notice. We may contact you to provide appointment reminders, or to inform you about
treatment alternatives or other health related benefits or services that may be of interest to you.
Under HIPAA, you have the
following rights with respect to your protected health information:
· You have the
right to request restrictions on certain uses and disclosures of protected health information, including restrictions placed upon
disclosure to family members, close personal friends, or any other person you may identify. We are, however, not required to agree
with a requested restriction.
· You have the right to receive confidential communications
of your protected health information, either directly from us or by alternative means or from alternative locations;
· You have the right to inspect and copy your protected health information;
· You have
the right to amend protected health information, however, this request may be denied under certain circumstances.
· You have the right to receive an accounting of disclosures or your protected health information made by us in the six years prior
to the date of the accounting request; and
· You have the right to obtain a paper copy
of this notice from us, even if you have already agreed to receive the notice electronically.
If you feel your privacy rights
or the provisions of this notice of privacy policies has been violated, you have the right to file a formal complaint.
CONTACT:
For more information about our office’s privacy policies, contact:
Patricia E Amor, Privacy Director, 354-4286
EFFECTIVE
DATE: April 1, 2003