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.
This notice describes the privacy practices of Today's Dentistry / Dr. Soe Dental Corporation, located at 4747 Mission Street, San Francisco, CA 94112, and all employees, staff, and other dental care personnel involved in your care and treatment at our facility.
We understand that health information about you and your dental health is personal. We are committed to protecting health information about you. We create a record of the dental care and services you receive at our office. We need this record to provide you with quality dental care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by this dental practice, whether made by dental personnel or your personal dentist. Your personal dentist may have different policies or notices regarding the dentist's use and disclosure of your health information created in the dentist's office or clinic.
This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
We are required by law to:
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
We may use health information about you to provide you with dental treatment or services. We may disclose health information about you to doctors, nurses, dental hygienists, technicians, dental students, or other dental practice personnel who are involved in taking care of you at our office.
For example, we might share information about your dental history with a specialist to whom we refer you for further dental care.
We may use and disclose health information about your dental treatment and services to bill and collect payment from you, your insurance company, or a third party payer. For example, we may need to give your health plan information about dental treatment you received at our office so your health plan will pay us or reimburse you for the treatment.
We may use and disclose health information about you for dental care operations. These uses and disclosures are necessary to run our dental practice and make sure that all of our patients receive quality care. For example, we may use your health information to evaluate the quality of care you receive, or to evaluate the performance of the dental care professionals who provide care to you.
We may use and disclose health information to contact you as a reminder that you have an appointment for dental treatment or dental care at our office.
We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
There are some services provided in our organization through contracts with business associates. For example, we may have a billing service. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
We will disclose health information about you when required to do so by federal, state or local law.
We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
If you are a member of the armed forces, we may release health information about you as required by military command authorities.
We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
We may disclose health information about you for public health activities. These activities generally include: preventing or controlling disease, injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with products; notifying people of recalls of products they may be using; and notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
We may release health information if asked to do so by a law enforcement official, for example, to identify or locate a suspect, fugitive, material witness, or missing person.
We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.
Under certain circumstances, we may use and disclose health information about you for research purposes. We will ask for your written authorization before using your health information for research.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official.
You have the following rights regarding health information we maintain about you:
You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes dental and billing records. To inspect and copy health information, you must submit your request in writing to our Privacy Officer. We may charge a fee for copying, mailing, and related supplies.
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, your request must be made in writing and submitted to our Privacy Officer.
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about you. To request this list, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years.
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care.
You have the right to request that we communicate with you about dental matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer.
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our front desk.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our office. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to the office for treatment or dental care, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer at the address below. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
For questions about this notice or to exercise your privacy rights, please contact:
Privacy Officer — Today's Dentistry
4747 Mission St, San Francisco, CA 94112
You may also contact the U.S. Department of Health & Human Services Office for Civil Rights at 1-800-368-1019 or www.hhs.gov/ocr.