Our Legal Duty
Your Courtesy Dental & Orthodontics practice (“we,” “our,” “us”), like all other medical and dental practices, is required by applicable federal and state laws to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice went into effect May 15, 2015. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us according to the means outlined in this notice.
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 DISCLOSURE OF HEALTH INFORMATION
TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
Courtesy Dental & Orthodontics uses and discloses your protected health information for treatment, payment and health care operations. It is the general policy of Courtesy Dental & Orthodontics that protected health information will be used and disclosed only in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) privacy standards and all other applicable state and federal laws, rules and regulations. Some examples of when our office may use or disclose your health care information for these purposes include:
– Sharing test results with other health care providers for confirmation of a diagnosis;
– Providing your diagnosis or other information about your health to your insurance
provider or our billing service to obtain payment for the health care services we provide;
– Reviewing information as part of our quality assurance program.
OTHER USES AND DISCLOSURES
Courtesy Dental & Orthodontics may also use or disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:
– Providing you with information related to your health;
– Contacting you regarding appointments, information about treatment alternatives, or
other health related services;
– Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.);
– Compliance with all laws (including reports of suspected abuse, neglect or violence);
– Providing certain specified information to law enforcement or medical examiner;
– Providing information to a worker’s compensation program for a work-related injury;
– Public health activities when requested by a public health authority or the FDA;
– Responding to court orders, subpoenas, discovery requests or other lawful process;
– When necessary to avert a serious threat to health or safety;
– Providing information to military or veterans affairs;
– Informing a family member, other relative, or close personal friend when:
• Information is relevant to the individuals’ involvement with your care;
• Notification of your location or general condition;
• To assist in your heath care (e.g., pick-up prescriptions or other documents, note follow-up care instructions, etc.).
Marketing Health-Related Services: We may use Patient Information internally to offer goods and services we believe may be of interest. We may use Patient Information to contact you to inquire or survey about the Patient experience at the location(s) visited and the prospect of future services or improvements needed to continue as your services provider. We may also create and use aggregate Patient Information that is not personally identifiable to understand more about the common traits and interests of our Patients.
We may utilize one or more third-party service providers to send email or other communications to you on our behalf, including Patient satisfaction surveys. These service providers are prohibited from using your email address or other contact information for any purpose other than to send communications on our behalf.
It is our intention to only send email communications that would be useful to you and that you want to receive. When you provide us with your email address as part of the registration or appointment setting process, we will place you on our list of patients to receive informational and promotional emails. In addition, patients and visitors to our website are given the opportunity to “opt-in” to receive electronic promotional communications by selecting the option to receive promotional emails from us on our website.
Each time you receive a promotional email, you will be provided the choice to “opt-out” of future emails by following the instructions provided in the email, or you can “opt-out” at any time by following the instructions provided.
- Measure usage of various pages on our website to help us make our information more pertinent to your needs and easy for you to access; and
- Provide functionality such, as online appointing, bill paying and other functionalities that we believe would be of interest and value to you.
Fundraising: We will not use your health information for fundraising activities without your written consent.
Required by Law: We may use or disclose your health information when we are required to do so by law.
Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence, or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety, or the health or safety of others.
National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose, to authorized federal officials, health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to a correctional institution or law enforcement official having lawful custody of protected health information of an inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
AUTHORIZATION FOR OTHER USES
Courtesy Dental & Orthodontics will make other uses and disclosure of your protected health information only after obtaining your written authorization. If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us in writing that you wish to revoke your authorization.
YOUR RIGHTS REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION
Subject to limitations outlined by law, you have certain rights related to use and disclosure of your protected health information, including the right to:
– Request restrictions on certain uses and disclosures. However, Courtesy Dental &
Orthodontics is not obligated to agree to requested restrictions;
– Receive confidential communications of protected health information;
– Inspect and copy your protected health information with some limited exceptions;
– Amend your health information;
– Receive an accounting of disclosures of your health information;
– Obtain a copy of this notice.
COURTESY DENTAL & ORTHODONTICS DUTIES REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION
Subject to limitations outlined by law, Courtesy Dental & Orthodontics has certain duties related to your protected health information, including:
– Courtesy Dental & Orthodontics is required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information.
– Courtesy Dental & Orthodontics is required to abide by the terms of the privacy notice that is currently in effect.
– Courtesy Dental & Orthodontics reserves the right to change a privacy practice described in this notice and to make such change effective for all protected health information. Revised notice will be posted in our office and available upon request.
If you believe your privacy rights have been violated, you may make a complaint by contacting our Customer Service Department at (800) 441-6440.