1711 N. Murray Blvd,
Colorado Springs, CO 80915
THIS NOTICE DESCRIBES HOW DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for treatment, payment or dental care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; examining your teeth; prescribing medications; referring you to another doctor or clinic for other dental care services; or getting copies of your dental/health information from another professional that you may have seen before us. Examples of how we use or disclose your dental/health information for payment purposes are: asking you about your health or dental care plans, or other sources of payment; preparing and sending bills or claim; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “dental/health care operations” mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your dental information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions; defense of legal matters; business planning; and storage of our records.
We routinely use your dental information inside our office for these purposes without any special permission. If we need to disclose your dental information outside of our office for these reasons, we usually will not as you for additional special written permissions.
USE AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose our health information without your permissions. Not all of these situations will apply to us; some may never come up at our office at all such uses or disclosures are:
Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicaid; or for investigation of possible violations of health care laws;
Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;
Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else.
Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
Uses and disclosures to prevent a serious threat to health or safety;
Disclosures relating to worker’s compensations programs’
Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;
Disclosures to “business associate” who perform dental/health care operations for us and who commit to respect the privacy of your health information;
Unless you object, we will also share relevant information about your care your family or friends who are helping you with your dental care.
We may call or write to remind you of scheduled appointments, or that it is time to make a routines appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointments reminder on a post card, and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.
OTHER USES AND DISCLOSURES
We will not make any other uses or disclosures of your health information unless you sin written “authorization form.’ The content of an “authorization form” is determined by federal law. Sometime, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it’s your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours. If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.
YOUR RIGHTS REGARDING YOUR DENTAL INFORMATION
The law gives you many rights regarding your dental information. You can:
Ask us to restrict our uses and disclosures for purposes of treatment (expect emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want.
As us to communicate with you in a confidential way, such as by phoning you at work rather than at home, or by mailing health information to a different address. We will accommodate this request if they are reasonable, and if you pay us for any extra cost.
Ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying for the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30-day extension if the time for us to give you access or photocopies if we send you a written notice of the extension.
Ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days’ form when you ask us. We will send the corrected information to persons who we know got the wrong information, and other that you specify. If we do not agree, you can write a statement of your position, and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of positions and/or our rebuttal is included in your health information. By law, we can have one 30-day extension of time to consider a request or amendment if we notify you in writing of the extension.
Get a list of the disclosures that we have made of your health information within the past six years (or shorter period if you want). By law, the list will not include: disclosures for purposes of treatment, payment or health care operations; disclosures with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30-day extension of time if we notify you of the extension in writing.
Get additional paper copies of this notice of Privacy practices upon request. It does not matter whether you got one electronically or in paper form already.
To amend restrictions, confidential communications, review or get photocopies of your dental information, amendments to your dental/health information, or additional copies of this Notice of Privacy Practices, send a written request to the office contact person(s) at the address shown at the beginning of this notice.
OUR NOTICE OF PRIVACY PRACTICES
By law we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by the law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the notice in our office and have copies available in our officer.
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Officer for Civil Rights. We will not retaliate against you if you make a compliant. If you want to complain to us, send a written compliant to the officer contact person at the address shown at the beginning of this Notice. If you prefer, you can discuss your compliant in person or by phone.