This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please Review it carefully.
OUR LEGAL DUTY We are required by applicable federal and state law 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 takes effect 09/01/2014, and will remain effect until we replace it. 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 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 make the changes. Before we make significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION We use and disclose health information about you for treatment, payment and healthcare operations. For Example:
Treatment We may use or disclose your health information to a physician or or other healthcare provider providing treatment to you.
Payment We may use and disclose your health information to obtain payment for services provided to you, unless you request that we restrict such disclosure to your health plan when you have paid out-of-pocket and in full for services rendered.
Healthcare Operations We may use and disclose your health information for treatment, payment or healthcare operations, include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, , accreditation, certification, licensing or credentialing activities.
Your Authorization In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.
To Your Family and Friends We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclosure your information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare but only if you agree that we may do so.
Persons Involved in Care We may use or disclose health information to notify, or assist in the notification of (including identifying or locating a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgement and experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of health information.
Marketing Health-Related Services We will not use your health information for marketing without your written authorization.
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 safety of others.
National Security We may disclose to the 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 correctional institution or law enforcement official having lawful custody of protected health information of 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, text messages, postcards or letters).
Patient Rights Access You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photo copies. We will use the format that you request unless we cannot practicably do so. (You must make a request in writing to obtain access to your health information. You may obtain a from to request access by using the contact information listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. You may also request access by sending us a letter to the address at the end of this Notice.
Alternative Communication You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. (You must make your request in writing.) Our request must specify the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative means or location you request.
Breach Notification In the event your unsecured protected health information is breached, we will notify you as required by law. In some situations, you may be notified by our business associates.
Amendment You have the right to request that we amend your health information. (Your request must be in writing, and it must explain why the information should be amended.) We may deny your request under certain circumstances.
Electronic Notice If you receive this Notice on our website or by electronic mail (email), you are entitled to receive this Notice in written form.
Change of Ownership If this dental practice is sold or merged with another practice or organization, your health records will become the property of the new owner. However, you may request that copies of your health information be transferred to another dental practice.
Public Health We may, and are sometimes legally obligated, to disclose your health information to public health agencies for purposes related to preventing or controlling disease, injury or disability: reporting abuse or neglects; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications;and reporting disease or infection exposure. Upon reporting suspected elder or dependent adult abuse or domestic violence, we will promptly inform you or your personal representative unless we believe the notification would place you at risk of harm or would require informing a personal representative we believe is responsible for the abuse or harm.
Questions and Complaints If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we make about access to your health information or in response to a request you make to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may send a written complaint to our office or the U.S. Department of Health and Human Services and the Office of Civil Rights.We will not retaliate against you for filing a complaint.
Contact Officer: Moya Denicore, Office Manager Telephone: (831) 430-9910 Fax: (831) 430-9914 Be Sure to include “HIPPA” in the subject heading. Email: [email protected] Web address: www.scottsvalleyoms.com Address: 223 Mount Hermon Road, Suite B, Scotts Valley, CA 95066