We disclose your PHI as a part of certain
operations, such as quality improvement. For example, we may use your PHI to
evaluate the quality of dental services that were performed.
We may be asked by the sponsor of your health plan to provide your PHI to
the sponsor. If we are asked to do so, we intend to honor such requests unless
we are prohibited by law.
|Help us be prepared for your first visit by completing the Notice of Privacy Practices Acknowledgement form prior to your first visit. Download the file, print it out, fill it out, and bring it with you to your first vist.
- Notice of Privacy Practices Acknowledgement
|We may use or disclose your PHI without your authorization for several other
reasons. Subject to certain requirements, we may give out PHI without your
authorization for public health purposes, auditing purposes, research studies,
and emergencies. We provide PHI when otherwise required by law, such as
for law enforcement in specific circumstances, or for judicial or administrative
proceedings. In any other situation, we will ask for your written authorization
before using or disclosing your PHI. If you choose to sign an authorization
to allow disclosure of your PHI, you can later revoke that authorization
to stop any future uses and disclosures (other than for treatment, payment,
health care operations).
We may change our policies at any time. Before we make a significant change
in our policies, we will change our notice and send the new notice to
you. You can also request a copy of our notice at any time.
In most cases, you have the right to view or get a copy of your PHI. You also
have the right to receive a list of instances where we have disclosed your
PHI without your written authorization for reasons other than treatment,
payment, or health care operations. If you believe that information in your
record is incorrect or if important information is missing, you have the
right to request that we correct the existing information or add the missing
information. You may request in writing that we not use or disclose your
PHI for treatment, payment, and health care operations except when specifically
authorized by you, when required by law, or in emergency circumstances. We
will consider your request but are not legally required to accept it. You
also have the right to receive confidential communications of PHI by alternative
means or at alternative locations if you clearly state that disclosure of
all or part of your PHI could endanger you.
If you are concerned that we have violated your privacy rights, or you disagree
with a decision we have made about access to your records, you may contact
the address listed below. You may also send a written complaint to the U.S.
Department of Health and Human Services. Customer Service can provide you
with the appropriate address upon request.
We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice. If you wish to inspect your records, receive a listing of disclosures, or correct or add to the information in your record, or if you have any questions, complaints, or concerns, please contact our office.