Notice of Privacy Practices
Notice of Privacy Practices
THIS NOTICE DECRIBES HOW MEDICAL/DENTAL INFORMATION ABOUT YOU MAY BE SUED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS INFORMATION CAREFULLY!!
The Health Insurance and Portability Account Act of 1996 (HIPAA) requires all health care records and other individually identifiable health information used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient or responsible party (if patient is under the age of 18) significant rights to understand and control how your health information is used. HIPAA provides penalties to covered entities in the case of misused personal health information. As required by HIPAA we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
Without specific written authorization we are permitted to use and disclose your health care records for the purposes of treatment, obtaining payment or in the instance of other health care operations.
· TREATMENT: Providing, coordinating or managing health care and related services by one or more health care providers. Examples of treatment would include: crowns, fillings, teeth cleaning services, etc.
· PAYMENT: The activities necessary for obtaining reimbursement for services, confirming coverage, billing or collection activities and utilization reviews. An example of this would be bill your dental plan for your dental services.
· HEALTH CARE OPERATIONS: The business aspects of running our dental practice such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis and customer service. An example would include a periodic assessment of our protocols and documentation, including electronic records.
In addition, your confidential information may be used to remind you of an appointment (by telephone, mail, email or text message) or provide you with information about treatment or other health related services. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions based on your previous authorization.
You have certain rights in regard to your protected health information which you can exercise by presenting a writing request to our Privacy Office at the practice address listed below:
The right to request restrictions on certain uses and disclosure of protected health information, including those related to disclosures to family members, other relatives, close personal friends or any other person identifies by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction we must abide by it unless you agree in writing to remove it.
The right to request that you receive confidential communications of protected health information from us by alternative means or at alternative locations.
The right to access, inspect and obtain a copy of your protected health information.
The right to request an amendment to your protected health information.
The right to receive an accounting of disclosure of protected health information outside of treatment, payment and health care operations.
The right to obtain a secondary copy of this notice from us upon request.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.
This notice is effective as of April 14, 2003 (with revision on April 22, 2015) and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the revised notice from this office.
You have the right to file a formal written complaint with us at the address below or with the Department of Health and Human Services, Office of Civil Rights in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.
For more information about our Privacy Practices please contact:
Cathi A. Gardner, Privacy Officer / Business Manager for Dr. Valerie A. Wroblewski 8210 Louisiana Blvd., NE Suite A Albuquerque, New Mexico 87113
For more information about HIPAA or to file a complaint please contact:
The U.S. Department of Health & Human Services Office of Civil Rights 200 Independence Avenue, SW Washington, DC 20201