NOTICE OF PRIVACY PRACTICES

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.

OUR RESPONSIBILITIES

We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI).
  • Provide you with this Notice of our legal duties and privacy practices regarding your PHI.
  • Notify you if a breach occurs that may have compromised the privacy or security of your information.
  • Follow the terms of this Notice that is currently in effect.

We may change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website (if applicable).

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

The following categories describe different ways we may use and disclose your PHI. Not every use or disclosure in a category will be listed, but all of the ways we are permitted to use and disclose information will fall within one of the categories.

1) For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental care and related services. For example, we may disclose information to another dentist, physician, specialist, laboratory, pharmacy, or other health care provider who is involved in your care.

2) For Payment

We may use and disclose your PHI to bill and collect payment for services you receive. For example, we may provide information to your dental plan, insurance company, or other payer to verify coverage, determine benefits, or process claims.

3) For Health Care Operations

We may use and disclose your PHI for office operations, quality assessment, training, and other activities necessary to run our practice and support patient care. For example, we may use information to evaluate staff performance, conduct audits, or improve services.

4) Appointment Reminders, Treatment Alternatives, and Health-Related Benefits/Services

We may contact you to remind you of an appointment or tell you about treatment options or other health-related benefits and services that may be of interest to you.

5) Individuals Involved in Your Care or Payment for Your Care

Unless you object, we may disclose your PHI to a family member, friend, or other person you identify who is involved in your care or helps pay for your care. We may also disclose information to notify (or assist in notifying) such persons of your location or general condition.

6) As Required by Law and for Public Health and Safety

We may disclose your PHI when required to do so by federal, state, or local law, and for certain public health and safety purposes, including to report abuse, neglect, or domestic violence (when required or authorized by law), to avert a serious threat to health or safety, or for health oversight activities.

7) Other Permitted Disclosures

We may disclose PHI for other reasons permitted or required by law, such as for judicial or administrative proceedings, law enforcement purposes, to coroners or medical examiners, for workers’ compensation, and for certain government functions, subject to applicable legal requirements.

SPECIAL PROTECTIONS FOR CERTAIN SUBSTANCE USE DISORDER (SUD) TREATMENT RECORDS (42 CFR PART 2)

Some information we may receive or maintain about you may be subject to additional federal confidentiality protections for substance use disorder (SUD) patient records under 42 CFR Part 2 (“Part 2 records”). If you are a patient of a federally assisted SUD treatment program, those records may have stricter rules on when they can be used or disclosed—especially for certain legal or law enforcement requests. If Part 2 records are part of your file, we will follow the applicable Part 2 requirements in addition to HIPAA.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

In most cases, we will obtain your written authorization before using or disclosing your PHI for purposes other than those described in this Notice or otherwise permitted by law. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

YOUR RIGHTS

You have the right to:

  • Get a paper copy of this Notice, even if you agreed to receive it electronically.
  • Inspect and obtain a copy of your dental records and other PHI we maintain about you, subject to certain exceptions and fees allowed by law.
  • Ask us to correct your PHI if you believe it is incorrect or incomplete.
  • Request confidential communications (for example, ask us to contact you at a different phone number or address).
  • Ask us to limit what we use or share. We are not required to agree to all requests, but we will comply with a request to restrict disclosure to your health plan if you pay for an item or service in full out-of-pocket and ask us not to share that information for payment or health care operations.
  • Get a list (accounting) of certain disclosures we have made of your PHI, as provided by law.
  • Choose someone to act for you (a personal representative) to exercise your rights and make choices about your health information.
  • File a complaint if you feel your rights have been violated.

HOW TO EXERCISE YOUR RIGHTS OR ASK QUESTIONS

To exercise any of the rights described above, or to request additional information, contact our Privacy Officer/Contact listed at the top of this Notice. We may ask you to submit your request in writing and may provide you with forms to complete.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer/Contact. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

OTHER INFORMATION

Business Associates: We may share your PHI with certain service providers (“business associates”) who perform services for us (such as billing, IT support, or shredding) and are required by law to protect your information.

ACKNOWLEDGMENT OF RECEIPT

We will make a good-faith effort to obtain your written acknowledgment that you received this Notice. Your care will not be conditioned on signing an acknowledgment.

                                    Sunrise Dental-Notice of Privacy Practices