THIS PRIVACY NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS VERY IMPORTANT TO US.
We use and disclose health information about you for treatment, payment and healthcare operations. Your protected health information (including individually identifiable information such as names, phone numbers**, email addresses, home addresses, social security numbers, demographic data, etc.) may be used or disclosed by us in the following respects:
- Internally, to staff members who have a role in providing or coordinating your orthodontic treatment;
- To other healthcare providers (your general dentist, oral surgeon, etc.) in connection with our rendering orthodontic treatment to you;
- To third party payers (insurance companies, employers with direct reimbursement, administrators of flexible spending accounts, etc.) or spouses in order to obtain payment of your account;
- To certifying, licensing and accrediting bodies (the American Board of Orthodontics, state dental boards, etc.) in connection with obtaining certification, licensure or accreditation;
- To your family members and close friends involved in your treatment;
- To provide you with appointment reminders or information about your treatment or other health-related benefits and services;
- In connection with our healthcare operations, including quality assessment/improvement activities, conducting training programs and evaluating practitioner/provider performance;
- When we are required to do so by law;
- To appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes, to the extent necessary to avert a serious threat to your health/safety or the health/safety of others;
- To military authorities or 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 protected health information to correctional institution or law enforcement officials having lawful custody under certain circumstances.
** Mobile phone numbers collected to opt in for SMS communication purposes (SMS Consent Form) will not be shared with any third parties or affiliates for marketing purposes. See SMS Terms & Conditions for additional information.
Under the privacy rules, you have the right to:
- Request a paper copy of this Privacy Notice;
- Give us written authorization to disclose your health information to anyone for any purpose. Authorizations may be revoked in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect;
- Request restrictions on the use and disclosure of your protected health information;
- Request confidential communication of your protected health information (for example, if you prefer communication via your mobile telephone rather than a residential telephone);
- Obtain and inspect copies of your protected health information upon written request (we may charge you a reasonable cost-based fee for such copies). You may ask that we provide copies in a format other than photocopies and we will use the format you request unless we cannot practicably do so;
- Amend or modify your protected health information in certain circumstances;
- Receive an accounting of certain disclosures made by us of your protected health information for purposes other than treatment, payment, healthcare operations and certain other activities for the last 6 years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests;
- Submit inquiries or complaints regarding any violation by us of your privacy rights to Dr. Sotomayor (our Privacy Contact Person) at our office address or the United States Secretary of Health and Human Services (must be filed within 180 days of the violation).
We have the following duties under the privacy rules:
- By law, to maintain the privacy of protected health information and provide you with this notice setting forth our legal duties and privacy practices with respect to such information;
- To abide by the terms of our current Privacy Notice;
- To advise you of our right to change the terms of this Privacy Notice and to make the new provisions effective for all protected health information maintained by us, and that if we do so, we will provide you with a copy of the revised Privacy Notice.
Please note that we are not obligated to:
- Honor any request by you to restrict the use or disclosure of your protected health information;
- Provide an atmosphere that is totally free of the possibility that your protected health information may be incidentally overheard by other patients and third parties.