HIPAA Compliance

Treatment: We may disclose your medical information, without your prior approval, to another dentist or healthcare provider  working in our facility or otherwise providing you treatment for the purpose of evaluating your health, diagnosing medical  conditions and providing treatment. For example, your health information may be disclosed to an oral surgeon to determine  whether surgical intervention is needed.  

Payment: We provide dental services. Your medical information may be used to seek payment from your insurance plan or from  you. For example, your insurance plan may request and receive information on dates that you received services at our facility in  order to allow your employer to verify and process your insurance claim.  

Health Care Operations: We may use and disclose your medical information, without your prior approval, for health care  operations. Health care operations include: 

∙ healthcare quality assessment and improvement activities; 

∙ reviewing and evaluating dental care provider performance, qualifications and competence, health care training programs,provider accreditation, certification, licensing and credentialing activities; 

∙ conducting or arranging for medical reviews, audits and legal services, including fraud and abuse detection and prevention;and 

∙ business planning, development, management and general administration including customer service, complaint resolutions and billing, de-identifying medical information, and creating limited data sets for health care operations, publichealth activities and research. 

We may disclose your medical information to another dental or medical provider or to your health plan subject to federal privacy  protection laws, as long as the provider or plan has had a relationship with you and the medical information is for that provider’s or health plan’s care quality assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection and prevention. 

Your Authorization: You (or your legal personal representative) may give us written authorization to use your medical information  or to disclose it to anyone for any purpose. Once you give us authorization to release your medical information, we cannot  guarantee that the person to whom the information is provided will not disclose that information. You may take back or “revoke”  your written authorization at any time, except if we have already acted based on your authorization. Your revocation will not affect  any use or disclosure permitted by your authorization while it was in effect. Unless you give us written authorization, we will not use  or disclose your medical information for any purpose other than those described in this notice. We will obtain your authorization  prior to using your medical information for marketing, fundraising purposes or for commercial use. Once authorize, you may opt out  of these communications at any time.  

Family, Friends and Others involved in your care or payment for care: We may disclose your medical information to a family  member, friend or any other person you involve in your care or payment for your health care. We will disclose on the medical  information that is relevant to the person’s involvement.  

We may use or disclose your name, location and general condition to notify, or to assist an appropriate public or private agency to  locate and notify, a person responsible for your care in appropriate situations, such as a medical emergency or during disaster relief  efforts.  

We will provide you with an opportunity to object to these disclosures, unless you are not present or are incapacitated or it is an  emergency or disaster relief situation. In those situations, we will use our professional judgment to determine whether disclosing  your medical information is in your best interest under the circumstances.  

Health-Related Products and Services: We may use your medical information to communicate with you about health-related  products, benefits, services, payment for those products and services and treatment alternatives.  

Reminders: We may use or disclose medical information to send you reminders about your dental care, such as appointment  reminders via US Mail, email and telephone. By providing your email address to us, you agree that you may receive reminders and  breach notifications via email as a possible alternative to US Mail. It is the policy of our office to leave a message on any voicemail or  answering machine that may be attached to a number that you provide (home, cell or work). If you prefer that we NOT leave a  message to confirm treatment or your appointments, please check this box. 

Plan Sponsors: If your dental insurance coverage is through an employer’s sponsored group dental plan, we may share summary  health information with the plan sponsor.  

Public Health and Benefit Activities: We may use and disclose your medical information, without your permission, when required  by law and when authorized by law for the following kinds of public health and public benefit activities; 

∙ for public health, including to report disease and vital statistics, child abuse, adult abuse, neglect or domestic violence; ∙ to avert a serious an imminent threat to health or safety; 

∙ for health care oversight, such as activities of state insurance commissioners, licensing and peer review authorities andfraud prevention agencies; 

∙ for research; 

∙ in response to court and administrative orders and other lawful process; 

∙ to law enforcement officials with regard to crime victims and criminal activities; 

∙ to coroners, medical examiners, funeral directors and organ procurement organizations; 

∙ to the military, to federal officials for lawful intelligence, counterintelligence, and national security activities, and tocorrectional institutions and law enforcement regarding persons in lawful custody; and ∙ as authorized by state worker’s compensation laws. 

1) HIV/AIDS; 

Special protections for SUD records: Substance Use Disorder (SUD) Treatment records have enhanced protections. They cannot be 2) Mental Health; 

used in legal proceedings without your consent or court order. 

3) Genetic Tests (in accordance with GINA 2009);

If a use or disclosure of health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.  

Business Associates: We may disclose your medical information to our business associates that perform functions on our behalf or  provide us with services if the information is necessary for such functions or services. Our business associates are required, under  contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as  specified in our contract.  

Data Breach Notification Purposes: We may use your contact information to provide legally required notices of unauthorized  acquisition, access or disclosure of your health information.  

Additional Restrictions on use and disclosure: Certain federal and state laws may require special privacy protections that restrict  the use and disclosure of certain health information, including highly confidential information about you. “Highly Confidential  Information” may include confidential information under Federal laws governing reproductive rights, alcohol and drug abuse  information and genetic information as well as state laws that often protect the following types of information:  

4) Alcohol and drug abuse; 

5) Sexually transmitted diseases and reproductive health information; and 

6) Child or adult abuse or neglect, including sexual assault.