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. Chalet Dental Clinic respects
your privacy. We understand that your personal health information is very
sensitive. We will not disclose your information to others unless you tell
us to do so, or unless the law authorizes or requires us to do so. The
law protects the privacy of the health information we create and obtain
in providing our care and services to you. For example, your protected
health information includes your symptoms, test results, diagnoses, treatment,
health information from other providers, and billing and payment information
relating to these services. Federal and state law allows us to use and
disclose your protected health information for purposes of treatment and
health care operations. State law requires us to get your authorization
to disclose this information for payment purposes. The Health Insurance
Portability & Accountability 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,
to be kept confidential. This federal law gives you, the patient, significant
new rights to understand and control how your health information is used.
HIPAA provides penalties for covered entities that misuse personal health
information. As required by law, 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, payment
and health care operations. Treatment means providing, coordinating, or
managing health care and related services by one or more health care providers.
For example, we may need to share information with other health care providers
or specialists involved in the continuation of your care.
Payment means such activities as obtaining reimbursement for services,
confirming coverage, billing or collection activities, and utilization
review. For example, we may disclose treatment information when billing
a dental plan for your dental services.
Health Care Operations include the business aspects of running our
practice. For example, patient information may be used for training purposes,
or quality assessment. Unless you request otherwise, we may use or disclose
health information to a family member, friend, personal representative,
or other individual to the extent necessary to help with your health care
or with payment for your health care. In the event of an emergency or your
incapacity, we will use our professional judgment in disclosing only the
protected health information necessary to facilitate needed care. In addition,
we may use your confidential information to remind you of appointments
by sending reminder postcards and/or leaving messages at home and/or work.
Your protected health information may also be used by our office to recommend
treatment alternatives or to provide you with information about health-related
benefits and services that may be of interest to you. In addition, we may
disclose your health information for public health oversight activities,
judicial or administrative proceedings, in response to a subpoena or court
order, to military authorities of Armed Forces personnel, to federal officials
for lawful intelligence, counterintelligence, and other national security
activities, to correctional institutions or law enforcement officials,
and/or to report suspected abuse, neglect, or domestic violence. 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 relying on your authorization. You have certain rights in
regards to your protected health information, which you may exercise by
presenting a written request to our Privacy Officer at the practice address
listed below: The right to request restrictions on certain uses and disclosures
of protected health information, including those related to disclosures
to family members, other relatives, close personal friends, or any other
person identified 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 to receive confidential
communications of protected health information from us by alternative means
or at alternative locations. The right to access, inspect, and copy your
protected health information, with limited exceptions. A reasonable fee
may be assessed. The right to request an amendment to your protected health
information. We may deny your request in certain situations. The right
to receive an accounting of disclosures of protected health information
made outside of treatment, payment, or health care operations…or based
on your previous authorization. You may receive this information without
charge once every 12 months. We will notify you of the cost involved if
you request this information more than once in 12 months. The right to
obtain a paper copy of this notice from us upon request, even if you have
agreed to receive the notice electronically. 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, 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 & 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. We have a Web
site that provides information about us. For your benefit, this Notice
is on the Web site at this address: www.chaletsmile.com. For more information
about our Privacy Practices, please contact:
Chalet Dental Clinic
6006 Summitview Avenue Yakima, WA. 98908
509-965-0080
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)
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