Effective March 21, 2019. If you have any questions about this notice, please contact our Office Manager at Info@smilecraftdentaltx.com or (469) 630-6383.
We are required by law to maintain the privacy of our patients' health information and to provide you with this notice of our legal duties and privacy practices with respect to protected health information. Protected health information consists of information about you - including demographic information - that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this notice. We may change the terms at any time; the new notice will be effective for all protected health information we maintain at the time of the change. You may request a revised copy at any time by calling our Office Manager or asking at your next appointment.
1. Uses and Disclosures of Protected Health Information
For Treatment, Payment, or Operations
Your protected health information may be used by your doctor for treatment, payment, and health care operations as described here without authorization from you. It may be used and disclosed by your doctor, the office staff, and others outside our office who are involved in your care and treatment for the purpose of providing health care services to you and to pay your health care bills, which are used to support the operation of the doctor's practice.
The following are examples of ways your protected health information may be used by your doctor and the office staff without your specific authorization. These examples are not meant to be exhaustive, only to describe the types of uses and disclosures that can possibly be made by our office.
- Treatment: Your protected health information may be used and disclosed to provide, coordinate, or manage your health care and any related services, including services rendered from another doctor, consultation with another doctor, or the management of your health care with a third party.
- Payment: Your information may be used, as needed, to obtain or provide payment for your medical services. This includes disclosures to other entities, such as your health insurance plan undertaking certain activities (for example, determining eligibility or coverage for benefits, reviewing services provided, and utilization review) before it approves or pays for services recommended to you.
- Operations: Your protected health information may be disclosed or used, as needed, to support the business activities of your doctor's practice. These activities include - but are not limited to - quality assessment and improvement activities; reviewing the competence or qualifications of professionals; business planning and development; and conducting or arranging for other business activities.
In conducting business activities, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your treating provider. We may also call you by name in the waiting room and use or disclose your protected health information, as needed, to contact you to remind you of your appointment.
Whenever your protected health information is used or disclosed in an arrangement between our office and a business associate, we will have a written contract that contains terms to protect the privacy of your information.
Based on Your Written Authorization
Other uses and disclosures of your protected health information will only be made with your written authorization unless otherwise permitted or required by law. You may revoke this authorization at any time in writing, except to the extent that your doctor or the practice has already taken action in reliance on the use or disclosure indicated in the authorization.
2. Your Rights
The following is a statement of your rights with respect to your protected health information, and a brief description of how these rights may be exercised.
- You have the right to inspect and copy your protected health information, including medical and billing records, and any other records your doctor and the practice may use to make decisions about your treatment. This does not extend to information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding.
- You have the right to request a restriction of your protected health information - asking our office not to use or disclose part of your information for treatment, payment, or health care operations, or not to disclose it to family or friends involved in your care. Your doctor is not required to agree, but if they do, we will honor it except where needed for emergency treatment.
- You have the right to request confidential communications by alternative means or at an alternative location; we will accommodate reasonable requests made in writing to our Office Manager.
- You have the right to request an amendment to your protected health information, though we may deny the request. If we do, you have the right to file a statement of disagreement.
- You have the right to receive an accounting of certain disclosures made by us of your protected health information, excluding disclosures for treatment, payment, operations, to you, to family or friends involved in your care, or under a signed authorization.
3. Complaints
You may make a complaint to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Office Manager. We will not retaliate against you for filing a complaint.
For further information about the complaint process, contact the Office Manager at (469) 630-6383 or Info@smilecraftdentaltx.com.