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
We respect our obligation to keep your health information private. We are obligated by law to
give you notice of our privacy practices. This notice describes how we protect your health
information and what rights you have regarding it.
USES AND DISCLOSURE OF HEALTH INFORMATION
We may use and disclose your health information to a denturist, dentist or other healthcare
provider for treatment purposes. We may use and disclose your health information to bill and
collect payment for services we provide to you. Within our professionaljudgment and unless
you object, we will share relevant health and dental information with family and friends
assisting in your care.
We will not use your information for marketing without your written authorization. We will
disclose your health information when required by federal, state or local law authorities or legal
processes such as, but not limited to subpoena, court order, warrants or summons. We may
disclose your information to appropriate authorities if we reasonably suspect you are a victim
of a possible crime so as to avert serious threat to your safety and the safety of those around
you. We may use your information to provide appointment reminders such as, but not limited
to post cards, voicemail or letters.
You have the right to look at or get copies of your health information with limited exceptions.
This request may be sent in writing to one of the addresses listed above via certified mail. you
will be charged a reasonable fee for copies, postage and staff time. You may have the right to
place additional restrictions on usage or disclosure of your health information. We are not
required by law to agree to these restrictions. To the best of our ability, we will abide by
restrictions except in the event of an emergency in our professional opinion. you may request
alternate means or locations of which to discuss your information. This must be presented in
writing with a satisfactory explanation and detailed format of how payments will be handled
under the alternate means or location you request. You have the right to amend your health
information in writing and it must explain why the amendment is to take place. We may deny
your request under certain circumstances.
By law, we must abide by the terms of the Notice of Privacy Practices until we choose to change
it. We reserve the right to change this notice at any time as allowed by law. lf we change this
notice, the new privacy practices will apply to your health information that we already have, as
well as to such information that we may generate in the future. lf we change our Notice of
Privacy Practices, we will post the new notice and have copies available in our office.
lf you think we have not properly respected the privacy of your health information, you are free
to complain to us or the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you if you make a complaint. lf you want to complain to us, send a
written complaint to the office contact person at one of the addresses listed at the top of this