Privacy Policy of Central Park Dental Care

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. THANK YOU.

We respect our legal obligation to keep health information that identifies you 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.

1. TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

The most common examples of how we use or disclose information for treatment purposes are: scheduling appointments, prescribing medication, referring you to another doctor or other health care services, or requesting copies of your health information from other doctors.
Other common examples of how we use or disclose information for payment purposes are: inquiring about your dental care plans, other sources of payment, preparing and sending bills and claims, and collecting unpaid amounts on payment plans (either ourselves or through a collection agency or attorney).
Healthcare operations have administrative and managerial functions. The most common examples of how we use or disclose information for administrative operations are: financial or billing audits, internal quality assurance, personnel decisions, participation in managed care plans, and defense in legal matters, business planning, and outside storage of our records.

We routinely use your health information inside our office for purposes without any special permission. If we need to disclose your health information outside of this office for these reasons we will ask for special permission.

2. USES AND DISCLOSURES FOR OTHER REASON WITHOUT PERMISSION

In some limited situations the law allows or requires us to disclose your health information without permission. Not all these situations will apply to us; in fact, some may never come up in our office at all.

Such uses and disclosures are:

When a state or federal law mandates that certain health information be reported for specific purposes.

For public health purposes, such as contagious disease reporting, investigative surveillance, and notices to and from the Federal Food and Drug Administration regarding drugs or medical devices.

Disclosures to governmental authorities about victims of suspected abuse, neglect, or domestic violence.

Uses and disclosures for health oversight activities such as for licensing of doctors, Medicare, and Medicaid, and for investigation of possible violation of health care laws.
Disclosure for judicial and administrative proceedings such as in response to subpoenas or orders of courts or administrative agencies.
Disclosure for law enforcement purposes such as providing information about someone who is or is to be a victim of a crime, to provide information about a crime at our office, or to report a crime that happened at another location.
Disclosure to a medical examiner to identify a deceased person or determine the cause of death, to aide funeral directors in burial, and also to organ and tissue donation organizations.

Uses or disclosure for health-related research.

Uses or disclosure for specialized government functions, such as for the protection of the President or higher ranking officials; for lawful national intelligence activities; for military purposes, or for the evaluation and health of members of the Foreign Service.
Disclosure relating to Worker’s Compensation Services.
Disclosure to business professionals that perform health care operations for your office.
Unless you object, we will share relevant information about your care with your family.

3. APPOINTMENT REMINDERS

We may call, email, or text to remind you of scheduled appointments or that it is time to make a routine appointment. We may also call, email or text to notify you of other treatment or services available at our office. Unless you request otherwise, we will call, email, text and/or leave a message on your answering machine or with someone who answers the phone if you are not available.

4. OTHER USES AND DISCLOSURES

We will not make any other uses or disclosures of your health information unless you sign a Written Authorization Form. The content of this Authorization Form is determined by federal law. You may initiate the authorization process if you would like us to send your information to another doctor. In some situations we may initiate the authorization process and ask you to sign the form. You DO NOT have to sign the form. If you do sign the form, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be written in writing.

5. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

The law gives you many rights regarding our health information, such as:

Asking our office to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or administrative operations. We do not have to agree to this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to our office.
Asking to communicate with you in a confidential way, such as by phoning you at work rather than at home, or mailing health information to a different address.

sking to see or get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access and copying. However, for the most part, you will be able to review or have a copy of your health information within 30 days of asking us (or 60 days if the information is stored off site). It may be necessary for you to pay for the photocopies in advance. If we deny your request we will send you a written explanation and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30 day extension of time for us to give you access or photocopies if we send you a written notice of explanation.

Asking us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask. We will send the corrected information to persons who we know got the wrong information. If we do not agree, you can write a statement of your position and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or our rebuttal is included in your health information, we will send it when we make our permitted disclose of your health information. By law, we can have one 30 day extension of time to consider a request for amendment if we notify you in writing of the extension.
Asking for a list of the disclosures that we have made of your health information within the past six years (or a shorter period if you request). By law, the list will not include: disclosures for purposes of treatment, payment or healthcare operations; disclosures with your authorization, incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you request more frequent lists, you will be asked to pay an administration fee in advanced. We will respond to your request within 60 days of receiving it, but by law, we have one 30 day extension of time to notify you of the extension in writing.
Requesting additional paper copies of this Notice of Privacy Practices.

If you should ever need to enforce your right regarding your health information please send a written request to the address printed on the front page.

SUD Treatment Information. If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your Part 2 Program record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.

In no event will we use or disclose you Part 2 Program record, or testimony that describes the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceeding by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provided you notice of the court order.

6. OUR NOTICE OF PRIVACY PRACTICES

By law, we must abide by the terms of this Notice of Privacy Practices. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new Privacy Practices will apply to your health information that we already have as well as toward future information. If we change our Notice of Privacy Practices, we will post the new Notice in our office and have copies available upon request.

7. COMPLAINTS

If you feel that we have not properly respected the privacy of your health information, you are free to contact us or the U.S. Department of Health and Human Services, Office of Civil Rights. We will not retaliate against you if you make a complaint. If you choose to contact us, send a written complaint to our address printed on the front page.

8. FOR MORE INFORMATION

If you desire more information about our privacy practices, please call or visit our office.

Thank you,

Dr. Mark Summerford

Central Park Dental Care, P.C.