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USES AND DISCLOSURES
Our office must provide you, the
patient, a description and at least one example of the types
of uses and disclosures that our office is permitted to make
for the purposes of treatment, payment and health-care
operations (all uses and disclosures, by the way, that are
permitted by the law without authorization by the patient).
TreatmentóOur
office will use and disclose your protected health information
(PHI) for purposes of treatment, meaning the provision,
coordination and management of your health care and related
services. For instance, we will use and disclose your health
information to coordinate benefits with a third-party payer,
or for consultation between our office and a specialist if
required for your care.
PaymentóOur
office will use and disclose the minimum necessary amount of
your PHI to obtain payment for services rendered. For example,
our office may share your treatment plan with your insurer to
determine the coverage allowed by your benefits plan.
Health-care OperationsóOur
office will use and disclose the minimum necessary amount of
your PHI for health-care operations, such as business planning
and development that involves conducting cost-management and
planning-related analyses related to managing and operating
the entity, including formulary development and
administration, development or improvement of methods of
payment or coverage policies.
This section of our policy also
must describe other purposes for which our office is permitted
or required to use or disclose your PHI without your written
authorization. No examples of each of the following instances
is required in this notice.
Required by lawóOur
office may use and disclose your PHI only to the extent that
such use is required by law.
Public health activitiesóOur
office may use and disclose the minimum necessary amount of
your PHI to appropriate public health authorities for reasons
such as, but not limited to, preventing or controlling
disease, injury or child abuse and neglect.
Reporting abuse, neglect
or domestic violenceóOur office may
use and disclose the minimum necessary amount of your personal
health information to the extent necessary to inform the
appropriate government authority if we reasonably believe you
to be a victim of abuse, neglect or domestic violence.
Health oversight
activitiesóOur office may use and
disclose the minimum
necessary amount of your PHI to a health oversight agency for
oversight activities authorized by law, such as for, but not
limited to, audits.
Judicial and
administrative proceedingsóOur
office may use and disclose
the minimum necessary amount of your PHI in the course of any
judicial or
administrative proceeding if required by law to do so.
Law enforcement agenciesóOur
office may use or disclose the minimum
necessary amount of your PHI to a law enforcement agency if
required by law to do so.
Deceased PatientsóOur
office may use or disclose the minimum necessary
amount of your PHI to a coroner or medical examiner for the
purpose of identifying a deceased person, determining a cause
of death or another matter authorized by law, or to funeral
directors to carry out their duties with respect to the
deceased individual.
Research purposesóOur
office may use and disclose the minimum necessary amount of
your PHI for research purposes without your written
authorization only if we have obtained one of the following:
documented institutional review board or privacy board
approval, either written or verbal representations that the
information is to be used only to prepare a research protocol,
either written or verbal representations that the information
being sought is solely for research on the PHI of decedents,
or a limited data use agreement.
Specialized government
functionsóIf you are a member of the
Armed Forces, our office will use and disclose the minimum
necessary amount of your PHI for military and veterans
activities. Our office also will use and disclose the minimum
necessary amount of your PHI for national security and
intelligence activities, for protective services for the U.S.
president and others. Our office also will use and disclose
the minimum necessary amount of your PHI to a correctional
institution or law enforcement agency if you are an inmate and
that agency or institution indicates the information is
necessary.
SafetyóOur
office may use or disclose the minimum necessary amount of
your PHI if we believe doing so is necessary to prevent or
lessen a serious and imminent threat to the health or safety
of a person or the public and other specific circumstances.
Workers' compensation
proceedingsóOur office may use or
disclose the minimum necessary amount of your PHI as
authorized by and to the extent necessary to comply with laws
related to workers' compensation or similar programs.
Patient directoryóExcept
when an objection is expressed by you, our office may use or
disclose the minimum necessary amount of your PHI to maintain
a directory of patients in the office. Said information
includes your name, your location in the office, your
condition described in general terms. We will inform you in
advance of any such need and give you an opportunity to
object, except in cases of emergencies when we must exercise
professional judgment to determine whether use and disclosure
of this information is in your best interest
Friend, family and
personal representativesóOur office
will use and disclose the minimum necessary amount of your PHI
that is directly relevant to the involvement of a family
member, other relative, a close personal friend or someone
else identified by you. Involvement could be in relation to
care or payment for services. Our office also will use and
disclose the minimum necessary amount of your PHI regarding
your location, general condition or death to a family member,
a personal representative of yours or another person
responsible for your care. Such uses and disclosures will be
made only with your permission if you are present, unless you
are incapacitated or there is an emergency circumstance where
our office must exercise professional judgment.
Federal investigationóOur
office may use and disclose the minimum necessary amount of
your PHI for an investigation by the U.S. Department of Health
and Human Services Secretary to
determine if our office is in compliance with the HIPAA
privacy regulation that requires us to protect your
individually identifiable health information.
Business associatesóOur
office may disclose the minimum necessary amount of your PHI
to a business associate or allow the business associate to
create or receive your PHI on our behalf only if the business
associate has agreed in writing to appropriately safeguard the
information.
Appointment remindersóOur
office may use and disclose the minimum necessary amount of
your PHI when contacting you to provide appointment reminders
or information about treatment alternatives or other
health-related benefits and services that may be of interest
to you.
MarketingóOur
office will obtain written authorization from you if we would
like to use your PHI for marketing purposes, except for
face-to-face communications or a promotional gift of nominal
value provided to you while visiting this office. This office
will inform you via the written authorization form if this
office is to receive remuneration in connection with any
marketing purpose. You have the right to revoke any
authorizations as long as you do so in writing.
General authorization
statementóFor any other purposes not
stated in this
notice, our office will not use or disclose your PHI without
your prior written
authorization.
PATIENT'S
RIGHTS
The patientóYou
have the right to inspect or obtain a copy of your PHI from
our office. Our office requires you to submit such requests in
writing to our privacy director. Our office must act on your
request no later than 30 days after receipt of your request,
unless the PHI requested is not maintained or accessible to
our office on site. In the latter case, our office must
respond to your request within 60 days of your request, and we
must inform you of any such delay in writing within the
initial 30-day timeframe. If further delays are required, our
office may extend the time needed to respond to your request
an additional 30 days provided that our office informs you in
writing of the reasons for the delay and offers a date by
which our office will respond to your request. Our office will
provide you with access to your PHI to inspect or to obtain a
copy, or both, in the form requested, if reasonable. If you
agree to receive a summary of your PHI, our office will supply
you with access to the summary. Our office will charge you a
cost-based fee for the provision of any copies provided to
you.
Denial of access appealsóIf
our office denies your request for access to your PHI in whole
or in part, we must provide you with access to any other PHI
for which access is not denied. For the information that is
denied, our office must inform you in writing of this denial
within 30 days of the original request, and the statement must
provide the basis for the denial. Reasons for denial may
include the following circumstances: The provider has
determined, using his/her professional judgment, that access
to the information is reasonably likely to endanger the life
or physical safety of you or another person; the information
requested makes reference to another person (unless the other
person is a health-care provider) and the provider has
determined, using his/her professional judgment, that granting
your request is reasonably likely to cause substantial harm to
this other person; and when the request for information is
made by your personal representative and the provider, using
his/her professional judgment, has decided that the provision
of the information to the personal representative is
reasonably likely to cause substantial harm to you or another
person. If access to your PHI is denied for these reasons, you
have the right to have the denial reviewed by the Privacy
Director. The Privacy Director cannot be involved in the
original decision to deny access to your PHI. Our office will
inform you in writing as to the decision by the Privacy
Director within a reasonable period of time.
RestrictionsóYou
have the right to request restrictions on certain uses and
disclosures of your PHI, though our office is not required to
grant such requests.
Confidential
communicationsóYou have the right to
request, and our office must accommodate, reasonable requests
to receive confidential communications of PHI from our office
by alternative means or at alternative locations.
Accounting of
disclosuresóYou have the right to
receive an accounting of disclosures of your PHI made by our
office for the six years prior to the date on which the
accounting is requested. The following disclosures are
exempted from this accounting: Disclosures to carry out
treatment, payment and health-care operations; to you, the
patient; for incidental uses or disclosures; disclosures made
according to your written authorization; for the office
patient directory: for national security; for correctional
institutions; for a limited data set; or any disclosure that
occurred prior to April 14, 2003. Our office will provide you
with a written accounting that includes the disclosures
required to be listed, such as those to business associates of
our office. This accounting will include the date of
disclosure, the name of the entity or person who received the
PHI.
Electronic noticeóYou
have the right to receive a paper form of this notice of
privacy policies from our office upon request if this notice
was received electronically.
Right to amendóYou
have the right to request our office amend your PHI. Our
office, however, may deny such a request if we determine that
the PHI was not created by our office, is not part of the
designated record set, the information is not available for
access to you, or the current information is accurate and
complete. Amendment requests must be made in writing to our
privacy director. Our office must act on such requests within
60 days of receipt of such requests. If we deny your request,
we will inform you in writing within 60 days, indicating one
of the reasons listed previously as the basis for the denial.
If you do not submit a statement of disagreement, you may
request that our office provide your request for amendment and
the denial with any future disclosures of your PHI that is the
subject of the amendment. If you submit a statement of
disagreement (limited to 500 words), our office may prepare a
written rebuttal to your statement. We will provide you with a
copy of the rebuttal.
DENTAL OFFICE
DUTIES
Our office is required by law to
maintain the privacy of your PHI and to pro-
vide you with notice of our legal duties and privacy practices
with respect to
PHI. Our office is required to abide by the terms of the
notice currently in effect Our office reserves the right to
change the terms of this notice and to make the new notice
provisions effective for all PHI that we maintain.
COMPLAINTS
Patients may file a complaint
with our office and with the U.S. Department of Health and
Human Services Secretary if they believe their privacy rights
have been violated. Complaints must be filed within 180 days
of when you knew or should have known that the alleged
violation occurred. To do so, please request a complaint form
from our privacy director. Please be assured, patients who
file complaints will not be retaliated against for doing so.
CONTACT
For more information about our officeís
privacy policies, contact:
Privacy Director, Standish
Denture Center PO Box 58, Standish, ME 04084
Telephone: 207.642.2310
EFFECTIVE DATE
This notice for our practice is effective
as of April 14, 2003 |
