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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected Health Information" is 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.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by your dentist, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the dentist's practice, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a specialist with whom you have been referred, to ensure that the dentist has the necessary information to diagnose or treat you.
Payment: Your protected heath information will be used, as needed to obtain payment for your health care services. For example, obtaining approval for treatment may require that your revelant protected health informaiton be disclosed to the health plan to obtain approval for the needed treatment.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of our practice. These activities include, but are not limited to: quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients in our office. In addition, we may use a sign-in sheet at registration where you will be asked to sign your name. We may also call you by name in the waiting room when our dentist is ready to see you. We may use your name and address as necessary, when contacting you to remind you of an appointment. Unless you opt out, we may leave a message of appointment date and time on an answering machine that identifies you as the one in possession of the machine or device.
Marketing and Advertising: We never disclose personal health information to third party advertising. We will not send out mailings for services offered without your consent. We may send out information regarding new services offered within our practice via direct mail. Unless you opt out you may receive mailings from our office.
We may use or disclose your protected health information in the following situations without your authorizations. These situations include but are not limited to: as Required by Law, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Coroners, Funeral Directors, Organ Donation, Research, Criminal Acitvity, Military Activity and National Security, Workers' Compensation, Inmates; Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other permitted and required uses and disclosures will be made with your consent, authorization or opportunity to object unless required by law.
You may revoke this authorization at any time, in writing, except to the extent that the practice has taken an action that requires the use or disclosure indicated in the authorization.
Your Rights: Following is a statement of your rights with respect to Protected Health Information.
You have the right to inspect and copy your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family memebers or friends who may be involved in your care or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restrictions requested and to whom you want the restriction to apply.
We are not required to agree a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your protected health information, your protected health informaiton will not be restricted. You then have the right to use another health care professional.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even it you have agreed to accept this notice alternatively.
You have the right to have our office amend your protected health information. If we deny your request for an amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide a copy of such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
We reserve the right to change the terms of this notice and will inform you by mail of any changes. An updated copy is posted in our office lobby at all times.
Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe that your privacy rights have been violated by our staff. You may file a complaint with us by notifying our privacy officer of your complaint. Our privacy officer is Lori A Gordon.
This notice was published and became effective September 1, 2013 and replaces any previously published notices.
We are required by law to maintain the privacy of and provide individuals with this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please to speak with our HIPPA Compliance Officer in person or by phone.
Lori A Gordon, Complaince Officer
Dr. Joseph R Hendrick, Jr
511 North Morgan Street, Shelby, NC 28150
704-484-0077
