Notice of Privacy Practices: Use and Disclosure of Health Information Protected under HIPAA. Effective May 1, 2014.
This document provides a summary of how healthcare information about you may be used and disclosed and how you can obtain access to this information.
We understand that information about you and your health is personal. We are committed to protecting your health information. It is our policy that the privacy of your protected health information (PHI) is not compromised while still allowing necessary access to ensure the healthcare you receive is appropriate and of the highest possible quality.
We pledge to you that we will protect the confidentiality of information provided to us. Your information will be used in the following manner, known as Treatment, Payment, and Healthcare Operations (TPO):
- To provide dental treatment and/or services.
- To facilitate payment by third-party payers, when appropriate, for health care treatment you receive.
- To facilitate the mechanisms which allow the operation of our facility.
In every use of your information, we will be responsible custodians of your PHI and adhere to the standards set forth in the legislation, which created these privacy practices. We recognize that all patients have the right to privacy in matters relating to their health. We will not use your PHI for uses other than TPO related to health care without your express permission.
You have the following rights regarding the medical information we maintain about you:
- Access, upon request, to information that may be used to make decisions about your care.
- To request restrictions or limitations on the PHI we disclose about you for treatment, payment or health operations. While we are not required to agree to your request, if we do agree, we will comply with the restrictions unless the information is needed to provide emergency treatment.
- To request that we amend the PHI we maintain about you if you believe that the information we have about you is incorrect or incomplete.
- To request an accounting of disclosures we have made for uses other than our own.
- To request confidential communications; i.e., that we communicate with you in a certain manner or at a certain location.
- To receive a paper copy of this notice.
All members of our staff are committed to adhering to the conditions set forth in this notice of privacy practices. Any violation will be grounds for disciplinary action. We reserve the right to change this policy in the future; such changes will be available to all patients.
Authorized Disclosures: Central Park West Dentistry will not use or disclose your PHI without your prior authorization. You can later revoke that authorization in writing to allow any future use and disclosure. The authorization will be obtained from you by Central Park West Dentistry.
Should you believe that your privacy rights have been violated, you may file a complaint with this facility or with the State oversight department; all complaints must be submitted in writing. You will not be penalized for filing a complaint.