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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 CAREFULLY.
The Health
Insurance Portability & Accountability Act of 1996 (HIPAA) requires
all health care records and other individually identifiable health information
used or disclosed to us in any form, whether electronically, on paper, or
orally, to be kept confidential. This federal law gives you, the patient,
significant new rights to understand and control how your health information
is used. HIPAA provides penalties for covered entities that misuse personal
health information. As required by law, we have prepared this explanation
of how we are required to maintain the privacy of your health information
and how we may use and disclose your health information.
Without specific
written authorization, we are permitted to use and disclose your health care
records for the purposes of treatment, payment and health care operations.
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Treatment means providing, coordinating, or managing health care and related services
by one or more health care providers. For example, we may need to share
information with other health care providers or specialists involved in
the continualion of your care. |
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Payment means such activities as obtaining reimbursement for services, confirming
coverage, billing or collection activities, and utilization review. For
example, we may disclose treatment information when billing a dental plan
for your dental services. |
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Health
Care Operations include the business aspects of running our practice.
For example, patient information may be used for training purposes, or
quality assessment. |
Unless you
request otherwise, we may use or disclose health information to a family
member, friend, personal representative, or other individual to the extent
necessary, to help with your health care or with payment for your health care.
In the event of an emergency or your incapacity, we will use our professional
judgment in disclosing only the protected health information necessary to
facilitate needed care. In addition, we may use your confidential information
to remind you of appointments by sending reminder postcards and/or leaving
messages at home and/or work. Your protected health information may also be
used by our office to recommend treatment alternatives or to provide you with
information about health related benefits and services that may be of interest
to you. In addition, we may disclose your health information for public health
oversight activities, judicial or administrative proceedings, in response
to a subpoena or court order, to military authorities of Armed Forces personnel,
to federal officials for lawful intelligence, counterintelligence, and other
national security activities, to correctional institutions or law enforcement
officials, and/or to report suspected abuse, neglect, or domestic violence.
Any other uses and disclosures will be made only with your written authorization.
You may revoke such authorization in writing and we are required to honor
and abide by that written request, except to the extent that we have already
taken actions relying on your authorization.
You have
certain rights in regards to your protected health information, which
you may exercise by presenting a written request to our Privacy Officer at
the practice address listed below:
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The
right to request restrictions on certain uses and disclosures of protected
health information, including those related to disclosures to family members,
other relatives, close personal friends, or any other person identified
by you. We are, however, not required to agree to a requested restriction.
If we do agree to a restriction, we must abide by it unless you agree
in writing to remove it. |
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The
right to request to receive confidential communications of protected health
information from us by alternative means or at alternative locations. |
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The
right to access, inspect, and copy your protected health information,
with limited exceptions. A reasonable fee may be assessed. |
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The
right to request an amendment to your pretected health information. We
may deny your request in certain situations. |
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The
right to receive an accounting of disclosures of protected health information
made outside of treatment, payment, or health care operations... or based
on your previous authorization. |
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The
right to obtain a paper copy of this notice from us upon request, even
if you have agreed to receive the notice electronically. |
We are required
by law to maintain the privacy of your protected health information and
to provide you with notice of our legal duties and privacy practices with
respect to protected health information.
This notice
is effective as of April 14, 2003, and we are required to abide by the
terms of the Notice of Privacy Practices currently in effect. We reserve the
right to change the terms of our Notice of Privacy Practices and to make the
new notice provisions effective for all protected health information that
we maintain. Revisions to our Notice of Privacy Practices will be posted on
the effective date and you may request a written copy of the Revised Notice
from this office.
You have
the right to file a formal, written complaint with us at the address below,
or with the Department of Health & Human Services, Office of Civil Rights,
in the event you feel your privacy rights have been violated. We will not
retaliate against you for filing a complaint.
For more
information about our Privacy Practices, please contact:
Annette M. Deymonaz
Brett Nydegger, DDS, MS
509 Olive Way #1511
Seattle, WA. 98101
206-624-5115
For more
information about HIPAA or to file a complaint:
The U.S. Department
of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)
In addition
to our office Privacy Practices, we also have an additional Privacy
Policy for our web site.
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