Sacramento Dental Group
NoticeofPrivacyPolicy HIPPA
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.
I. Dental Practice Covered by this Notice
This Notice
describes the privacy practices of Sacramento Dental Group (“Dental Practice”).
“We” and “our” means the Dental Practice. “You”
and “your” means our
patient.
II. How to Contact Us/Our Privacy Official
If you have any
questions or would like further information about this Notice, you can contact
Sacramento Dental Group’s Privacy Official at:
Sacramento Dental
Group][
[6611 Coyle Ave.]
[Carmichael,
CA]
[Phone:916-965-6250]
[Fax: 916-965-6357
[EMAIL:
info@sacramentodentalgroup.com]
III. Our Promise to You and Our Legal
Obligations
The privacy of your health information is important to us. We
understand that your health information is personal and we are committed to
protecting it.
This Notice describes how we may use and disclose your
protected health information 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.
We are required by law
to:
• Maintain the privacy of your protected health
information;
• Give you this Notice of our legal duties and privacy
practices with respect to that information; and
• Abide by the terms
of our Notice that is currently in effect.
IV. Last Revision
Date
This Notice was last revised on June, 2013.
V. How We May Use
or Disclose Your Health Information
The following examples describe
different ways we may use or disclose your health information. These examples
are not meant to be exhaustive. We
are permitted by law to use and
disclose your health information for the following purposes:
A. Common
Uses and Disclosures
1. Treatment. We may use your health information to
provide you with dental treatment or services, such as cleaning or examining
your teeth or performing
dental procedures. We may disclose health
information about you to dental specialists, physicians, or other health care
professionals involved in your care.
2. Payment. We may use and disclose
your health information to obtain payment from health plans and insurers for
the care that we provide to you.
3. Health Care Operations. We may use and
disclose health information about you in connection with health care
operations necessary to run our practice,
including review of our
treatment and services, training, evaluating the performance of our staff and
health care professionals, quality assurance, financial
or billing
audits, legal matters, and business planning and development.
4.
Appointment Reminders. We may use or disclose your health information when
contacting you to remind you of a dental appointment. We may
contact
you by using a postcard, letter, phone call, voice message,
text or email.
5. Treatment Alternatives and Health-Related Benefits and
Services. We may use and disclose your health information to tell you about
treatment options
or alternatives or health-related benefits and
services that may be of interest to you.
6. Disclosure to Family Members
and Friends. We may disclose your health information to a family member or
friend who is involved with your care or payment
for your care if
you do not object or, if you are not present, we believe it is in your best
interest to do so.
7. Disclosure to Business Associates. We may disclose
your protected health information to our third-party service providers
(called, “business associates”)
that perform functions on our behalf
or provide us with services if the information is necessary for such
functions or services. For example, we may use a
business associate
to assist us in maintaining our practice management software. All of our
business associates are obligated, under contract with us,
to
protect the privacy of your information and are not allowed to
use or disclose any information other than as specified in our
contract.
B. Less Common Uses and Disclosures
1. Disclosures
Required by Law. We may use or disclose patient health information to the
extent we are required by law to do so. For example, we are
required
to disclose patient health information to the U.S.
Department of Health and Human Services so that it can investigate complaints
or determine our compliance
with HIPAA.
2. Public Health
Activities. We may disclose patient health information for public health
activities and purposes, which include: preventing or
controlling
disease, injury or disability; reporting births or
deaths; reporting child abuse or neglect; reporting adverse reactions to
medications or foods; reporting product
defects; enabling product
recalls; and notifying a person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease
or
condition.
3. Victims of Abuse, Neglect or Domestic Violence. We may
disclose health information to the appropriate government authority about a
patient whom we
believe is a victim of abuse, neglect or domestic
violence.
4. Health Oversight Activities. We may disclose patient
health information to a health oversight agency for activities necessary for
the government to
provide appropriate oversight of the health care
system, certain government benefit programs, and compliance with certain
civil rights laws.
5. Lawsuits and Legal Actions. We may disclose patient
health information in response to (i) a court or administrative order or
(ii) a subpoena, discovery
request, or other lawful process that is
not ordered by a court if efforts have been made to notify the patient or to
obtain an order protecting the information
requested.
6. Law
Enforcement Purposes. We may disclose your health information to a law
enforcement official for a law enforcement purposes, such as to
identify
or locate a suspect, material witness or missing person or
to alert law enforcement of a crime.
7. Coroners, Medical Examiners and
Funeral Directors. We may disclose your health information to a coroner,
medical examiner or funeral director to allow
them to carry out
their duties.
8. Organ, Eye and Tissue Donation. We may use or disclose
your health information to organ procurement organizations or others that
obtain, bank or
transplant cadaveric organs, eyes or tissue for
donation and transplant.
9. Research Purposes. We may use or disclose your
information for research purposes pursuant to patient authorization waiver
approval by an Institutional
Review Board or Privacy Board.
10.
Serious Threat to Health or Safety. We may use or disclose your health
information if we believe it is necessary to do so to prevent or lessen a
serious
threat to anyone’s health or safety.
11.
Specialized Government Functions. We may disclose your health information to
the military (domestic or foreign) about its members or veterans,
for
national security and protective services for the President or
other heads of state, to the government for security clearance reviews, and to
a jail or prison
about its inmates.
12. Workers'
Compensation. We may disclose your health information to comply with
workers' compensation laws or similar programs that provide
benefits
for work-related injuries or illness.
VI. Your
Written Authorization for Any Other Use or Disclosure of Your Health
Information
Uses and disclosures of your protected health information that
involve the release of psychotherapy notes (if any), marketing, sale of your
protected health
information, or other uses or disclosures not
described in this notice will be made only with your written authorization,
unless otherwise permitted or required
by law. You may revoke this
authorization at any time, in writing, except to the extent that this office
has taken an action in reliance on the use of disclosure.
[FName] [LName]
Sacramento Dental Group
6611 Coyle
Ave
Carmichael, CA 956086311
(916)
965-6250
support@hrdsq.com