Notice of Privacy Practices

Your rights

You have the right to:

• Get an electronic or paper copy of your dental and medical record.
• Ask us to correct information you believe is incorrect or incomplete.
• Request confidential communications.
• Ask us to limit certain uses or disclosures.
• Get a list of certain disclosures we have made.
• Get a paper copy of this notice.
• Choose someone with legal authority to act for you.
• File a complaint if you believe your privacy rights were violated.

Get a copy of your record

You may ask to see or obtain an electronic or paper copy of your dental record and other health information we maintain about you. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee as permitted by law.

Ask us to correct your record

You may ask us to correct health information that you believe is incorrect or incomplete. We may deny the request in some circumstances, but we will explain the reason in writing within 60 days.

Request confidential communications

You may ask us to contact you in a specific way—for example, at home, at work, or on your cell phone—or to send mail to a different address. We will agree to reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are not always required to agree, particularly when the restriction could affect your care. If you pay for a service in full out of pocket, you may ask us not to share information about that service with your health plan for payment or operations purposes, unless the law requires us to do so.

Get a list of disclosures

You may ask for an accounting of certain disclosures of your health information made during the six years before your request. The list does not include every disclosure, such as many disclosures for treatment, payment, health care operations, or disclosures you specifically requested. One accounting in a 12-month period is provided without charge; a reasonable fee may apply to additional requests.

Choose someone to act for you

A person with legal authority—such as a health care power of attorney or legal guardian—may exercise your rights and make choices about your health information. We will verify that authority before taking action.

File a complaint

You may contact our Privacy Officer if you believe we violated your privacy rights. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.

Your choices

In certain situations, you may tell us your preferences about sharing information with family, close friends, or others involved in your care or payment for your care, and for disaster-relief purposes. If you cannot tell us your preference, we may share information when we believe it is in your best interest or when necessary to lessen a serious and imminent threat to health or safety.

We will not use or disclose your information for marketing, sell your health information, or disclose most psychotherapy notes without your written authorization. Your Dental Life does not use protected health information for fundraising.

How we typically use or share your information

Treatment

We may use your health information and share it with dentists, physicians, laboratories, specialists, pharmacies, or other professionals involved in your care.

Practice operations

We may use and share health information to operate our practice, improve your care, manage services, train staff, conduct quality reviews, and contact you when necessary.

Payment

We may use and share health information to bill and obtain payment from dental or health plans and other entities responsible for payment.

Other permitted or required uses and disclosures

Subject to applicable legal requirements and safeguards, we may use or disclose health information for:

• Public health and safety activities.
• Reporting suspected abuse, neglect, or domestic violence.
• Product recalls and adverse-event reporting.
• Health research permitted by law.
• Health oversight activities.
• Workers' compensation claims.
• Law-enforcement and other authorized government requests.
• Organ and tissue donation requests.
• Coroners, medical examiners, and funeral directors.
• Court or administrative orders, subpoenas, and legal actions.
• Other disclosures required by federal or state law.

When another law gives health information greater protection, we will follow the more protective requirement.

Substance use disorder records

To the extent we maintain patient records protected by 42 CFR Part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order accompanied by a subpoena or other legal mandate, as required by law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you promptly if a breach may have compromised the privacy or security of your information.
• We must follow the duties and practices described in this notice and provide you with a copy.
• We will not use or share your information other than as described here unless you authorize us in writing. You may revoke that authorization in writing at any time, except to the extent we have already acted in reliance on it.

Changes to this notice

We may change the terms of this notice. Changes may apply to all health information we maintain, including information created or received before the change. The current notice will be available upon request, at our office, and on this website.