HIPAA Notice
HIPAA Notice of Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
INTRODUCTION
This Notice of Privacy Practices is being provided to you by ProHEALTH
Dental (the “Practice”) and the employees and practitioners
that work at the Practice with respect to services provided at the Practice
(collectively referred to herein as “We” or “Our”).
We understand that your medical information is private and confidential.
Further, we are required by law to maintain the privacy of “protected
health information.” “Protected health information”
or “PHI” includes any individually identifiable information
that we obtain from you or others that relates to your past, present or
future physical or mental health, the health care you have received, or
payment for your health care. We will share protected health information
with one another, as necessary, to carry out treatment, payment or health
care operations relating to the services to be rendered by the Practice.
As required by law, this notice provides you with information about your
rights and our legal duties and privacy practices with respect to the
privacy of your PHI. This notice also discusses the uses and disclosures
we will make of your PHI. We must comply with the provisions of this notice
as currently in effect, although we reserve the right to change the terms
of this notice from time to time and to make the revised notice effective
for all PHI we maintain. You can always request a written copy of our
most current privacy notice from our Privacy Officer at 516 654-4400 or
you can access it on our website at: Prohealthcaredental.com.
PERMITTED USES AND DISCLOSURES
We can use or disclose your PHI for purposes of treatment, payment and
health care operations. For each of these categories of uses and disclosures,
we have provided a description and an example below. However, not every
particular use or disclosure in every category will be listed.
- Treatment means the provision, coordination or management of your dental
care, including consultations between health care providers relating to
your care and referrals for care from one provider to another.
- Payment means the activities we undertake to obtain reimbursement for the
dental care provided to you, including billing, collections, claims management,
determinations of eligibility and coverage and other utilization review
activities. For example, we may need to provide PHI to your Third Party
Payor to determine whether the proposed course of treatment will be covered
or if necessary to obtain payment. Federal or state law may require us
to obtain a written release from you prior to disclosing certain specially
protected PHI for payment purposes, and we will ask you to sign a release
when necessary under applicable law.
- Health care operations means the support functions of the Practice, related
to treatment and payment, such as quality assurance activities, case management,
receiving and responding to patient comments and complaints, dentist reviews,
compliance programs, audits, business planning, development, management
and administrative activities. For example, we may use your PHI to evaluate
the performance of our staff when caring for you. We may also combine
PHI about many patients to decide what additional services we should offer,
what services are not needed, and whether certain new treatments are effective.
We may also disclose PHI for review and learning purposes. In addition,
we may remove information that identifies you so that others can use the
de-identified information to study health care and health care delivery
without learning who you are.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
We may also use your PHI in the following ways:
- To provide appointment reminders for dental care.
- To tell you about or recommend possible treatment alternatives or other
health-related benefits and services that may be of interest to you.
- To your family or friends or any other individual identified by you to
the extent directly related to such person’s involvement in your
care or the payment for your care. We may use or disclose your PHI to
notify, or assist in the notification of a family member, a personal representative,
or another person responsible for your care, of your location, general
condition or death. If you are available, we will give you an opportunity
to object to these disclosures, and we will not make these disclosures
if you object. If you are not available, we will determine whether a disclosure
to your family or friends is in your best interest, taking into account
the circumstances and based upon our professional judgment.
- When permitted by law, we may coordinate our uses and disclosures of PHI
with public or private entities authorized by law or by charter to assist
in disaster relief efforts.
- We will allow your family and friends to act on your behalf to pick-up
filled prescriptions, dental supplies, X-rays, and similar forms of PHI,
when we determine, in our professional judgment, that it is in your best
interest to make such disclosures.
- We may use or disclose your PHI for research purposes, subject to the requirements
of applicable law. For example, a research project may involve comparisons
of the health and recovery of all patients who received a particular procedure.
All research projects are subject to a special approval process which
balances research needs with a patient’s need for privacy. When
required, we will obtain a written authorization from you prior to using
your health information for research.
- We will use or disclose PHI about you when required to do so by applicable law.
- In accordance with applicable law, we may disclose your PHI to your employer
if we are retained to conduct an evaluation relating to medical surveillance
of your workplace or to evaluate whether you have a work-related illness
or injury. You will be notified of these disclosures by your employer
or the Practice as required by applicable law.
Note: incidental uses and disclosures of PHI sometimes occur and are not
considered to be a violation of your rights. Incidental uses and disclosures
are by-products of otherwise permitted uses or disclosures which are limited
in nature and cannot be reasonably prevented.
SPECIAL SITUATIONS
Subject to the requirements of applicable law, we will make the following
uses and disclosures of your PHI:
- Organ and Tissue Donation. If you are an organ donor, we may release PHI
to organizations that handle organ procurement or transplantation as necessary
to facilitate organ or tissue donation and transplantation.
- Military and Veterans. If you are a member of the Armed Forces, we may
release PHI about you as required by military command authorities. We
may also release PHI about foreign military personnel to the appropriate
foreign military authority.
- Worker’s Compensation. We may release PHI about you for programs
that provide benefits for work-related injuries or illnesses.
-
Public Health Activities. We may disclose PHI about you for public health
activities, including disclosures:
- to prevent or control disease, injury or disability;
- to report child abuse or neglect;
- to persons subject to the jurisdiction of the Food and Drug Administration
(FDA) for activities related to the quality, safety, or effectiveness
of FDA-regulated products or services and to report reactions to medications
or problems with products;
- to notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe that an adult
patient has been the victim of abuse, neglect or domestic violence. We
will only make this disclosure if the patient agrees or when required
or authorized by law.
- Health Oversight Activities. We may disclose PHI to federal or state agencies
that oversee our activities (e.g., providing dental care, seeking payment,
and civil rights).
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we
may disclose PHI subject to certain limitations.
-
Law Enforcement. We may release PHI if asked to do so by a law enforcement official:
- In response to a court order, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime under certain limited circumstances;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct on our premises; or
- In emergency circumstances, to report a crime, the location of the crime
or the victims, or the identity, description or location of the person
who committed the crime.
- Coroners, Medical Examiners and Funeral Directors. We may release PHI to
a coroner or medical examiner. We may also release PHI about patients
to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. We may release PHI about
you to authorized federal officials for intelligence, counterintelligence,
other national security activities authorized by law or to authorized
federal officials so they may provide protection to the President or foreign
heads of state.
- Inmates. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release PHI about you to
the correctional institution or law enforcement official. This release
would be necessary (1) to provide you with dental care; (2) to protect
your health and safety or the health and safety of others; or (3) for
the safety and security of the correctional institution.
- Serious Threats. As permitted by applicable law and standards of ethical
conduct, we may use and disclose PHI if we, in good faith, believe that
the use or disclosure is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public or is
necessary for law enforcement authorities to identify or apprehend an
individual.
Note: HIV-related information, genetic information, alcohol and/or substance
abuse records, mental health records and other specially protected health
information may enjoy certain special confidentiality protections under
applicable state and federal law. Any disclosures of these types of records
will be subject to these special protections.
OTHER USES OF YOUR HEALTH INFORMATION
Certain uses and disclosures of PHI will be made only with your written
authorization, including uses and/or disclosures: (a) for marketing purposes;
and (b) that constitute a sale of PHI under the Privacy Rule. Other uses
and disclosures of PHI not covered by this notice or the laws that apply
to us will be made only with your written authorization. You have the
right to revoke that authorization at any time, provided that the revocation
is in writing, except to the extent that we already have taken action
in reliance on your authorization.
YOUR RIGHTS
- You have the right to request restrictions on our uses and disclosures
of PHI for treatment, payment and health care operations. However, we
are not required to agree to your request unless the disclosure is to
a health plan in order to receive payment, the PHI pertains solely to
your dental care items or services for which you have paid the bill in
full, and the disclosure is not otherwise required by law. To request
a restriction, you may make your request in writing to the Privacy Officer.
- You have the right to reasonably request to receive confidential communications
of your PHI by alternative means or at alternative locations. To make
such a request, you may submit your request in writing to the Privacy Officer.
-
You have the right to inspect and copy the PHI contained in our Practice
records, except:
- for information compiled in reasonable anticipation of, or for use in,
a civil, criminal, or administrative action or proceeding;
- for PHI involving laboratory tests when your access is restricted by law;
- if you are a prison inmate, and access would jeopardize your health, safety,
security, custody, or rehabilitation or that of other inmates, any officer,
employee, or other person at the correctional institution or person responsible
for transporting you;
- if we obtained or created PHI as part of a research study, your access
to the PHI may be restricted for as long as the research is in progress,
provided that you agreed to the temporary denial of access when consenting
to participate in the research;
- for PHI contained in records kept by a federal agency or contractor when
your access is restricted by law; and
- for PHI obtained from someone other than us under a promise of confidentiality
when the access requested would be reasonably likely to reveal the source
of the information.
In order to inspect or obtain an electronic or paper copy your PHI, you
may submit your request in writing to the Privacy Officer. If you request
a copy, we may charge you a fee for the costs of copying and mailing your
records, as well as other costs associated with your request.
We may also deny a request for access to PHI under certain circumstances
if there is a potential for harm to yourself or others. If we deny a request
for access for this purpose, you have the right to have our denial reviewed
in accordance with the requirements of applicable law.
-
You have the right to request an amendment to your PHI but we may deny
your request for amendment, if we determine that the PHI or record that
is the subject of the request:
- was not created by us, unless you provide a reasonable basis to believe
that the originator of PHI is no longer available to act on the requested
amendment;
- is not part of your dental or billing records or other records used to
make decisions about you;
- is not available for inspection as set forth above; or
- is accurate and complete.
In any event, any agreed upon amendment will be included as an addition
to, and not a replacement of, already existing records. In order to request
an amendment to your PHI, you must submit your request in writing to Privacy
Officer at our Practice, along with a description of the reason for your request.
-
You have the right to receive an accounting of disclosures of PHI made
by us to individuals or entities other than to you for the six years prior
to your request, except for disclosures:
- to carry out treatment, payment and health care operations as provided above;
- incidental to a use or disclosure otherwise permitted or required by applicable law;
- pursuant to your written authorization;
- to persons involved in your care or for other notification purposes as
provided by law;
- for national security or intelligence purposes as provided by law;
- to correctional institutions or law enforcement officials as provided by law;
- as part of a limited data set as provided by law.
To request an accounting of disclosures of your PHI, you must submit your
request in writing to the Privacy Officer at our Practice. Your request
must state a specific time period for the accounting (e.g., the past three
months). The first accounting you request within a twelve (12) month period
will be free. For additional accountings, we may charge you for the costs
of providing the list. We will notify you of the costs involved, and you
may choose to withdraw or modify your request at that time before any
costs are incurred.
- You have the right to receive a notification, in the event that there is
a breach of your unsecured PHI, which requires notification under the
Privacy Rule.
COMPLAINTS
If you believe that your privacy rights have been violated, you should
immediately contact the Practice Privacy Officer at 516 654-4400. We will
not take action against you for filing a complaint. You also may file
a complaint with the Secretary of the U. S. Department of Health and Human Services.
CONTACT PERSON
If you have any questions or would like further information about this
notice, please contact the Practice Privacy Officer at
516-654-4400.
This notice is effective as of August 12, 2019.
