Hipaa Notice Of Privacy Practices
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3HIPAA 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 Dental Practice Covered by this Notice
This Notice describes the privacy practice of All Grins 4
Kids.
“We” and “our” means the Dental Practice. “You and “your”
means our patient.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry
out treatment, payment or health care operations (TPO) 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 and your child, 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.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your dentist, our office staff and others outside of our
office that are involved in your care and treatment for the purpose of providing dental care services to you, to pay your
dental care bills, to support the operation of the dental practice, and any other use required by law.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your dental care and any related
services. This includes the coordination or management of your dental care with a third party. For example, we would
disclose your PHI, as necessary, to a home health agency that provides care to you. For example, your PHI may be
provided to a physician or dentist to whom you have been referred to ensure that the physician or dentist has the
necessary information to diagnose or treat you.
Payment: Your PHI will be used, as needed, to obtain payment for your dental care services. For example, obtaining
approval for dental care may require that your relevant PHI be disclosed to the dental plan to obtain approval for the
necessary services.
Healthcare Operations:
We may use or disclose, as-needed, your PHI in order to support the business activities of our
dental practice. These activities include, but are not limited to, quality assessment activities, employee review activities,
training of dental students, licensing, and conducting or arranging for other business activities. For example, we may
disclose your PHI to dental school students that see patients at our office. In addition, we may use a sign-in sheet or
computer at the registration desk where you will be asked to sign your name and indicate your dentist or hygienist. We
may also call you by name in the waiting room when your dentist or hygienist is ready to see you. We may use or disclose
your PHI, as necessary, to contact you to remind you of your appointment. We may use email, text messaging or fax to
communicate with you. If you do not want electronic communications, you may request in writing to not receive electronic
communications.
We may use or disclose your PHI in the following situations without your authorization. These situations include: as
Required By Law, Public Health issues as required by law, Communicable Diseases; Health Oversight; Abuse or Neglect:
Food and Drug Administration requirements; Legal Proceedings; Law Enforcement; Coroners, Funeral Directors, and
Organ Donation; Research; Criminal Activity; Military Activity and National Security; Workers' Compensation; Inmates;
Required Uses and Disclosures. Under the law, we must make disclosures to you and when required by the Secretary of
the Department of Health and Human Services to investigate or determine our compliance with the requirements of
Section 164.500.
Other Permitted and Required Uses and Disclosures will be made Only with Your Consent, Authorization or
Opportunity to object unless required by law.
2. You may revoke this authorization, at any time, in writing, except to the extent that your dentist or the dental practice
has taken an action in reliance on the use or disclosure indicated in the authorization.
3. Your Rights: The following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. Under federal law, however, you may not
inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a
civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.
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