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Notice of privacy practices

Our Legal Duty

We are required by law to protect the privacy of your Protected Health Information (PHI). We are also required to provide you this notice about our privacy practices, our legal duties, and your rights concerning your medical information (PHI). We may amend the terms of this notice at any time. If we make a material change to privacy practices we will provide the revised notice to you. The current notice will be available on our website or in office. We maintain physical, electronic and procedural safeguards in the handling and maintenance of our patients’ PHI in accordance with applicable state and federal standards to protect against risks such as loss, destruction and misuse.

Uses and Disclosures of Your Medical Information

Treatment: We may disclose your medial information (PHI) without your prior approval to another dentist or healthcare provider working in our facility or otherwise providing you treatment for the purpose of evaluating your health, diagnosing dental/medical conditions and providing treatment. For example: Your PHI may be disclosed to an oral surgeon to determine whether surgical intervention is needed.

Payment: We may disclose PHI to your insurance plan to seek payment. For Example: Your insurance plan may request and receive information on dates and types of treatment at our facility in order to verify and process your insurance claim.

Healthcare Operations: We may use and disclose your PHI without your prior approval for health care operations including: healthcare quality assessment and improvement activities; reviewing and evaluating dental care provider performance, qualifications and competence, health care training programs, provider accreditation, certification, licensing and credentialing activities: conducting or arranging for medical reviews, audits and legal services, including fraud and abuse detection and prevention; and business planning, development, management and general administration including customer service, complaint resolutions and billing, de-identifying medical information, and creating limited data sets for health care operations, public health activities and research.

We may disclose your PHI to another dental or medical provider or to your health plan subject to federal privacy protection laws, as long as the provider or plan has had a relationship with you and the PHI is for that provider’s or health plan’s quality care assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection or prevention.

Your Authorization

You, or your legal representative) may give us written authorization to use your PHI or to disclose it to anyone for any purpose. Once you give us authorization to release PHI, we cannot guarantee that the person to whom the information is provided will not disclose that information. You may revoke your authorization at any time, in writing. PHI will not be disclosed for any purpose other than those described in this notice without a signed Authorization. We will obtain your authorization prior to using your PHI for marketing, fundraising purposes or for commercial use. Once authorized, you may opt out at any time.

Public Health and Benefit Activities

We may use and disclose your PHI without your permission, when required by law and when authorized by law for the following kinds of public health and public benefit activities: for public health, including to report disease and vital statistics, abuse, neglect or domestic violence; to avert a serious imminent threat to health or safety; for health care oversight such as activities of state insurance commissioners, licensing, and peer review authorities and fraud prevention agencies; for research; in response to court and administrative orders and other lawful process; to law enforcement officials with regard to crime and victims and criminal activities; to coroners, medical examiners, funeral directors and organ procurement organizations; to the military, to federal officials for lawful intelligence, counterintelligence, and national security activities, and to correctional institutions and law enforcement regarding persons in lawful custody; and as authorized by state worker’s compensation laws.

Special Protections for SUD Records

Substance Abuse Disorder (SUD) Treatment records have enhanced protections, They cannot be used in legal proceedings without your consent or court order. If an use or disclosure of PHI described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.

Business Associates

We may disclose your PHI to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your PHI and are not allowed to disclose any information other than as specified in our contract.

Data Breach Notification

We may use your contact information to provide legally required notices of unauthorized acquisition, access or disclosure of your PHI.

Additional Restrictions on Use and Disclosure

Certain federal and state laws may require the special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. “Highly Confidential Information” may include confidential information under federal laws governing reproductive rights, alcohol and drug abuse information and genetic information as well as state laws that often protect the following types of information: HIV/Aids, Mental Health, Genetic Tests (in accordance with GINA 2009), alcohol and drug abuse, sexually transmitted diseases and reproductive health information and child or adult abuse or neglect, including sexual assault.

Your Rights

  1. You have the right to see and get a copy of your health records.
  2. You have a right to request an amendment be made to your health records by submitting a request in writing to our privacy officer. Your request does not guarantee the amendment, but does guarantee that it will be reviewed and considered.
  3. You have a right to ask and to get an Accounting of Disclosures of when and why your PHI was shared for certain purposes.
  4. You are entitled receive a Notice of Privacy Practices that tells you how your PHI may be used and shared.
  5. You may decide if you want to give your Authorization for your PHI may be shared for certain purposes including marketing. It is the policy of our office NOT to sell or disclose your information to any outside firms or business partners. Your information may be used, only within our office, for the purposes of presenting to you, certain products or services which our dentists or staff feel may present a benefit for you, your oral health or happiness with your smile.
  6. You have the right to receive you information in a confidential manner and restrict certain communication methods.
  7. You have the right to restrict who receives your information.
  8. If you believe your rights are being denied or your PHI is not being protected, you can file a complaint with your provider or health insurer -or- with the US Government.

Complaints

If you are concerned that we may have violated your privacy rights, or you disagree with a decision made about access to your PHI, about amending your PHI, about restricting or disclosure of your PHI, or about how we communicate with you about your PHI (including a breach notice notification), you may contact our Privacy Officer to register either a verbal or written complaint at 108 E Grinnell Plaza, Sheridan, WY 82801. You may also submit a written complaint to the Office for Civil Rights of the United States Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, Washington DC, 20201. You contact the Office for Human Rights hotline at 1-800-368-1019. We support your right to privacy of your PHI. We will not retaliate in any way if you choose to file and complaint with us or with the US Department of Health and Human Services.