Notice of Privacy Policy

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY

The  Health Insurance Portability and Accountability Act of 1996 (HIPAA)  requires that health providers keep your medical and dental information  private. The HIPAA Privacy Rule states that health providers must also  post in a clear and prominent location, and provide patients with, a  written Notice of Privacy Policy.
 

The privacy practices described are currently in effect. We reserve the  right to change our privacy practices, and the terms of this Notice at  any time, provided such changes are permitted by law. If changes are  made, a new Notice of Privacy policy will be displayed in our office and  provided to patients. You may request a copy of our Notice at any time.  Additional information may be obtained from the HIPAA Coordinator  listed in our written HIPAA plan.

USES AND DISCLOSURES OF HEALTH INFORMATION
The following describes how information about you may be used in this dental office:

• Treatment Services: We may use  or disclose your health information to all of our staff members, other  dentists, your physicians, and/or other health care providers taking  care of you.
   
• Payment and Health Care  Operations: We may use or disclose your health information to obtain  payment for services we provide to you, to participate in quality  assurance, disease management, training, licensing, and certification  programs. Upon your written request, we will not disclose to your health  insurer any services paid by you out of pocket.
   
• Marketing/Fundraising: We will  not use your health information for marketing or fundraising purposes  without your written consent. You can opt out of receiving information  about our marketing or fundraisers. We will not sell your health  information without your explicit authorization.
   
• Appointment Reminders: We may  use or disclose your health information to provide you with appointment  reminders such as voicemail messages, text messages, emails, postcards,  or letters.
   
• Legal Requirements: We may use or disclose your health information when required to do so by law.
   
• Abuse or Neglect: If abuse or  neglect is reasonably suspected, we may use or disclose your health  information to the appropriate governmental authorities.
   
• National Security: When  required, we may disclose military personnel health information to the  Armed Forces. Information may be given to authorized federal offices  when required for intelligence and national security activities. Health  information for inmates in custody of law enforcement may be provided to  correctional institutes.
   
• Family Members, Friends, and  Others Involved in Care: At your request, we may disclose your health  information to a family member or other person if necessary to assist  with your treatment and/or payment for services. Based on our judgement  and as per 164.522(a) of HIPAA we may disclose your information to these  persons in the event of an emergency situation. We also may make  information available so that another person may pick up filled  prescriptions, medical supplies, records, or x-rays for you. Your  information may be disclosed to assist in notifying a family member,  caregiver, or personal representative of your location, condition, or  death.
   
• Business Associates: Some  services in our organization are provided through contacts with business  associates. Examples include practice management software  representatives, accountants, answering service personnel, etc. When  these services are contracted, we may disclose your health information  to our business associates so that they can perform the job we have  asked them to do and bill you or your third-party payer for services  rendered. All of our business associates are required to safeguard your  information and to follow HIPAA Privacy Rules.
   
• Workers' Compensation: We may  release medical information about you for workers' compensation or  similar programs. These programs provide benefits for work-related  injuries or illnesses.
   
• Research: We may use or  disclose medical information to researchers when an institution's review  board or special privacy board has reviewed the proposed study and  established protocols to ensure the privacy of the health information  used in their research and determined that the researcher does not need  to obtain your authorization prior to using your medical information for  research purposes.
   
• Public Health Activities: We  may use or disclose your health information for public health  activities, to include the following: to prevent or control disease,  injury, or disability; to report reactions with medications or problems  with products, to notify people of recalls of products they may be  using; to notify a person who may have been exposed to a disease or who  may be at risk for contracting or spreading a disease of condition; to  notify the proper government authority if we believe a patient has been  the victim of abuse, neglect, or domestic violence (when required by  law).
   
• Other Authorizations: In  addition to our use of your health information for treatment, payment,  or healthcare operations, you may give us written authorization to use  your health information or to disclose it to anyone for any purpose. If  you give us authorization, you may revoke it at any time. Your  revocation will not affect any use or disclosures permitted by your  authorization while it was in effect. Unless you give us a written  authorization, we cannot use or disclose your health information for any  reason except those described in this Notice.
   
• Breach Notification: We will  notify you any time your PHI may have been compromised through  unauthorized acquisition, use or disclosure.
   

PATIENT RIGHTS

• Access: You have the right to  look at or get copies of your health information, with limited  exceptions. You may request that we provide copies in a format other  than photocopies. We will use the format you request unless we cannot  practicably do so. You must make a request in writing to obtain access  to your health information.
  We will charge you a reasonable cost-based fee for expenses such as  copies. If you request X-Rays, there will be a fee for any copies of  films. You are not entitled to originals, only copies. Postage will be  added if copies are to be mailed. If you prefer, we will prepare a  summary or an explanation of your health information for a fee. Details  of all fees are available from the HIPAA Coordinator.
   
• Accounting of Disclosures: You  have the right to receive a list of instances in which we or our  business associates disclosed your health information for purposes,  other than treatment, payment, healthcare operations and certain other  activities, for the last 6 years. If you request this accounting more  than once in a 12-month period, we may charge you a reasonable,  cost-based fee for responding to these additional requests.
   
• Restriction: You have the  right to request that we place additional restrictions on our use or  disclosure of your health information. We will keep your information  confidential from your health plans if you pay cash, at your request. In  some instances, we may not be required to agree to these additional  restrictions, but if we do, we will abide by our agreement (except in an  emergency).
   
• Alternative Communication: You  have the right to request that we communicate with you about your  health information by alternative means or to alternative locations.  (You must make your request in writing.) Your request must specify the  alternative means or location, and provide satisfactory explanation how  payments will be handled under the alternative means or location you  request.
   
• Amendment: You have the right  to request that we amend your health information. (Your request must be  in writing, and must explain the reason for the amendment.) We may deny  your request under certain circumstances.
   

QUESTIONS AND COMPLAINTS
If you want more information about our Privacy Policy or have questions  or concerns, please contact us. If you have concerns relating to a  perceived violation of your privacy rights, to access to your health  information, to amending or restricting the use or disclosure of your  health information, or to requesting alternative means of communication,  you may contact us using the contact information listed at the end of  this Notice. You also may submit a written complaint to the Department  of Health and Human Services (HHS). We will provide you with the HHS  address upon request.
 

We support your right to the privacy of your health information. We will  not retaliate in any way if you choose to file a complaint with us or  with the HHS.

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HIPAA Coordinator: Ana M.

Telephone: (301)881-6708

Fax: (301)881-0634

Email: amfamilydentalcare@gmail.com

Address:121 Congressional Lane #306 Rockville, MD 20852