Notice of Privacy Practices

This notice describes how health information about you as a patient may be used and disclosed, and how you can get access to this information. The privacy of your health information is important to us.

Federal and state law requires us to maintain the privacy of your health information and to give you this notice about our privacy practices, legal duties, and your rights. We are required to follow the privacy practices described in this notice while it is in effect. This notice originally took effect March 15, 2012, and remains in effect until it is replaced.

We reserve the right to change our privacy practices and this notice at any time, as permitted by law. Changes may apply to all health information we maintain, including information created or received before the change. Before making a significant change, we will revise this notice and make the updated notice available upon request.

You may request a paper copy at any time. Contact us using the information at the end of this notice for more information or additional copies.

Treatment: We may use your health information for treatment or disclose it to a dentist, physician, or other health care provider who is treating you.

Payment: We may use and disclose your health information to obtain payment for services we provide. We may also disclose it to another health care provider or entity subject to federal privacy rules for its payment activities.

Health care operations: We may use and disclose your information for quality assessment and improvement, professional review, training, accreditation, certification, licensing, credentialing, and fraud or abuse detection. We may share information for certain operations with another covered provider or organization that has a relationship with you, as permitted by law.

Your authorization: You may give us written authorization to use or disclose your health information for a particular purpose. You may revoke that authorization in writing at any time. Revocation does not affect uses or disclosures already made while the authorization was in effect. Except as described in this notice or otherwise permitted by law, we will not use or disclose your information without written authorization.

Family and friends: We may share information with a family member, friend, or another person involved in your care or payment, to the extent necessary. When possible, you will have an opportunity to object. If you are unavailable, incapacitated, or experiencing an emergency, we may use professional judgment to determine whether disclosure is in your best interest. This may include allowing someone to pick up prescriptions, supplies, X-rays, or similar information, or helping notify someone involved in your care of your location and general condition.

Appointment reminders: We may use your information to provide reminders by methods such as voicemail, postcards, or letters.

Disaster relief: We may disclose information to a public or private organization legally authorized to assist with disaster-relief efforts.

When authorized or required by law, we may use or disclose your health information:

• as required by federal, state, or local law;
• for public-health activities, including disease and vital-statistics reporting, child-abuse reporting, FDA oversight, and certain work-related illness or injury reporting;
• to report adult abuse, neglect, or domestic violence;
• to health-oversight agencies;
• in response to court or administrative orders and other lawful processes;
• to law-enforcement officials in circumstances permitted by law, including certain subpoenas, investigations, emergencies, crimes on our premises, and efforts to identify or locate a person;
• to coroners, medical examiners, funeral directors, and organ-procurement organizations;
• to avert a serious threat to health or safety;
• for certain legally authorized research activities;
• to the military or authorized federal officials for lawful intelligence, counterintelligence, or national-security activities;
• to correctional institutions concerning inmates; and
• as authorized by workers’ compensation laws.

You have the right to inspect or receive copies of your health information, with limited exceptions. Requests for access must be made in writing and sent to our office at the address below.

You may request a format other than photocopies, and we will use it when reasonably practicable. We may charge a reasonable, cost-based fee for labor, copying, postage, or an alternative format. If you prefer, we may offer to prepare a summary or explanation for a fee. Contact us for current fee information.

Restrictions: You may ask us to place additional restrictions on how we use or disclose your information. We are not always required to agree. If we do agree, we will follow the written agreement except in an emergency.

Alternative communications: You may ask us in writing to communicate with you by alternative means or at another location. Your request must identify the preferred method or location and explain how payment will be handled under the requested arrangement.

If you want more information about our privacy practices, or have questions or concerns, please contact Calm Dental Care using the information below.

You may contact us if you believe we violated your privacy rights; made an incorrect decision about access to your information; responded incorrectly to a request to amend or restrict information; or should communicate with you by another method or at another location.

You may also submit a written complaint to the U.S. Department of Health and Human Services Office for Civil Rights. We will provide the appropriate complaint address upon request. We support your right to privacy and will not retaliate against you for filing a complaint with us or with the Department of Health and Human Services.