Privacy Policy
Notice of Privacy Practices for Protected Health Information
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!
With your consent, the practice is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and healthcare operations. Protected health information (PHI) is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.
Example of uses of your health information for treatment purposes:
A nurse obtains treatment information about you and records it in a health record. During the course of your treatment, the doctor determines the need to consult with another specialist in the area. The doctor will share the information with such specialists and obtain input.
Example of use of your health information for payment purposes:
We submit a request for payment to your health insurance company. The health insurance company requests information from us regarding medical care given. We will provide information to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.
Your Health Information Rights
The health records we maintain and billing records are the physical property of the practice. The information in it, however, belongs to you. You have a right to:
- Ask someone who has medical power of attorney or your legal guardian, to exercise your rights and make choices about your health information.
- Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office. We are not required to grant the request but we will comply with any request granted;
- Request a restriction on disclosures of medical information to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains solely to a health care service for which the provider has been paid out of pocket in full—we must comply with this request;
- Request you be allowed to inspect your health record and billing record – you may exercise this right by delivering the request in writing to our office;
- Obtain a copy of your paper or electronic record.
- Appeal a denial of access to your protected health information except in certain circumstances;
- Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office;
- File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
- Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;
- Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office; and,
- Elect to opt out of receiving further communications to raise funds for the practice.
- Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office.
If you want to exercise any of the above rights, please contact Courtney Schnell in person or in writing, during normal hours. She will provide you with assistance on the steps to take to exercise your rights.
Our Responsibilities
The practice is required to:
- Maintain the privacy of your health information as required by law;
- Provide you with a notice of our duties and privacy practices as to the information we collect and maintain about you;
- Abide by the terms of this Notice;
- Notify you if we cannot accommodate a requested restriction or request;
- Accommodate your reasonable requests regarding methods to communicate health information with you;
- We will never share your information (for marketing purposes, sale of your information, sharing of psychotherapy notes) without your written permission, and
- Notify you if you are affected by a breach of unsecured PHI
We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Courtney Schnell, Practice Manager, at 410.583.7600.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to Courtney Schnell. You may also file a complaint by mailing it or e-mailing it to the Secretary of Health and Human Services whose street address and e-mail address is:
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775
- We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the practice.
- We cannot, and will not, retaliate against you for filing a complaint with the Secretary.
Other Disclosures and Uses
Notification
Unless you object, we may use or disclose your protected health information to notify or assist in notifying, a family member, personal representative, or other person responsible for your care, your location, your general condition, or your death.
Communication with Family
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person's involvement in your care or in payment for such care if you do not object or in an emergency.
Food and Drug Administration (FDA)
We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects, or post-marketing surveillance information to enable product recalls repairs, or replacements.
Workers Compensation
If you are seeking compensation through Workers’ Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers’ Compensation.
Public Health
As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Abuse & Neglect
We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose to the institution, or its agents, your protected health information necessary for your health and the health and safety of other individuals.
Law Enforcement
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.
Health Oversight
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.
Other Uses
Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided.
Website
If we maintain a website that provides information about our entity, this Notice will be on the website. Effective Date: 02.10.2014
OPTIONAL/ADDITIONAL Uses and Disclosures
Notice of Privacy Practices for Protected Health Information
The following are segments of the Notice of Privacy Practices that may not be applicable to a dental or OMS practice. If any are applicable and your Notice of Privacy would need to incorporate them, we have provided model language. An example would be: If your practice participates in drug research, then you would need to include the first item listed below in your Notice of Privacy Practices.
Research
We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Disaster Relief
We may use and disclose your protected health information to assist in disaster relief efforts.
Funeral Directors/Coroners
We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.
Organ Procurement Organizations
Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Marketing
We may contact you to provide you with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you.
Fund Raising
We may contact you as part of a fundraising effort.
For Specialized Governmental Functions
We may disclose your protected health information for specialized government functions as authorized by law, such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
LeadPost Services / User Sniping
We may use a service to obtain personal and non-personal information about You. This collection is triggered when you access our Website through a pixel placed on our Website. The Service may collect the following information when you interact with the page(s) on our Website where the pixel is present: (i) information about your web browser; (ii) your IP address, (iii) web pages visited; and (iv) cookies stored in your browser. We may use the data collected by the service to obtain personal information about You and use this data for marketing to You. For more information about the service data use and collection policies and practices and your opt out rights, please review the Privacy Policy located at https://leadpost.com/privacy-policy.
