Privacy Policy

This notice describes how infor­ma­tion about you may be used and dis­closed and how you can gain access to this infor­ma­tion. Please review it care­fully. You may request a copy of this from our office at any time.

  1. Dental 1 may use and dis­close pro­tected health infor­ma­tion for treat­ment, pay­ment and health­care oper­a­tions. Exam­ples of these include, but are not lim­ited to, requested preschool, life insur­ance or sports phys­i­cals, refer­ral to nurs­ing homes, fos­ter care homes, home health agen­cies and/or refer­ral to other providers for treat­ment. Pay­ment exam­ples include, but are not lim­ited to, insur­ance com­pa­nies for claims includ­ing coör­di­na­tion of ben­e­fits with other insur­ers; col­lec­tion agen­cies. Health­care oper­a­tions includes, but is not lim­ited to, inter­nal qual­ity con­trol and assur­ance includ­ing audit­ing of records.
  2. Dental 1 is per­mit­ted or required to use or dis­close pro­tected health infor­ma­tion with­out the indi­vid­u­als writ­ten autho­riza­tion in cer­tain cir­cum­stances. Two exam­ples of such are for pub­lic health require­ments or court orders.
  3. We may release pro­tected health infor­ma­tion about you for worker’s com­pen­sa­tion or sim­i­lar programs.
  4. Dental 1 will not make any other use or dis­clo­sure of a patient’s pro­tected health infor­ma­tion with­out the individual’s writ­ten autho­riza­tion. Such autho­riza­tion may be revoked at any time. Revo­ca­tion must be written.
  5. Dental 1 may at times con­tact the patient to pro­vide appoint­ment reminders or infor­ma­tion regard­ing treat­ment alter­na­tives or other health-related ben­e­fits and ser­vices that may be of inter­est to the indi­vid­ual patient.
  6. We may release or dis­close pro­tected health infor­ma­tion about you to a friend or fam­ily mem­ber who is involved in your med­ical care. We may also give infor­ma­tion to some­one who helps pay for your care. We may also tell your fam­ily or friends the con­di­tion that you are in. You will be pro­vided a form to list spe­cific peo­ple who we may speak to regard­ing your med­ical care. In addi­tion, we may dis­close pro­tected health infor­ma­tion about you to an entity assist­ing in a dis­as­ter relief effort so that your fam­ily can be noti­fied about your con­di­tion, sta­tus and location.
  7. Dental 1 will abide by the terms of this notice or the notice cur­rently in effect at the time of the disclosure.
  8. Dental 1 reserves the right to change the terms of its notice and to make new notice pro­vi­sions effec­tive for all pro­tected health infor­ma­tion that it retains.
  9. Dental 1 will pro­vide each patient with a copy of any revi­sions of it’s Notice of Pri­vacy Prac­tices at the time of their next visit, or at their last known address if there is a need to use or dis­close any pro­tected health infor­ma­tion of the patient. Copies may also be obtained at any time at our offices.
  10. A patient can file a com­plaint to the Prac­tice and to the Depart­ment of Health and Human Ser­vices, Office of Civil Rights if they believe their pri­vacy rights have been vio­lated. To file a com­plaint with the prac­tice please con­tact the Pri­vacy Offi­cer at the fol­low­ing address and/or phone num­ber 617-698-0600. All com­plaints will be addressed and the results will be reported to the Cor­po­rate Com­pli­ance Offi­cer or Physician.
  11. It is Dental 1’s pol­icy that no retal­ia­tory action will be made against any indi­vid­ual who sub­mits or con­veys a com­plaint of sus­pected or actual non-compliance of the pri­vacy standards.
  12. The name, title and tele­phone num­ber of a per­son in the office to con­tact for fur­ther infor­ma­tion is Dental 1 Pri­vacy Offi­cer, 617-698-0600.
  13. The effec­tive date is August 11, 2010.

Patients have been granted indi­vid­ual rights under the HIPAA Leg­is­la­tion. This includes the following:

  1. You have the right to inspect and copy pro­tected health infor­ma­tion that may be used to make deci­sions about your care. Usu­ally, this includes med­ical and billing records, but does not include psy­chother­apy notes, infor­ma­tion com­piled in rea­son­able antic­i­pa­tion of or use in a civil, crim­i­nal or admin­is­tra­tive action or pro­ceed­ing, or Pro­tected Health Infor­ma­tion that is sub­ject to or exempt from the Clin­i­cal Lab­o­ra­to­ries Act of 1988. To inspect and copy pro­tected health infor­ma­tion that may be used to make deci­sions about you, you must sub­mit your request in writ­ing to the Pri­vacy Offi­cer listed above. If you request a copy of the infor­ma­tion , we may charge a fee for the costs of copy­ing (includ­ing labor), mail­ing or other sup­plies asso­ci­ated with your request.
  2. If you feel that pro­tected health infor­ma­tion we have about you is incor­rect or incom­plete, you may ask us to amend the infor­ma­tion. You have the right to request an amend­ment for as long as the infor­ma­tion is main­tained in the des­ig­nated record set. To request an amend­ment, your request must be made in writ­ing and sub­mit­ted to the Pri­vacy Offi­cer listed above. You must pro­vide a rea­son that sup­ports your request and we may deny your request for an amend­ment if is not in writ­ing or does not include a rea­son to sup­port the request. In addi­tion, We may deny your request if you ask us to amend infor­ma­tion that was not cre­ated by us, unless the per­son or entity that cre­ated the infor­ma­tion is no longer avail­able to make the amend­ment, is not part of the pro­tected health infor­ma­tion kept by or for our prac­tice: is not part of the infor­ma­tion which you would be per­mit­ted to inspect and copy : or is accu­rate and com­plete. We may deny your request to inspect and copy in cer­tain very lim­ited cir­cum­stances. If you are denied access to pro­tected health infor­ma­tion, you may request that the denial be reviewed. Another licensed health care pro­fes­sional cho­sen by our orga­ni­za­tion will review your request and the denial. The per­son con­duct­ing the review will not be the per­son who denied your request and we will com­ply with the out­come of the review.
  3. You have the right to request an “account­ing of dis­clo­sures.” This is a list of the dis­clo­sures we made of pro­tected health infor­ma­tion about you that was not made for treat­ment, pay­ment and health care oper­a­tions, there are cer­tain excep­tions to this right. To request this list or account­ing of dis­clo­sure, you must sub­mit your request in writ­ing to the Pri­vacy Offi­cer listed above. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indi­cate in what form you want the list (for exam­ple, on paper, elec­tron­i­cally). The first list you request within a 12– month period will be free. Fore addi­tional lists we may charge you for the costs of pro­vid­ing the list. We will notify you of the cost involved and you may choose to with­draw your request at that time before any costs are incurred. The account­ing must be pro­vided to you no later than 60 days after the receipt of your request, unless we uti­lize the 30-day exten­sion period.
  4. You have the right to right to request a restric­tion or lim­i­ta­tion on the pro­tected health infor­ma­tion we use or dis­close about you for treat­ment, pay­ment or health care oper­a­tions. You also have the right to request a limit on the pro­tected health infor­ma­tion we dis­close about you to some­one who is involved in your care or the pay­ment for your care, like a fam­ily mem­ber or friend. We are not required to agree to your request. If we do agree, we will com­ply with your request unless the infor­ma­tion is needed to pro­vide you emer­gency treat­ment. To request restric­tions, you must make your request in writ­ing to the Pri­vacy Offi­cer listed above. In your request, you must tell us (1) what infor­ma­tion you want to limit; (2) whether you want to limit our use, dis­clo­sure or both; and (3) to whom you want the lim­its to apply, for exam­ple, dis­clo­sures to your spouse. Either you or we may ter­mi­nate the restric­tion upon noti­fi­ca­tion of the other.
  5. You have the right to request that we com­mu­ni­cate with you about med­ical mat­ters in a cer­tain way or at a cer­tain loca­tion. For exam­ple, you can ask that we only con­tact you at work or by mail. To request con­fi­den­tial com­mu­ni­ca­tions, you must make your request in writ­ing to the Pri­vacy Offi­cer listed above. We will not ask you the rea­son for your request. We will accom­mo­date all rea­son­able requests. Your request must spec­ify how or where you wish to be contacted.

You will be asked to sign an acknowl­edg­ment or receipt of this Notice of Pri­vacy Prac­tices. You will also be asked to out­line or define spe­cific instances or infor­ma­tion that you would like kept com­pletely con­fi­den­tial (between you and the orga­ni­za­tion). If you have any ques­tions regard­ing this Notice of Pri­vacy Prac­tices, please do not hes­i­tate to con­tact our Pri­vacy Offi­cer for more infor­ma­tion or clarification.

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