Smile Magic Dentistry
Notice of Privacy Practices
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
The health insurance Portability & Accountability act of 1996(HIPAA) is federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper or orally are kept properly confidential. This Act gives you, the Patient significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entitles the misuse personal health information.
As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may disclose your health information.
We may use and disclose your medical records only for each of the following purposes:
- Treatment, Payment, and Healthcare Operations
- Treatment means providing, coordinating or managing healthcare related services by one or more healthcare providers. An example of this would include teeth cleaning services.
- Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
- Healthcare Operations include the business aspects of running our practice. Such as conducting quality assessment and improvement activities, auditing functions, cost management analysis and customer service. An example would be an internal quality assessment review.
- In response to a court order or other legal requirement.
- Pursuant to an individual’s authorization. (i.e. an authorized family member or next of kin)
- As required for compliance with the HIPAA Administrative Simplification Rules
Any other uses and disclosures will be made only with written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.
You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the privacy officer.
- The right to request restrictions on certain uses and disclosures of health information. Including those related to disclosures to family members, relatives, close personal friends or any other person identified by you.
- The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
- The right to inspect and copy your protected health information.
- The right to amend your protected health information.
- The right to receive an accounting of disclosures of protected health information.
- The right to obtain and we have obligation to provide to you a copy of this notice.
- The right to provide and we are obligated to review a written acknowledgement that you have received a copy of our Privacy Practices.
We are required by law to maintain the privacy of your protected health information and provide you with notice of our legal duties and privacy practices with respect to protected health information.
Office of Civil Rights
200 Independence Ave. S.W.
Washington, D.C. 20201