Carmichael Dental Care
Chet E. Swartzentruber, DMD

Effective Date: August 1, 2007
Notice Date: November 17, 2014

This notice describes how our office may use and disclose medical information about you, and how you may obtain access to this information. Please review it carefully. Your information is important and confidential. Our ethics and policies require that your information be held in strict confidence.

Introduction

We maintain protocols to ensure the security and confidentiality of your personal information. We have physical security in our building, passwords to protect databases, compliance audits, and virus/intrusion detection software. Within our practice, access to your information is limited to those who need it to perform their jobs. We are committed to treating and using protected health information about you responsibly. This Notice of Privacy Policies describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective 1 August 2007, and it applies to all protected health information as defined by federal regulations.

Understanding Your Health Record

Each time you visit Carmichael Dental Care, we make a record of your visit. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical records, serves as a:

• Basis for planning your care and treatment

• Means of communication among the health professionals who contribute to your care

• Legal document describing the care you received

• Means by which you or a third-party payer can verify that services billed were actually provided

• Tool for educating health professionals

• Source of data for medical research

• Source of information for public health officials charged with improving the health of the state and nation

• Source of data for our planning and marketing

• Tool by which we can assess and continually work to improve the care we render and outcomes we achieve.

Disclosure Of Your Health Care Information

Treatment

We may disclose your health care information to other healthcare professionals with whom we associate for the purpose of treatment, payment, or health care operations.

Payment

We may disclose your health information to your insurance provider for the purpose of payment or health care operations.

Workers' Compensation

We may disclose your health information as necessary to comply with State Workers' Compensation Laws.

Emergencies

We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care, about your medical condition or in the event of an emergency or your death.

Public Health

As required by law, we may disclose your health information to public health authorities for purposes related to:

• Preventing or controlling disease, injury, or disability.

• Reporting child abuse or neglect.

• Reporting domestic violence.

• Reporting problems with products and reactions to medications to the Food and Drug Administration.

• Reporting disease or infection exposure.

Judicial and Administrative Proceedings

We may disclose your health information in the course of any administrative or judicial proceeding.

Law Enforcement

We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person; complying with a court order or subpoena; and other law enforcement purposes.

Deceased Persons

We may disclose your health information to coroners or medical examiners.

Research

We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

Public Safety

It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

Specialized Government Agencies

We may disclose your health information for military, national security, prisoner, and government benefits purposes.

Change of Ownership

In the event that Carmichael Dental Care is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

You have the following rights regarding your protected health information:

• You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Carmichael Dental Care is not required to agree to the restriction that you requested.

• You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.

• You have the right to inspect and copy your health information.

• You have the right to request that Carmichael Dental Care amend your protected health information. Please be advised, however, that Carmichael Dental Care is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.

• You have the right to receive an accounting of disclosures of your protected health information made by Carmichael Dental Care.

• You have the right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to This Notice of Privacy Practices

Carmichael Dental Care reserves the right to amend this Notice of Privacy Practices at any time in the future and will make the new provisions effective for all information that it maintains.

Until such amendment is made, Carmichael Dental Care is required by law to comply with this Notice.

Carmichael Dental Care is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.

If you have questions about any part of this notice or if you want more information about your privacy rights, please contact:

Carmichael Dental Care
Phone: 334-270-9924

If Carmichael Dental Care is not available, you may make an appointment for a personal conference in person or by telephone within two working days.

Complaints

Complaints about your privacy rights, or how Carmichael Dental Care has handled your health information, should be directed to Carmichael Dental Care by calling 334-270-9924.

If Carmichael Dental Care is not available, you may make an appointment for a personal conference in person or by telephone within two working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201