NOTICE OF PRIVACY PRACTICES  

本通知描述如何使用和披露您的医疗信息,以及您如何获得这些信息.  PLEASE REVIEW IT CAREFULLY.  IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT OUR “PRIVACY OFFICER” AT 714-845-8605.

法律要求我们维护受保护健康信息的隐私,并向您提供本通知,说明我们在受保护健康信息方面的法律责任和隐私做法.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, 当前或未来的身体或精神健康或状况以及相关的医疗保健服务或医疗保健服务的支付.

This Notice was published and became effective on January 1, 2020.  We are required to abide by the terms of this Notice currently in effect.  We may change the terms of this Notice at any time.  The new Notice will be effective for all protected health information that we maintain at that time.  You may obtain a copy of any revised Notice by accessing our website, calling our Privacy Contact and requesting that a revised copy be sent to you in the mail, or asking for one at the time of your next appointment.

 

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION 

To Contact YouWe may use your protected health information to contact you to remind you about appointments, inform you about treatment options, or advise you about other health-related benefits and services. 

TreatmentWe may use and disclose your protected health information to provide, coordinate or manage your health care and any related services.  This includes coordinating your health care with a third party, consulting with another health care provider, or referring you to another health care provider.  For example, 您的牙医可能需要知道您是否有其他可能使您的治疗复杂化的健康问题,因此可能会向为您提供治疗的其他医疗保健提供者索要您的医疗记录. We may also share your health information with other providers as described herein.  向其他提供者披露您的健康信息可以通过诸如“处处关怀”之类的健康信息交换以电子方式完成, 这使得参与你的护理的提供者可以访问你的一些健康信息,以协调为你提供的服务和治疗.

PaymentWe may use and disclose your protected health information to obtain or provide payment for your dental services.  This may include sharing information with the person or entity responsible for paying, such as your health insurer.  您的保险公司或健康计划可能需要您的信息用于确定保险福利的资格或覆盖范围以及审查提供给您的服务.  For example, we may give your insurance company information about your dental surgery so your insurance will pay for the care.

OperationsWe may use or disclose your protected health information for our health care operations, such as to support our business activities and to ensure that quality dental care is provided.  Some of these activities involve quality assessments, peer or employee review, training health care professionals, licensing and accreditation activities, data aggregation, compliance- or audit-related activities, and business planning and development.  For example, we may use your information to evaluate the performance of our dentists and staff in providing care to you.  We may also disclose your protected health information to another provider, health plan, or health care clearinghouse that has or has had a relationship with you for certain of its health care operations.

Business AssociatesWe may disclose your protected health information to third parties that perform services, such as billing or legal services.  我们与第三方签订了书面合同,要求他们保护您受保护的健康信息的隐私.

Treatment Alternatives and Health-Related Products and Services我们可能会使用或披露您受保护的健康信息,向您提供有关某些产品或服务的信息,包括描述我们参与牙医网络或健康计划网络的情况, products or services we provide or include in a plan of benefits, and alternative treatments, therapies, dentists or settings of care.

Family and FriendsWe may disclose your protected health information to individuals, such as family and friends, who are involved in your care or who help pay for your care.  We may do this if you tell us we can do so, or if you know we are sharing your information with these people and you do not object.  If you are unavailable or unable to tell us your preference, we may also disclose your information if, based on our professional judgment, we believe that disclosing the information is in your best interest and you would not object.  For example, 如果您的配偶陪同您进入检查室或允许您的配偶取药,我们可能会假定您同意向您的配偶披露您的信息, dental supplies and X-rays.

If you are a minor, you also may have the right to block parental access to your health information in certain circumstances, if permitted by state law. You can contact your dental provider or our Privacy Officer at the number at the top of this Notice.

 

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION  We may use or disclose your protected health information without your authorization in certain other circumstances, such as when required by law or for public health and safety purposes.  We will comply with the legal requirements and limitations applicable to these circumstances.    

As Required by LawWe may use or disclose your protected health information when and as required by federal, state or local law.

Public Health Activities我们可能会向公共卫生当局披露您受保护的健康信息,用于预防或控制疾病等公共卫生活动, injury or disability; to respond to or report suspected abuse or neglect, non-accidental physical injuries, reactions to medications, or problems with products; and to comply with medication or product recalls.

Health Oversight ActivitiesWe may disclose your protected health information to health oversight agencies, such as government agencies that oversee the health care system, government programs, or compliance with civil rights laws, for oversight activities such as audits, investigations, inspections and licensing.

Lawsuits and Disputes我们可能会在行政或司法程序中根据法院或行政命令使用或披露您受保护的健康信息, or in response to a subpoena, discovery request or other legal process. 

Law EnforcementWe may use or disclose your protected health information for law enforcement purposes, so as to respond to legal processes, identify or locate a suspect, provide information about crime victims, report crimes occurring on our premises, and report suspected crimes in a medical emergency.

Coroners, Medical Examiners and Funeral DirectorsWe may disclose your protected health information 供死因裁判官或法医鉴定死者身份或确定死因或进行其他合法活动, or to a funeral director, as necessary to allow him/her to carry out his/her activities.

Organ and Tissue DonationIf you are an organ or tissue donor, we may disclose your protected health information to organizations that handle organ procurement or organ, eye or tissue donation or transplantation.

Research如果得到机构审查委员会或隐私委员会的批准,我们可能会在研究准备或研究中使用和披露您受保护的健康信息.

Serious Threat to Health or Safety; Disaster Relief我们可能会在必要时向适当的个人或组织披露您受保护的健康信息,以防止对个人(包括您自己)或公众的健康和安全构成严重威胁.  We may also disclose your protected health information to identify, locate or notify your family members or persons responsible for you in a disaster.

Military and Veterans如果您是武装部队成员,我们可能会根据军事指挥或其他政府部门的要求披露您受保护的健康信息.

National Security; Intelligence Activities; Protective ServiceWe may disclose your protected health information to federal officials for intelligence, counterintelligence and other national security activities authorized by law, including activities related to the protection of the President, other authorized persons or foreign heads of state, or related to the conduct of special investigations.

Workers’ CompensationWe may disclose your protected health information for workers’ compensation or similar work-related injury programs, to the extent permitted or required by law.

InmatesWe may disclose your protected health information to a correctional institution (if you are an inmate) or a law enforcement official (if you are in that official’s custody) as necessary (i) for the institution to provide you with health care; (ii) to protect your or others’ health and safety; or (iii) for the safety and security of the correctional institution.

 

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITH YOUR AUTHORIZATION

本通知未涵盖的您受保护的健康信息的所有使用和披露将仅在您的书面授权下进行.  For example, we will not sell your protected health information without your written authorization.  联邦和州法律可能会提供额外的保护或进一步限制我们如何使用或披露您受保护的健康信息.  We will comply with these laws and, when necessary, ask for your authorization to use or disclose your protected health information.  Examples of protected health information that may be subject to special protections include psychotherapy notes, genetic information, mental health information, HIV/AIDS test results or information, reproductive health information, sexually transmitted or other communicable disease information, and alcohol or substance use disorder information.  

You may revoke any authorization, at any time, by notifying, in writing, our Privacy Contact.  If you revoke your authorization, we will no longer use or disclose your protected health information as allowed by the authorization, except to the extent we have already relied on the authorization.  

 

YOUR RIGHTS WITH RESPECT TO PROTECTED HEALTH INFORMATION

You have the following rights with respect to your protected health information.  You may exercise these rights by submitting a written request to our Privacy Contact.  Please contact our Privacy Contact with any questions about these rights.

Right to Inspect and CopyYou may inspect and obtain a copy of your protected health information maintained in your dental chart, including clinical and billing records and any other records that we use to make decisions about you.  We may charge you a fee to cover costs of copying, mailing and associated supplies.

We may refuse to allow you to inspect or copy certain records, such as information compiled for legal actions and proceedings.  If we deny your request, you may have a right to have this decision reviewed. 

Right to Request RestrictionsYou may request that we not use or disclose any part of your protected health information for a particular treatment, payment or health care operations-related purpose.  您还可以要求不将您受保护的健康信息的任何部分透露给可能参与您护理的特定家庭成员或朋友. 

We are not required to agree to a restriction that you may request, 除非您要求将您受保护的健康信息的披露限制为与付款或医疗保健操作相关的健康计划,并且受保护的健康信息仅与您已全额支付的医疗保健项目或服务相关,而不是通过保险.  If we agree to the requested restriction, we may still use or disclose your protected health information as needed for emergency treatment.  

Right to Request Confidential CommunicationsYou may request that we communicate with you via alternative means or at an alternative location.  For example, you may request that we contact you using your work phone number, rather than a home phone number.  We will accommodate reasonable requests and will not require an explanation for the request, 但我们可能需要您提供其他信息,以确保我们能够与您国外正规买球app官方版下载并安排账单和付款. 

Right to AmendYou may request an amendment of your protected health information to correct an error or omission.  In certain cases, we may deny your request for an amendment.  If we deny your request for an amendment, you have the right to file a statement of disagreement with us.  We may prepare a rebuttal to your statement and, if we do, we will provide you with a copy of any such rebuttal. 

 

 

Right to an Accounting of Disclosures您可以要求对您的受保护健康信息在您提出请求前最多六年内的某些披露进行核算.  This accounting does not include disclosures made to you or with your authorization; for treatment, payment or health care operations; to family members or friends involved in your care or for notification purposes; and certain other disclosures.  The right to receive this information is subject to certain exceptions, restrictions and limitations. 

Right to Breach Notification.  如果我们或我们的服务提供商不当使用或披露您受保护的健康信息,从而危及该信息的隐私或安全(“违规”), we will notify you as required by law.

Right to Paper Copy of This NoticeYou may receive a paper copy of this Notice upon request, even if you have agreed to accept this Notice electronically.

 

QUESTIONS OR COMPLAINTS

We take our obligations to protect your privacy seriously.  If you have any questions about this Notice, please contact our Privacy Contact.  If you believe your privacy rights have been violated, 您可以通过本表格顶部的隐私国外正规买球app官方版下载人向我们提交投诉.S. Department of Health and Human Services.  You will not be penalized for filing a complaint.