THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY
This Facility is required by law to provide you with this Notice of Privacy Practices (hereafter: "Notice") so that you will understand how we may use or share your information from your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as "Protected Health Information" ("PHI") or simply "health information." We are required to adhere to the terms outlined in this Notice, to maintain the privacy of your PHI, and to notify affected individuals of a breach of unsecured PHI. If you have any questions about this Notice, please contact our HIPAA Compliance Officer.
Each time you are admitted to our Facility, a record of your stay is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide and payment for the treatment. We may use and/or disclose this information to:
Understanding what is in your record and how your health information is used helps you to: ensure it is accurate; better understand who may access your health information; make more informed decisions when authorizing disclosure to others.
The following categories describe the ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.
For Treatment
We may use or disclose health information about you to provide you with medical treatment. We may disclose health information about you to Facility personnel who are involved in taking care of you at our Facility. Different departments of a Facility also may share health information about you in order to coordinate your care. We may also disclose health information about you to people outside the Facility who may be involved in your care after you leave a Facility. This may include family members, or visiting nurses to provide care in your home.
For Payment
We may use and disclose health information about you so that the treatment and services you receive at a Facility may be billed to you, an insurance company or a third party. For example, in order to be paid, we may need to share information with your health plan about services provided to you. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations
We may use and disclose health information about you for our day-to-day health care operations. This is necessary to ensure that all residents receive quality care. For example, we may use health information for quality assessment and improvement activities and for developing and evaluating clinical protocols.
We may also combine health information about many residents to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective. Health information about you may be used for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs. We may also use and disclose information for professional review, performance evaluation, and for training programs.
Business Associates
There may be some services provided in our Facility through contracts with business associates. When these services are contracted, we may disclose your health information so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Treatment Alternatives
We may use and disclose health information to tell you about possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services and Reminders
We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care
Unless you object, we may disclose health information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care.
As Required By Law
We will disclose health information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may use and disclose health information about you to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Organ and Tissue Donation
If you are an organ donor, we may disclose health information to organizations that handle organ procurement to facilitate donation and transplantation.
Military and Veterans
If you are a member of the armed forces, we may disclose health information about you as required by military authorities.
Research
Under certain circumstances, we may use and disclose health information about you for research purposes, subject to a special approval process.
Workers' Compensation
We may disclose health information about you for workers' compensation or similar programs.
Public Health Risks
We may disclose health information about you for public health purposes, including prevention or control of disease, injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with products.
Health Oversight Activities
We may disclose health information to a health oversight agency for activities authorized by law including audits, investigations, inspections, and licensure.
Judicial and Administrative Proceedings
If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order.
Law Enforcement
We may disclose health information when requested by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process.
Coroners, Medical Examiners and Funeral Directors
We may disclose medical information to a coroner or medical examiner as necessary to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities
We may disclose health information about you to authorized federal officials for intelligence and other national security activities authorized by law.
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.
Although your health record is the property of the Facility, the information belongs to you. You have the following rights regarding your health information:
Right to Inspect and Copy
With some exceptions, you have the right to review and copy your health information. You must submit your request in writing to our HIPAA Compliance Officer.
Right to Amend
If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You must submit your request in writing to our HIPAA Compliance Officer and provide a reason for your request.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures" — a list of certain disclosures we made of your health information, other than those made for purposes such as treatment, payment, or health care operations.
Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you. You must submit your request in writing to our HIPAA Compliance Officer.
Right to Request Alternate Communications
You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically.
We reserve the right to change this Notice. We will post a copy of the current Notice in the Facility and on the website.
If you believe your privacy rights have been violated, you may file a complaint with the Facility or with the Secretary of the Department of Health and Human Services. To file a complaint with the Facility, contact our HIPAA Compliance Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you wish to contact us regarding the terms in this Notice, please contact:
Name: Dr. Mallika Rupani
Phone Number: 803-592-5463
Email: info@kinddental.com
I have been given a copy of this Office's Notice of Privacy Practices ("Notice"), which describes how my health information is used and shared. I understand that this Office has the right to change this Notice at any time. I am aware that I may obtain a current copy by contacting the Office's HIPAA Compliance Officer.
