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Privacy
Policy
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)
requires all health care records and other individually identifiable
health information used or disclosed to us in any form, whether
electronically, on paper, or orally, be kept confidential. This
federal law gives you, the patient, significant new rights to
understand and control how your health information is used. HIPAA
provides penalties for covered entities that 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 use and disclose your health information.
Without specific written authorization, we are permitted to use and
disclose your health care records for the purposes of treatment,
payment and health care operations.
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Treatment
means providing, coordinating, or managing health care and related
services by one or more health care providers. For example, we may
need to share information with other providers or specialists involved
in the continuation of your care or we may disclose information to
dental laboratories who assist us with dental laboratory procedures.
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Payment
means such activities as obtaining
reimbursement for services, confirming coverage, billing or collection
activities, and utilization review. For example, we disclose
treatment information when billing a dental plan for your dental
services.
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Health
Care Operations include the business aspects
of running our practice. For example, patient information may be used
for training purposes, or quality assessment.
Unless you request
otherwise, we may use or disclose health information to a family
member, friend, or other personal representative who is involved in
your healthcare to the extent necessary to help with your healthcare
or with payment for your healthcare. In addition, we may use your
confidential information to remind you of appointments by sending
reminder postcards and/or leaving messages at home and/or work. We may
use or disclose your health information when we are required to do so
by law. Any other uses and disclosures will be made only with your
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 certain rights in
regards to your protected health information, which you can exercise
by presenting a written request to our Privacy Officer at the practice
address listed below:
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The right to request restrictions on certain uses and disclosures of
protected health information, including those related to disclosures
to family members, other relatives, close personal friends, or any
other person identified by you. We are, however, not required to
agree to a requested restriction. If we do agree to a restriction, we
must abide by it unless you agree in writing to remove it.
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The right to request to receive confidential communications of
protected health information from us by alternative means or at
alternative locations.
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The right to access, inspect and copy your protected health
information. If you request copies, there may be a charge.
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The right to request an amendment to your protected health
information.
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The right to receive an accounting of disclosures of protected health
information outside of treatment, payment and health care operations.
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The right to obtain a paper copy of this notice from us upon request.
We are required by law to
maintain the privacy of your protected health information and to
provide you with notice of our legal duties and privacy practices with
respect to protected health information.
This notice is effective
as of April 14, 2003 and we are required to abide by the terms of the
Notice of Privacy Practices currently in effect. We reserve the right
to change the terms of our Notice of Privacy Practices and to make the
new notice provisions effective for all protected health information
that we maintain. Revisions to our Notice of Privacy Practices will
be posted on the effective date and you may request a written copy of
the Revised Notice from this office.
You have the right to file
a formal, written complaint with us at the address below, or with the
Department of Health & Human Services, Office of Civil Rights, in the
event you feel your privacy rights have been violated. We will not
retaliate against you for filing a complaint.
For more information about
our Privacy Practices, please contact:
Privacy Officer:
George W. Blashford, D.M.D., P.C.
35 Westminster Drive
Carlisle, PA 17013
717-243-2372
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