Protecting: Your Confidential Health Information Is Important to Us -- Notice of Privacy Practices

Our Promise:
Dear Patient: This is not meant to alarm you! Quite the opposite! It is our desire to communicate to you that we are complying with the new Federal (HIP AA- Health Insurance Portability and Accountability Act) laws. The purpose of this new legislation is to insure the confidentiality of your health information.

So what has changed? Why a privacy policy now?:
The most significant variable that has motivated the Federal government to legally enforce the importance of the privacy of health information is the rapid evolution of computer technology and its use in healthcare. The government has appropriately sought to standardize and protect the privacy of the electronic exchange of your health information. This has challenged us to review not only how your health information is used within our computers but also with the Internet, phone, faxes, copy machines and charts. We believe this has been an important exercise for us because it has disciplined us to put in writing the policies and procedures we use to ensure the protection of your health information everywhere it is used.

We want you to know about these policies and procedures which we developed, to make sure your health information will not be shared with anyone who does not require it. Our office is subject to State and Federal law regarding the confidentiality of your health information and in keeping with these laws, we want you to understand our procedures and your rights as our valuable patient.

We will use and communicate your heath information only for the purposes of providing your treatment, obtaining payment and conducting health care operations. Your health information will not be used for other purposes unless we have asked for and been voluntarily given your written permission.

How Your Health Information May Be Used:
To Provide Treatment
We will use your health information within our office to provide you with the best orthodontic care possible. This may include administrative and clinical office procedures designed to optimize scheduling and coordination of care between the orthodontist, orthodontic assistant, and business staff. In addition, we may share your health information with physicians, referring dentists, other specialists, clinical and dental laboratories, pharmacies or other health care personnel providing your treatment.

To Obtain Payment
We may include your health information with an invoice used to collect payment for treatment you receive in our office. We may do this with insurance forms filed for you in the mail or sent electronically.

In Patient Reminders
Because we believe regular care is very important to your oral and general health, we will remind you of a scheduled appointment or that it is time for you to contact us and make an appointment. Additionally, we may contact you to follow up on your care and inform you of treatment options or services that may be of interest to you and your family. These notices may include postcards, letters and telephone reminders.

Abuse or Neglect
We will notify government authorities if we believe a patient is a victim of abuse, neglect or domestic violence. We will make this disclosure only when we are compelled by our ethical judgment, when we believe we are specifically required or authorized by law or with the patient's agreement.

Family, Friends and Caregivers
We may share your health information with those you tell us will be helping you with your home hygiene, treatment, medications, or payment. We will be sure to ask you, your permission first. In case of emergency, where you are unable to tell us what you want, we will use our very best judgment when sharing your health information only when it will be important to those participating in providing your care.

Patient Rights:
Restrictions
You have the right to request restrictions on certain utilizations and disclosures of your health information. Our office will make every effort to honor reasonable restriction preferences from our patients.

Confidential Communications
You have the right to request that we communicate with you in a certain way. You may request that we only communicate your health information privately with no other family members present or through mailed communications that are sealed. We will make every effort to honor your reasonable request for confidential communications.

Inspect and Copy Your Health Information
You have the right to read, review, and copy your health information, including your complete chart, x-rays and billing records. If you would like a copy of your health infoTI11ation, please let us know. We may need to charge you a reasonable fee to duplicate and assemble your copy.

Amend Your Health Information
You have the right to ask us to update or modify your records if you believe your health information records are incorrect or incomplete. In order to standardize our process, please provide us with your request in writing and describe your reason for the change.

Documentation of Health Information
You have the right to ask us for a description of how and where your health infoTI11ation records are used by our office for any reason other than for treatment, payment, or health operations. Our documentation procedures will enable us to provide information on health information usage from April 14, 2003 and forward.

Request a Paper Copy of This Notice
You have the right to obtain a copy of this Notice of Privacy of Practices directly from our office at any time or you can print it directly from our web site. Stop by or give us a call and we will mail a copy to you as well.

We are required by law to maintain the privacy of your health information and to provide to you and your representative the Notice of our Privacy Practices. We are required to practice the policies and procedures described in this notice but we do reserve the right to change the terms of our Notice. If we change our privacy practices, we will be sure all our patients receive a copy of the revised Notice.