Mountainside Dental Group 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.
Our practice is dedicated to maintaining the privacy of your protected health information (PHI). In conducting our business, we will create records regarding you and your treatment and the services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this Notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the following important information:
We may use your PHI to provide you with healthcare treatment or services. We may disclose your healthcare information to other healthcare professionals within our practice for the purpose of treatment, payment, or healthcare operations.
We may use and disclose your PHI to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits, and we may provide your insurer with details regarding your treatment to determine if your insurer will pay for your treatment.
We may use and disclose your PHI to operate our business. These uses and disclosures are necessary to make sure that all our patients receive quality care and to operate and manage our office.
We may use and disclose your PHI to contact you and remind you of appointments. If you are not home, we may leave this information on your answering machine or in a message with the person answering the phone.
We may use and disclose your PHI to inform you of potential treatment options or alternatives.
We may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
We may release your PHI to a friend or family member who is involved in your care or who assists in taking care of you.
We may use or disclose your PHI when we are required to do so by law. For example, we must disclose your PHI to the U.S. Department of Health and Human Services upon request for purposes of determining whether we are in compliance with federal privacy laws.
We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.
We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
We may disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal, or in response to a subpoena.
We may release PHI if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process.
We may release PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
You have the right to inspect and copy your PHI that may be used to make decisions about your care. This includes medical and billing records. To inspect and copy your medical information, you must submit your request in writing.
If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information.
You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
We reserve the right to change this Notice and make the new Notice apply to PHI we already have as well as any information we receive in the future. We will post a copy of our current Notice at our office. The Notice will contain the effective date on the first page.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
If you have questions about this Notice or wish to exercise any of your rights, please contact:
Mountainside Dental Group
Privacy Officer
Phone: (760) 492-7993
Email: privacy@mountainside-dental.com
Effective Date: This Notice of Privacy Practices is effective as of January 1, 2023.
