NOTICE OF PRIVACY PRACTICES

USES AND DISCLOSURES OF HEALTH INFORMATION 

We may use and disclose health information about you for treatment, payment, and healthcare operations. 

Treatment: We may use or disclose your health information for your treatment, For example, to a physician or other healthcare provider providing treatment to you. 

Payment: We may use and disclose your health information to obtain payment for services and treatment you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. 

Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. 

Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice. 

To Your Family and Friends: We may disclose your health information to a family member, friend or other person identified by you to the extent necessary to help with your healthcare or with payment for your healthcare. Additionally, we may disclose information about you to a patient representative if a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.  

Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization. 

Required by Law: We may use or disclose your health information when we are required to do so by law. 

Public Health Activities: We may disclose your health information for public health activities, including disclosures to prevent or control disease, injury or disability, report child abuse or neglect, report reactions to medications or problems with products or devices, notify a person of a recall, repair, or replacement of product or devices, notify a person who may have been exposed to a disease or condition, or report abuse, neglect, or domestic violence. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. 

National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of PHI of an inmate or patient under certain circumstances. 

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, text messages, emails or letters). 

Secretary of HSS: We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.

Worker’s Compensation: We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law. 

Law Enforcement: We may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order. 

Health Oversight Activities: We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws. 

Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested. 

Coroners, Medical Examiners, and Funeral Directors: We may release your PHI to coroner or medical examiner. We may also disclose PHI to funeral director consistent with applicable law to enable them to carry out their duties. 

OTHER USES AND DISCLOSURES OF PHI

Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. We will also obtain your written authorization before using or disclosing PHI for purposes other than those provided for in this Notice. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.  

PATIENT RIGHTS

Access: You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to the address at the end of this Notice. You may request that we provide information as photocopies or electronically. We will use the format you request unless we cannot practicably do so. If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law. 

Disclosure Accounting: With the exception of certain disclosures, you have the right to receive an accounting of disclosures in which we, or our business associates, disclosed your health information in accordance with applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit your request in writing to the Privacy Official. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to the additional requests. 

Right to Request a Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official. Your written request must include (1) what information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply. We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan), has paid our practice in full. 

Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request. However, if we are unable to contact you using the ways or locations you have requested we may contact you using the information we have. 

Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances. If we agree to your request, we will amend your record(s) and notify you of such. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it and explain your rights. 

Electronic Notice: You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our Web site or by email.

No mobile opt-in message consent will be shared with third parties or affiliates for marketing purposes.

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QUESTIONS AND COMPLAINTS 

If you want more information about our privacy practices or have questions or concerns, please contact us: 

Springville Children’s Dentistry 
355 Springville Station Blvd
Springville, AL 35146
205-859-8439 (Main)
205-859-8553 (Fax)

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.