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.
Your medical information is the information gathered by your dentist and/or other dental professionals during the time you are being treated at S. Edward Hopwood D.M.D., P.A. (“P.A.”). It is private, and no one without a legitimate need to know may have access to it. P.A. is required by law to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices. In the unlikely event that your medical information becomes unsecured, P.A. will provide you with prompt notification.
P.A. will not use or disclose your health information except as described in this Notice of Privacy Practices (“Notice”). This Notice applies to all of the medical records generated as a result of dental services provided to you by the P.A.
EXAMPLES OF DISCLOSURE FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS
The following categories describe the ways that P.A. may use and disclose your health information:
Treatment: P.A. will use your health information in the provision and coordination of your healthcare. We may disclose all or any portion of your medical record information to your physician, consulting physician(s), nurses and other healthcare providers who have a legitimate need for such information in the care and continued treatment of the patient.
Payment: P.A. may release medical information about you for the purposes of determining coverage, billing, claims management, medical data processing and reimbursement. The information may be released to an insurance company, third-party payor or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies or excerpts of your medical record that are necessary for payment of your account. For example, a bill sent to a third party payor may include information that identifies you, your diagnosis, the procedures and supplies used.
Routine Healthcare Operations: P.A. may use and disclose your medical information during routine healthcare operations, including quality assurance, utilization review, internal auditing, accreditation, certification, licensing or credentialing activities, medical research and educational purposes.
Business Associates: P.A. may use and disclose certain medical information about you to its business associates. A business associate is an individual or entity under contract with P.A. to perform or assist P.A. in a function or activity that necessitates the use or disclosure of medical information. Examples of business associates include but are not limited to, a copy service used by the P.A. to copy medical records, consultants, independent contractors, accountants, lawyers, medical transcriptionists and third-party billing companies. P.A. requires the business associate to protect the confidentiality of your medical information. In addition, P.A. requires any subcontractor of P.A.’s business associate to protect the confidentiality of your medical information.
Regulatory Agencies: P.A. may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability. For example, billing practices may be audited by the State Auditor and records are subject to review by the Secretary of Health and Human Services and his/her authorized representatives.
Workers’ Compensation: P.A. may release medical information about you for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
Military Veterans: P.A. may disclose your medical information as required by military command authorities if you are a member of the armed forces.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement officer, P.A. may release your medical information to the correctional institution or law enforcement official.
Required by Law: P.A. will disclose medical information about you when required to do so by law.
Other Uses: Any other uses and disclosures will be made only with your written authorization.
PATIENT INFORMATION RIGHTS
Although all records concerning your treatment obtained at P.A. are the property of P.A., you have the following rights concerning your medical information:
Right to Confidential Communications: You have the right to receive confidential communications of your medical information by alternative means or at alternative locations. For example, you may request that P.A. contact you only at work or by mail.
Right to Inspect and Copy: You have the right to inspect and copy your medical information.
Right to Amend: You have the right to amend your medical information. Any request for amendment should be submitted to P.A. in writing, stating a reason in support of the amendment.
Right to an Accounting: You have the right to obtain an accounting of the disclosures of your medical information made during the preceding six (6) year period.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your medical information. P.A. is not required to honor your request except where: (i) the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law, and (ii) the medical information pertains solely to a healthcare item or service for which you, or person other than the health plan on your behalf, has paid P.A. in full.
Right to Receive a Paper Copy: You have the right to receive a paper copy of this Notice.
Right to Receive Electronic Copies: You have the right to receive electronic copies of your medical information.
Right to Revoke Authorization: You have the right to revoke your authorization to use or disclose your medical information, except to the extent that action has already been taken in reliance on your authorization. A request to exercise any of these rights must be submitted, in writing, to S. Edward Hopwood D.M.D., P.A., 2461 Enterprise Road, Suite A, Clearwater, FL 33763.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact us at (727) 791-9474. If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services. You may also file a complaint with us by contacting our Front Desk. All complaints must be submitted in writing. There will be no retaliation for filing a complaint.
CHANGES TO THIS NOTICE
P.A. will abide by the terms of the Notice currently in effect. P.A. reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all protected health information that it maintains.
NOTICE EFFECTIVE DATE
This Notice is effective as of July 2013.