Notice of Privacy Practices

 We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect 03/01/2015 and will remain in effect until we replace it. 

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request. 

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.


How we may use and disclose health information about you

We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records. 

Treatment We may use and disclose your health information for your treatment. For example, we may disclose your health information to a physician providing treatment to you, in order to ensure that the physician has the necessary information to diagnose or treat you. 

Payment We may use and disclose your health information to obtain reimbursement for the treatment and services 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. For example, we may need to give your health plan information about your treatment so they can pay us, or reimburse you. 

Health Care Operations We may use and disclose your health information in connection with our healthcare operations. For example, we may use medical information to review out treatment and services, to evaluate the performance of our staff, in caring for you, we or our designee may send you a patient satisfaction survey. 

Individuals Involved in Your Care or Payment for Your Care We may disclose your health information to your family or friends or any other individual identified by you when they are involved in your care or in the payment for your care. 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. 

Disaster Relief We may use or disclose your health information to assist in disaster relief efforts. 

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

Public Health Risk 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 products or devices; 
  • Notify a person who may have been exposed to a disease or condition; or 
  • Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. 

National Security We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorize 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 the protected health information of an inmate or patient. 

Secretary of HHS We may 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 under federal or state law, we may be required to provide copies of your PHI in connection with a workers’ compensation claim to your employer, to you or your dependents, to certain state agencies or to others involved in your claim for compensation. 

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, court order, warrant, or summons. 

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. 

Research We may disclose your PHI to researchers when their research has been approved by an institutional review board, or privacy board, that has reviewed the research proposal and established protocols to ensure the privacy of your information. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. 

Coroners, Medical Examiners, and Funeral Directors We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to carry out their duties. 

Fundraising We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you will be given the opportunity to notify the privacy official in writing. 

Other uses and disclosure of PHI

The following uses and disclosures of you PHI will be made only with your written authorization, 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 your PHI for purposes other than those provided for in this Notice (or as otherwise permitted or required by law). 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. 

Your health information rights

Access You have the following rights, subject to certain limitations regarding your PHI. You have the right to look at, or get copies of your health information, with limited exceptions. We have up to 30 days to make your PHI available to you. You may obtain a form to 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. If you request information that we maintain on paper, we may provide photocopies. If you request information that we maintain electronically, you have the right to an electronic copy. We will use the form and format you request if readily producible. We will charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for postage if you want copies mailed to you. Contact us using the information listed at the end of this Notice for an explanation of our fee structure. You can only direct us in writing to submit you PHI to a third party, not covered in this notice. 

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. 

Accounting of Disclosure With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations, this is a list of the disclosures we made of medical information about you to others. 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 additional restrictions or limitations on, use, or disclosure of your PHI about you to a health plan for purpose of payment or health care operations, 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 (email or text) or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request. We will accommodate all reasonable requests. 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, if you feel the medical information we have about you is incorrect or incomplete. Your request must be in writing, and it must explain why 

the information should be amended. 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. 

Right to Notification of a Breach You will receive notifications of breaches, of your unsecured protected health information as required by law. 

Electronic/Paper Notice You may receive a paper copy of this Notice upon request, even if you have read this notice on our web site @ eldonfamilydentistry.com 

Changes to this Notice We reserve the right to change this notice, to make the revised or changed notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of the current notice in our facilities. 

Questions and Complaints

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

If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. 

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. 

Our Privacy Official: Kelly Edwards
Telephone: (573) 392-5213
Fax: (573) 392-5213
Address: 202 N Maple St Eldon, MO 65026
E-Mail: info@eldonfamilydentistry.com