Dear Patient:
It is our desire to communicate to you that we are taking
the NEW Federal (HIPAA - Health Insurance Portability and Accountability Act)
laws written to protect the confidentiality of your health information
seriously. We do not ever want you to delay treatment because you are afraid
your personal health history might be unnecessarily made available to others
outside of our office.
What has Changed? Why a Privacy Policy Now?
The rapid evolution of computer technology and its use in healthcare has
motivated the Federal government to legally enforce the importance of the
privacy of health information.
We want you to know about the 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 HEALTH 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 dental care possible. This may include administrative and clinical office
procedures designed to optimize scheduling and coordination of care between
hygienist, dental assistant, dentist, and business office staff. In addition,
we may share your health information with physicians, referring dentists,
clinical and dental laboratories, pharmacies or other health care personnel
providing you treatment.
To Obtain Payment
We may include your health information with an invoice used to collect
payment for treatment you received in our office. We may do this with insurance
forms filed on your behalf in the mail or sent electronically. We will be sure
to only work with companies with a similar commitment to the security of your
health information.
To Conduct Healthcare Reminders
Health information may be included in training programs for our business and
clinical employees, associates, students, and interns.
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 or your family. They may include postcards, letters,
telephone reminders or electronic reminders such as email (unless you tell us
that you do not want to receive these reminders).
Abuse or Neglect
We will notify government authorities if we believe a patient is the 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 patients agreement.
Public Health and National Security
We may be required to disclose to Federal officials or military authorities
health information necessary to complete an investigation related to public
health or national security. Health information could be important when the
government believes that the public safety could benefit when the information
could lead to the control or prevention of an epidemic or the understanding of
new side effects of a drug treatment or medical device.
For Law Enforcement
As permitted or required by State or Federal law, we may disclose your
health information to a law enforcement official for certain law enforcement
purposes, including, under certain limited circumstances, if you are a victim of
a crime or in order to report a crime.
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 your permission first. In case of an 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.
Authorization to Use or Disclose Health Information
Other than is stated above or where State, Federal or Local law requires us,
we will not disclose your health information other than with your written
authorization. You may revoke that authorization in writing at any time.
Patient Rights
This new law is careful to describe that you have the following rights related
to your health information.
Restrictions
You have the right to request restrictions on certain uses and disclosers 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 requests for
confidential communications.
Inspect and copy Your Health Information
You have the right to request your health information. If you would like a
copy of your health information please let us know. You will be charged 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. We will be happy
to accommodate you as long as our office maintains this information. In order
to standardize our process, please provide us with your request in writing and
describe your reason for the change.
Your request may be denied if the health information record
in question was not created by our office, is not part of our records.
Documentation of Health Information
You have the right to ask us for a description of how and where your health
information was 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. Please let us know in writing the time period for which you are
interested. There is a fee for this request.
Request a Paper Copy of this Notice
You have a right to obtain a copy of this Notice of Privacy Practices
directly from our office at any time. Stop by or give us a call and we will mail
you a copy.
We are required by law to maintain the privacy of your
health information and to provide to you and your representative this Notice of
our Privacy Practices.
You have the right to express complaints to us or to the
Secretary of Health Services if you believe your privacy rights have been
compromised. Please let us know of your concerns in writing.
Timothy W. Conway, D.D.S., P.A.
Michael S. Mathews, D.M.D.
2005 Thonotosassa Rd. Suite: A
Plant City, Fl. 33563
813-754-3794
