Notice of Privacy Practices

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Joe D. Arbutante, D.D.S. - Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information.

Protected health information (PHI) written and/or electronic is information about you, including of your contacts or visits for healthcare services, demographic information (i.e., name, address, phone number, etc.), that may identify you and relates to your past, present, or future physical or mental health condition and related healthcare services. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.

Your Rights Under the Privacy Rule

You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practice upon your requests – This Notice will also be posted in a conspicuous location within the practice. We reserve the right to change the terms of our notice at any time. You may contact our office and request that a revised copy be sent to you in the mail or ask for one at your appointment.

You have the right to authorize other use and disclosure that is not specified within this notice –For example, we would need your written authorization to use or disclose your PHI for marketing purposes or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that our practice has taken an action in reliance on the use or disclosure indicated in the authorization.

You have the right to request an alternative means of confidential communication (i.e., email, telephone) and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the means we have on file. We will follow all reasonable requests.

You have the right to inspect and obtain a copy your PHI – If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.

You have the right to request, in writing, a restriction of your PHI not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.

You may have the right to request an amendment to your protected health information for as long as we maintain this information. In certain cases, we may deny your request.

You have the right to request a disclosure accountability – This means you may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office.

You have the right to receive a privacy breach notice if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.

Examples of How We May Use or Disclose Protected Health Information

Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party (i.e. pharmacy or other health care providers) that is involved in your care and treatment.

Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your case. Also, we may contact you to provide information about health-related benefits and services offered by our office or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.

Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.

Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions, and patient safety activities.

Health Information Organization – The practice may elect to use a healthcare information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare – Unless you object, we may disclose your PHI to a member of your family, a relative, a close friend, or any other person, that you identify. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.

Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker's compensation; when an inmate in a correctional facility; and if requested from the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.

Privacy Questions & Complaints
If you have any questions or complaints regarding your privacy rights, please feel free to contact our Privacy Manager at 17357 Van Wagoner Rd., Suite 1, Spring Lake, MI 49456, (616) 842-0090. You also have the right to complain to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.

Effective Date: July 1, 2014

Publication Date: July 1, 2014

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