Campbell Oral Surgery and Dental Implant Center is required by applicable federal and state law to maintain the privacy of your personal health information (“PHI”). We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect, and which 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 and make the new notice available upon request. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes.
Uses and Disclosures of Health Information
We use and disclose health information about you for treatment, payment, and healthcare operations. Some instances, but not limited to:
Payment: We may use or disclose your PHI to obtain payment for services we provide to you.
Treatment: We may use or disclose your PHI to a physician or other healthcare provider providing treatment to you.
Persons Involved in Care: We may use or disclose health information to notify or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, location, general condition, or death. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.
Required by Law: We may use or disclose your PHI when we are required to do so by law.
Abuse or Neglect: We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.
Appointment Reminders: We may use or disclose your PHI to provide you with appointment reminders (such as, but not limited to voicemail messages, postcards, or letters).
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 PHI required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
Marketing Health-Related Services: We will not use your PHI for marketing communications without your written authorization.
Access: You have the right to get copies of your PHI, with limited exceptions. You must complete a Medical Records Release Request to obtain access to your information. Your copies can be mailed to you, you may pick them up at our office, or we will mail them to a specified location.
Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
Amendment: You have the right to request that we amend your PHI. Your request must be in writing and explain why the information should be amended. We may deny your request under certain circumstances.
Breach Notification: We are required to notify you in the event your PHI has been, or is reasonably believed to have been accessed, acquired, or disclosed due to a breach.
Accounting of Disclosures: You have the right to receive a list of disclosures of your PHI that has been made at any time during the six (6) years prior to the date of your request. This list will not include disclosure for which you have provided a written authorization, and does not include certain uses and disclosures to which this notice already applies, such as those related to treatment, payment, healthcare operations, to persons involved in your healthcare, to correctional institutions or law enforcement officials. You must submit any request in writing. If you make more than one request in a year you may be charged a fee for each additional request.
- You should arrive on time for appointments and cancel, when necessary, by telephone or in person.
- You should provide timely payment for any services requested and delivered.
- You should notify this office of any changes in your health status.
- You should notify this office of any changes in your insurance, employment, or demographic information.
- You should accept responsibility if you decide to refuse treatment.
- You should ask questions if you do not understand.