Terms & Conditions
West Cobb Family Dentistry
Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health information. 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 the Notice while it is in effect. This Notice takes effect April 14, 2003, 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.
We reserve the right to make the changes in our privacy practices and the new terms of our Notice useful for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request. You may request information about our privacy practices, or additional copies of this Notice. Please contact us using the information listed at the end of this Notice.
Uses and Disclosures of Protected Health Information
We use and disclose health information about you for treatment, payment, and healthcare operations. For Example:
We may use or disclose your health information to a dental provider or physician or other healthcare provider providing treatment to you.
Your protected health information will be used as needed to obtain payment for your health care services. This may include certain activities that your dental insurance plan may undertake before it approves or pays for dental care services we recommend for you, such as deciding of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for prosthetics may require that your relevant protected health information be disclosed to the health plan to obtain approval for treatment.
There may be times when your protected health information in regards to finances may be Discussed in our office, and we will strive to the best of our ability to use discretion and privacy when deemed necessary. Your Protected Health information may be used in connection with risk adjustments, billing and collection activities, and disclosures to consumer reporting agencies limited to specified identifying information about the individual, his or her payment history, and identifying information about the covered entity.
We may use or disclose, as needed, your health information in connection with our healthcare operations. Healthcare operations include quality and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities. We will continue to use your protected health information in some of these specific ways: by calling you by your first and last name from the reception area, by having a sign-in sheet in our reception area, by emailing you a reminder appointment card with the reason for visit, by calling to confirm appointments and leaving a message if necessary on an answering machine or with a live person, by continuing to post a daily schedule and by presenting treatment needs in the waiting room for minors unless otherwise notified.
We may confirm your insurance coverage with your employer or insurance company. We may use your protected health care information, using discretion when applicable, by lowering our voices to provide you with information about treatment and health-related benefits and services that may be of interest to you or necessary for your treatment. We will strive to use all reasonable and appropriate safeguards. All staff members have access to your health information as applicable and are trained according to the privacy law.
In addition to our use of your health information for treatment, payment for healthcare operations, you may give us written authorization to use your health information to disclose it to anyone for your purpose. If you authorize us, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
Others Involved in Your Healthcare
We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose to a family member, friend, or other people that you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to do so or object to such a disclosure, we may disclose such information as necessary if we determine that it is your best interest based on our professional judgment.
We may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for the care of your location, general condition, or death. 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.
Marketing Health-related Services Required by Law
We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use of disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made to control disease, injury, or disability.
Abuse or Neglect
We may disclose your health information 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 health information to the extent necessary to avert a serious threat to your health or the safety of others. Any disclosure will be made consistent with the requirements of applicable federal and state laws.
We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to the correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
Patients Rights Access
You have the right to look at or acquire copies of your health information with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must request in writing to obtain access to your health information. If you request an alternative format, we will charge a cost-based fee providing your health information in that format. If you prefer, we will prepare a summary or an explanation for your health information for a fee.
You have the right to receive a list of instances in which our business associates or we disclosed your health information for purposes other than treatment, payment healthcare operations, and certain other activities, for the last six years, but not before April 14, 2003. If you request this account more than once in 12 months, we may charge you a reasonable cost-based fee for responding to these additional requests.
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. (You must make your request in writing). Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights or 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 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.