HIPAA Notice of Privacy Practices

About this notice

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.

Smile Quest Dental is required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you following a breach of unsecured PHI.

How we may use and disclose your PHI

We may use and disclose your PHI without your written authorization for:

• Treatment — for example, sharing X-rays with a specialist or lab involved in your care.
• Payment — for example, submitting claims to your dental insurance or a financing company you choose.
• Health care operations — for example, quality review, staff training, and appointment reminders by phone, text or email.
• Individuals involved in your care — family or friends you identify, unless you object.
• Business associates — vendors who perform services for us under agreements that require them to protect your PHI.
• As required by law, and for public health, health oversight, abuse or neglect reporting, judicial and law-enforcement proceedings, coroners, workers’ compensation, serious threats to health or safety, and specialized government functions.

Uses that require your authorization

We will obtain your written authorization before using or disclosing PHI for marketing, before any sale of PHI, and for most uses of psychotherapy notes. Other uses not described in this notice will be made only with your written authorization, which you may revoke in writing at any time (except to the extent we have already acted on it).

California law (the Confidentiality of Medical Information Act) may be more protective than HIPAA in some cases. When it is, we follow the stricter requirement.

Your rights

• Inspect and copy — request an electronic or paper copy of your dental records. We will respond as required by law, and may charge a reasonable, cost-based fee.
• Amend — ask us to correct information you believe is incorrect or incomplete. We may deny the request in writing with an explanation.
• Accounting of disclosures — request a list of certain disclosures we made in the prior six years.
• Restrictions — ask us to limit uses or disclosures. We must agree if you pay out of pocket in full and ask us not to share that information with your health plan.
• Confidential communications — ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests.
• Paper copy of this notice — at any time, even if you agreed to receive it electronically.
• Choose someone to act for you — a medical power of attorney or legal guardian may exercise your rights.

To exercise any of these rights, submit a written request to our Privacy Officer at the address below.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer, or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, 1-877-696-6775, or at hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

Changes to this notice

We reserve the right to change this notice, and the new notice will apply to all PHI we maintain. Updated notices will be available on this page and in our office, and you may request a copy at any visit.