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 this Notice while it is in effect. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. This Notice takes effect July1, 2023 and will remain in effect until we replace it.
For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
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 effective 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 a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact our Privacy Officer using the information listed at the end of this Notice.
This Notice is followed by: All employees and business associates and all health care professionals authorized to enter information into a patient’s medical or dental file.
In addition, the Practice may share health information with each other for treatment, payment, or healthcare operations described in this notice, and as allowed by Federal and state laws and rules.
USES AND DISCLOSURES OF HEALTH INFORMATION
Summary: We use your information to submit insurance claims, contact you for needed treatment and we do not use third-party marketing. We use a confirmation software to email or text to remind you of appointments or billing information.
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:
Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare
operations include quality assessment 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.
In addition, we may disclose health information as follows: Your Authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose to another party. If you give us an authorization, 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. To You or Your Personal Representative: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree in writing that we may do so.
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, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. 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.
Marketing Health-Related Services: If we use your health information for marketing communications, we will first obtain your written authorization.
Required by Law: We may use or disclose your health information when we are required to do so by law.
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.
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 health information required for lawful intelligence, counterintelligence, and other national security activities.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, e-mails, text, postcards, or letters).Research: We can use or share your information for health research.
Address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you: For workers’ compensation claims; law enforcement purposes or with a law enforcement official; and with health oversight agencies for activities authorized by law.
Work with a medical examiner or funeral director: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health information, with limited exceptions. You may obtain a form to request access by using the contact information listed at the end of this Notice. You must make a request in writing to obtain access to your health information, and we will provide you with your records within 30 calendar days of our receipt of your written request. If you request copies, we will text and/or e-mail your records to your designated recipient at no charge. However, if you request paper copiesor another format, we may charge you no more than 75 cents per page, plus $10 for time spent retrieving and copying the records and/or for staff time to format for providing your health information in that format.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years. If you
request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction: 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).
Alternative Communication: 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. Amendment: You have the right to request that we amend your health information that you believe is incorrect or incomplete. (Your request must be in writing, and it must explain why the information should be amended.) We may deny your request under certain circumstances, but we will tell you why within 60 days.
Electronic Notice: If you receive this Notice on our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form.
Choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
TYPES OF INFORMATION WE COLLECT FROM OUR WEBSITE AND HOW IT IS USED
When you request services or information, or contact us directly, we may ask you to provide some or all of the following types of information:
Lead Generation/Contact Forms: We may ask for your contact information, including items such as name, company name, address, email address, and telephone number. This information is NOT used to market our products and services.
Email Marketing and Newsletters: For those of you that have expressly opted in to receive our newsletter, you are easily able to unsubscribe by following the “unsubscribe” links included in every email. Without systematically doing so, we may analyze and track the email click rates (times you click on a link in an email) and open rates (the fact that you opened an email) to assess performance rates on our mailouts you receive.
Testimonials: We may publish a list of Customers & Testimonials on our site with information on customer names. We obtain the authorization of every customer before publishing any testimonial on its website.
Automatic Data Collection (Website Analytics): As is true of most websites and mobile applications, we gather certain information automatically and store it in log files. We use analytics providers such as Google Analytics. Google Analytics uses cookies to collect non-identifying information. This information includes internet protocol (IP) addresses, browser type, internet service provider (ISP), referring/exit pages, operating system, date/time stamp, and clickstream data, mobile device identifiers, and advertising identifiers. We use this information, which does not identify individual users, to analyze trends, to administer the site, to track users’ movements around the site and to gather demographic information about our user base as a whole. We do not link this automatically-collected data to personal information. Cookies and Tracking Technologies: We do not use cookies.
Social Media Widgets: Our web site includes social media features, such as the Facebook Like button and widgets, such as the ‘Share This’ button. These features may collect your IP address, which page you are visiting on our site, and may set a cookie to enable the feature to function properly. Social media features and widgets are either hosted by a third party or hosted directly on our web site. Your interactions with these features are governed by the privacy policy of the company providing it.
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 complain to us using the contact information listed at the end of this Notice. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201,
Attention: Privacy officer
Sapphire Family Dental
Telephone: (952)934-3569
Address: 7825 Terrey Pine Ct. Suite 201
Eden Prairie MN 55347