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 healthcare information is important to Stanley Family Dentistry.

This notice describes how we will use and disclose your protected health information to provide treatment, obtain payment, and conduct health care operations. Other purposes permitted or required by law also apply to this notice. It also describes your rights concerning your protected health information. “Protected health information” is information about you, including demographic information that may identify you and related to your past, present, or future physical or mental health condition and related health care services.

We are required by law to follow the practices described in this notice. We may change the terms of this notice at any time. The new notice will be effective for all protected health information we maintain at the time including health information we created or received before we made the changes.

You may obtain a copy of our notice of privacy practices at any time by calling our office at 704-263-3770 or requesting one at your next appointment.

Uses and Disclosures of Health Information

We will use and disclose your health information to provide, coordinate, and manage health care related services for you. For example, we will disclose information to a specialist to whom you have been referred to ensure the provider has enough information to diagnose and/or treat you. We may also disclose information to a laboratory that, at our request, becomes involved in your treatment. 


Payment

We may use and disclose your information to obtain payment for services we provided to you. For example, we will send the necessary information to your health insurance company to obtain payment for the treatment provided and we will send family billing statements to the designated party.


Healthcare Operations

We will use and disclose your health information to conduct the business activities of this office. These activities include, but are not limited to, quality assessment and improvement activities, review of the performance and qualifications of employees, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities. Other business activities may include; appointment confirmation by phone and postcards and leaving messages with other persons regarding appointments, etc. We may also leave messages on an automated answering device.

We may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when we are ready to begin your treatment. 

We will share your protected health information with business associated that performs specific functions for our practice such as billing. When a business arrangement of this type requires the use of your information, we will have a written contract with a third party to protect the privacy of your protected health information.


Others Involved in Your Healthcare

We must disclose your health information to use as described in the Patient Rights section of this notice. We may disclose your health information to a family member or other person to the extent necessary to help with your health care or with payment for your health care, but only if you agree. If we determine it is in your best interest based on our professional judgment or experience with common practices, we may allow another person to pick up filled prescriptions, medical supplies, x-rays, or other forms of health information.

We may use or disclose protected health information to notify or assist in notifying a family member, a personal representative, or other person responsible for your care of your location, general condition, or death. If you are present prior to the use or disclosure of your protected health information, we will provide you with the opportunity to object to such uses or disclosures. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family members or others involved in your health care.


Emergencies

In the event of your incapacity or in emergency circumstances, we may use or disclose your protected health information to treat you.

Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that an action has already been taken in reliance on the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization. 


Required by Law

We may use or disclose your protected health information to the extent that law requires the use or disclosure. The use or disclosure in compliance with the lad will be limited to the relevant requirements of the law.

We must make disclosures to you and, when required, to the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Privacy Rule, Section 164.500et.seq.


Public Health

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 for the purpose of controlling disease, injury, or disability. Additionally, we may disclose your protected health information if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

We may disclose protected health information to a health oversight agency for activities authorized by law such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regularity programs, and civil rights laws.


Abuse or Neglect

We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect, or domestic violence to the government entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

 


Legal Proceedings

We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery or other lawful purpose.


Law Enforcement

We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1)Legal processes and otherwise required by law, (2)Limited information request for identification and location purposes, (3)Pertaining to victims of a crime, (4)Suspicion that death has occurred as a result of criminal conduct, (5)In the event that a crime occurs on the premises of the practice, and (6)Medical Emergency (not on the practice's premises) and it is likely a crime occurred.


Military Activity and National Security

When the appropriate conditions apply, we may disclose, to military authorities, protected health information of individuals who are Armed Forces personnel. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activity including for the provision of protective services to the President or others legally authorized.


Workers' Compensation

We may disclose your protected health information as authorized to comply with workers' compensation laws and other similar legally-established programs.


Inmates

We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.


Your Rights

Your rights with respect to your protected health information and how you may exercise those rights are outlined below.

You have the right to obtain a copy and or inspect your health information. Health information includes treatment records, billing records, and any other records used by us to make decisions about your treatment. You may obtain a form from our office to request access. A reasonable cost-based fee will be charged for expenses such as staff time, copies, and postage. Contact us as indicated in the "contact us" section of our website if you have a question about access or applicable fees.

You have a right to request a restriction on use and disclosure of your protected health information. You may ask us not to use or disclose some part of your protected health information for the purposes of treatment, payment, or operations. You may also request that we do not disclose some part of your information to family and others who may be involved in your care or for notification purposes as otherwise described in this Notice. We are not required to agree to the restrictions but if we do, we are obligated to abide by the agreement except in cases of emergency. You may request a restriction by sending your request in writing to our office.

You have a right to request to receive confidential communications by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to your office. You may have the right to request an amendment to your protected health information. You may also request that we amend protected health information about you. Your request must be submitted in writing to your office and must contain an explanation as to why the information should be amended. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement or disagreement with us. We may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal. You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures made by our Business Associates or us. It excludes disclosures for treatment, payment, or health care operations as described in this Notice.