HIPAA Privacy Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our Promise to You
At the dental practice of Dr. Alan S. Lee, DDS, we are committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also describes your rights regarding your health information. A paper copy of this notice is available at our front desk at any time.
How We May Use and Disclose Your Health Information
The following categories describe the ways we may use and disclose your protected health information (PHI).
For Treatment
We may use your health information to provide, coordinate, or manage your dental treatment and related services. For example, we may share your health information with specialists, dental laboratories, or other healthcare providers involved in your care. We may also disclose your PHI to another healthcare provider who treats you after we have provided care.
For Payment
We may use and disclose your health information so that the treatment and services you receive may be billed to your insurance plan and payment may be collected from you. For example, we may need to give your insurance plan information about your dental treatment so they will pay us or reimburse you for the services provided. We may also tell your insurance plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Healthcare Operations
We may use and disclose your health information for our practice operations. These uses and disclosures are necessary to run our practice and ensure that all patients receive quality care. For example, we may use health information to review our treatment and services and evaluate the performance of our staff. We may also combine health information about many patients to decide what additional services we should offer, whether new services are effective, or how we can improve care. We may also disclose information to doctors, dentists, and other healthcare students for teaching and learning purposes.
Appointment Reminders
We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or dental care at our office. We may also use and disclose your information to send you information about other health-related benefits and services that may be of interest to you.
Treatment Alternatives
We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Business Associates
We may disclose your health information to our business associates who perform services on our behalf. For example, we may use a billing service to submit claims to your insurance. We require our business associates to protect your health information through appropriate safeguards and business associate agreements.
Other Permitted and Required Uses and Disclosures
As Required By Law
We will disclose your health information when required by federal, state, or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
Public Health Activities
We may disclose your health information for public health activities and purposes to a public health authority that is authorized by law to collect or receive the information. This includes reporting disease outbreaks, adverse events, or product defects. We may also disclose information to the Food and Drug Administration (FDA) for reporting adverse events or product problems.
Health Oversight Activities
We may disclose your health information to a health oversight agency for audits, investigations, inspections, and other activities necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Legal Proceedings
We may disclose your health information in the course of any judicial or administrative proceeding in response to a court order, administrative order, subpoena, discovery request, or other lawful process, but only when we have made reasonable efforts to notify you of the request or to obtain a protective order.
Law Enforcement
We may disclose your health information for law enforcement purposes, including: to comply with a court order, subpoena, warrant, or similar process; to identify or locate a suspect, fugitive, missing person, or material witness; about a victim of a crime if we are unable to obtain the person's agreement; about a death we believe may be the result of criminal conduct; or to provide information about criminal conduct at our office.
Coroners, Medical Examiners, and Funeral Directors
We may disclose your health information to a coroner, medical examiner, or funeral director as necessary to carry out their duties, such as identifying a deceased person or determining cause of death.
Organ and Tissue Donation
We may disclose your health information to organizations that handle organ procurement or tissue donation for the purpose of transplantation.
Research
We may disclose your health information for research purposes when an institutional review board or privacy board has reviewed the research proposal and established protocols to protect your privacy, or when the research involves only de-identified information.
To Avert a Serious Threat to Health or Safety
We may disclose your health information when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone who is able to help prevent or lessen the threat.
Military, Veterans, and National Security
We may disclose your health information as required by military command authorities if you are a member of the armed forces. We may also disclose information to authorized federal officials for national intelligence and counterintelligence purposes, or to authorized federal officials for the provision of protective services to the President.
Workers' Compensation
We may disclose your health information to comply with workers' compensation laws or similar programs that provide benefits for work-related injuries or illness.
Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the correctional institution or law enforcement official as necessary for your health and the health and safety of others.
Your Rights Under HIPAA
Under HIPAA, you have the following rights regarding your protected health information:
Right to Access and Copy
You have the right to inspect and copy your protected health information that is maintained in a designated record set. This includes medical and billing records, but does not include psychotherapy notes. To request access, you must submit your request in writing to our Privacy Officer. We may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request under certain circumstances, but you may request a review of the denial.
Right to Amend
You have the right to request an amendment to your protected health information if you believe it is incorrect or incomplete. Your request must be made in writing to our Privacy Officer and must include a reason that supports your request. We may deny your request if the information was not created by us, is not part of the records you are allowed to inspect, is not part of the records maintained by our practice, or is already accurate and complete. If we deny your request, you may submit a statement of disagreement.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your protected health information for purposes other than treatment, payment, or health care operations within the six years prior to your request. This does not include disclosures made with your authorization, to you about your own records, or for national security purposes. The first list you request in a 12-month period is free; subsequent requests may involve a reasonable fee.
Right to Request Restrictions
You have the right to request a restriction or limitation on the use or disclosure of your health information for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose to someone involved in your care or payment for your care. We are not required to agree to your request except as required by law, including the requirement that we honor a request to restrict disclosure to a health plan if you pay for services out of pocket in full.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may request that we contact you at work instead of at home. We will accommodate all reasonable requests. Your request must be made in writing and specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this notice electronically, you are entitled to a paper copy. To obtain a paper copy, please contact our office.
Right to Receive Notice of a Breach
You have the right to be notified in writing if there is a breach of your unsecured protected health information. We will notify you no later than 60 days after we discover a breach, as required by the HIPAA Breach Notification Rule.
Right to Authorize Other Uses
Any other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you do authorize a use or disclosure, you may revoke your authorization at any time by submitting a written request to our Privacy Officer, to the extent that we have not already taken action based on your prior authorization.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We must provide you with this Notice of our legal duties and privacy practices with respect to your health information.
We must follow the terms of the Notice that is currently in effect.
We reserve the right to change this Notice, and the revised Notice will be effective for all health information we maintain. We will post a copy of the current Notice in our office and on our website.
We will not use or disclose your health information without your written authorization, except as described in this Notice.
Changes to This Notice
We reserve the right to change the terms of this Notice at any time. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office and on our website at dralanlee.com/hipaa-privacy. The Notice will contain the effective date. You may also obtain a copy of the current Notice by contacting our Privacy Officer.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.
To file a complaint with our practice, contact our Privacy Officer at the address below. To file a complaint with the Office for Civil Rights, you may send your complaint to:
Practice Privacy Officer
Dr. Alan S. Lee, DDS
715 N Main St
Manteca, CA 95336
Phone: (209) 239-2990
Email: [email protected]
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-800-368-1019
hhs.gov/ocr/privacy
Contact Our Office
If you have any questions about this Notice or your privacy rights, please don't hesitate to contact us.