HIPAA Notice of Privacy Practices

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.

This Notice applies to the protected health information ("PHI") created or received by Englewood Dentistry as part of providing dental care to our patients, and describes our legal duties and your rights under the Health Insurance Portability and Accountability Act (HIPAA). This Notice is separate from, and governs different information than, the website Privacy Policy, which covers information collected through this website rather than through the provision of dental care.

Our Responsibilities

We are required by law to:

• Maintain the privacy of your PHI;
• Provide you with this Notice describing our legal duties and privacy practices regarding your PHI;
• Abide by the terms of the Notice currently in effect; and
• Notify you if we are unable to agree to a requested restriction on use or disclosure.

How We May Use and Disclose Your PHI

The following categories describe common ways we use and disclose PHI. Not every use or disclosure in a category will be listed; however, all permitted uses and disclosures will fall into one of these categories.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental care, and any related services. This includes coordination of care with other dentists, physicians, specialists, or providers involved in your treatment.

Payment

We may use and disclose your PHI to obtain payment for services we provide to you, such as verifying insurance coverage, submitting claims, and billing you or a third-party payer.

Health Care Operations

We may use and disclose your PHI for our operations, including quality assessment, staff training, licensing, and other administrative activities necessary to run our practice and support patient care.

Appointment Reminders and Treatment Options

We may use and disclose your PHI to contact you with appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care

We may disclose PHI to a family member, other relative, close personal friend, or other person you identify, to the extent it is directly relevant to that person's involvement in your care or payment for care, unless you object.

As Required by Law

We will disclose your PHI when required to do so by federal, state, or local law, such as in response to a court order, subpoena, or public health reporting requirement.

Other Permitted or Required Disclosures

Subject to applicable legal requirements, we may also disclose PHI:

• To public health authorities for public health purposes;
• To report suspected abuse, neglect, or domestic violence;
• For health oversight activities, such as audits or inspections;
• For judicial or administrative proceedings;
• To law enforcement officials, under limited circumstances;
• To coroners, medical examiners, or funeral directors as necessary;
• For organ or tissue donation purposes, if applicable;
• For workers' compensation purposes, as authorized by law; and
• To avert a serious threat to health or safety.

Uses and Disclosures Requiring Your Written Authorization

Other uses and disclosures not described in this Notice — including most uses and disclosures of psychotherapy notes (if applicable), uses for marketing purposes, and disclosures that constitute a sale of PHI — will be made only with your written authorization. You may revoke that authorization in writing at any time, except to the extent we have already relied on it.

Your Rights Regarding Your PHI

You have the following rights regarding the PHI we maintain about you:

• Right to Inspect and Copy. You may request to inspect and receive a copy of your PHI that we use to make decisions about your care, generally including dental and billing records.
• Right to Amend. You may request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request under certain circumstances.
• Right to an Accounting of Disclosures. You may request a list of certain disclosures we have made of your PHI, other than disclosures for treatment, payment, health care operations, and certain other exempted disclosures.
• Right to Request Restrictions. You may request a restriction on how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to every requested restriction, except where the disclosure is to a health plan for payment or operations purposes and the PHI pertains to a service you paid for out of pocket in full.
• Right to Request Confidential Communications. You may request that we communicate with you about your care in a specific way or at a specific location.
• Right to a Paper Copy. You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
• Right to Be Notified of a Breach. We will notify you as required by law if there is a breach of your unsecured PHI.

To exercise any of these rights, please submit a written request to our Privacy Officer using the contact information below.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already maintain, as well as PHI we create or receive in the future. The current Notice is available at our office and on this website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, by visiting www.hhs.gov/hipaa/filing-a-complaint or calling 1-800-368-1019. You will not be penalized for filing a complaint.

Contact Us

Questions about this Notice, or requests to exercise your rights under it, should be directed to our Privacy Officer:

Englewood Dentistry — Privacy Officer
334 Grand Ave, Englewood, NJ 07631
Phone: (201) 541-8111
Email: frontdesk@englewooddentistry.com