This notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.

We are required to abide by the terms of the Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION BASED UPON YOUR WRITTEN CONSENT

You will be asked by your dentist to sign a consent/acknowledgment form. By signing the consent/acknowledgment form, your dentist, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you may also use and disclose your PHI (Protected Health Information) to pay your dental care bills and support the operation of the dentist's office. Following are examples of the types of uses and disclosures of you protected health care information that the dentist's office is permitted to make once you have signed our consent/acknowledgment form.

Treatment: We will use and disclose you protected health information to provide, coordinate, or manage your dental care and any related services. This includes the coordination and management of your dental care with a third party that has already obtained your permission to have access to your protected health information.

Payment: Your protected dental information will be used, as needed, to obtain payment for your dental services. This may include certain activities that your dental insurance plan may undertake before it approves or pays for the dental care services we recommend for you such as; making a determination of eligibility of coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the activities of your dentist's practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training, licensing, marketing, and conducting or arranging for other business activities.

In addition, we may call you by name in the waiting room when your provider is ready to see you or discuss a family member's treatment. We will try to be discreet in discussing your personal information while you are at the front desk scheduling you next appointment, going over your treatment plan, reviewing your services performed and paying for your services. If you wish, another area could be designated for this purpose. We may use or disclose your (PHI), as necessary to contact you to remind you of an appointment. This may include telephone calls in which as message could be left on an answering machine or with a person answering your home or business phone. Our office also mails postcards for the following purposes: scheduled appointment reminders, if you are due or late for a visit, and Birthday wishes. We may mail newsletters, holiday greetings, other greetings, and billing statements. Our Office also takes photos of children and posts then on bulletin boards in the operatories. We may take photos for other purposes.

We will share your protected health information with third party "business associates" that perform various activities for the office, such as collection agencies, and dental laboratories. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Other Permitted Uses and Disclosures That May Be Made With Your Consent,
Authorization or Opportunity to Object

We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your dentist may, using professional judgement, determine weather the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your dental care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgement. We may use or disclose protected health care information to notify or assist in notifying a family member, or any other person that is responsible for your care of your location, general condition, or death. 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 or other individuals involved in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens your dentist shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment.

We may use or disclose your protected health information without your consent or authorization when and for: Required by Law, Public Health, Health Oversight, Abuse or Neglect, Legal Proceedings, Law Enforcement, Coroners, Funeral Directors, Organ Donation, Criminal Activity, Military Activity, Inmates, and National Security.

THIS NOTICE WAS PUBLISHED AND BECOMES EFFECTIVE ON APRIL 14, 2003