As a provider of medical services we are required, under the HealthInsurance Portability and Accountability Act, to inform you of your rights toprotect your personal health information. As a covered entity, we must informall patients of their rights regardless of insurance coverage. You have theright to obtain a copy of this notice.
Our Duty to you
As your dental provider, we will do everything within our control tomaintain your records and information in a secure and private manner. We doreserve the right to change our policies, but you will be informed of anychanges in advance. We will only release information about you and yourtreatment under specific circumstances. These include, but are not limited tothe following:
Treatment: With your written consent, we may use or disclose yourprotected health information during the course of treatment, including certainsensitive information for treatment, payment, and healthcare operations. Thisincludes releasing information to other dentists, physicians, other health careproviders, and our staff. Our staff includes full and part-time employees, aswell as temporary personnel.
Payment: We may disclose personal information about you and yourtreatment to third party carriers and payment processing entities. Thisincludes insurance carriers, claims clearinghouses, collection agencies and third-partyadministrators such as employee medical reimbursement accounts.
Operations: We may use your personal information in the course of operationof our office. This may include quality assurance/quality improvement reviews,credentialing, training, and certification and accreditation activities.
Miscellaneous Uses: At certain times we may be required to use yourinformation for other purposes that aren’t described above. Examples of theseuses include appointment reminders (cards, voice messages and letter),abuse/neglect, national security, family and friends (only to the extent foruse in healthcare operations or payment), and in some cases to law enforcementand court ordered releases.
Substance use disorder (sud) records
Certain health information related to substance use disorderdiagnosis, treatment, or referral for treatment is subject to additionalfederal protections under 42 CFR Part 2. We will not use or disclose theserecords without your written authorization unless otherwise permitted orrequired by law. Disclosures made with your consent may be subject toredisclosure by the recipient and may no longer be protected by federal law.You have the right to revoke your authorization at any time, except to theextent that action has already been taken in reliance on it. We will not use ordisclose substance use disorder records for the purpose of investigating orprosecuting you without a court order.
Your Rights
Restrictions: You have the right to request certain restrictions ordisclosure usage. We are not required to accept these restrictions, but we willmake a note of the request and honor that request if applicable.
Access: You have the right to access your personal health information.A request for access must be made in writing. You may speak to our privacyofficer to schedule an appointment to view your information. You may alsorequest a copy of your personal health information. We will charge you a feefor the copies as set by the Texas State Board of Dental Examiners.
Amendment: You have the right to request that we amend your personalhealth information. Your request must be in writing and explain what should beamended and the rationale for such request. We have the right to deny thisrequest if we feel that it would render your information inaccurate. We willinform you of the decision to amend your information.
Disclosure: You have the right to request a list of the times andentities to whom we have disclosed your personal health information. Thesedisclosures are only for instances other than treatment, payment or operations.This disclosure will be given free on an annual basis if requested. We reservethe right to charge for this if requested more than once in a 12-month period. Informationdisclosed from records protected by federal substance use disorderconfidentiality rules may not be redisclosed without your written consentunless otherwise permitted by law.
Complaints: Please contact our privacy officer with any questions orcomplaints. If you feel that we have violated your privacy, you can submit awritten complaint to the U.S. Department of Health and Human Services withoutfear of retaliation. We can provide you with the address upon request.
contact us
If you have questions or comments about this Privacy Policy, please contact us at:
4056 State Highway 6 South
College Station, TX 77845
