Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW YOUR DENTAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS INFORMATION CAREFULLY.
Waimea Smiles uses health information about you for treatment, payment and health care operations. Your health information is contained in paper and electronic records that are the property of Waimea Smiles.
Use or Disclosure of Your Health Information
For Treatment:
Your dentist may use your health information to provide you with dental treatment and services. For example, information obtained by your dentist will be included in your dental records that is related to your treatment. This information is necessary for your dentist to determine what treatment you should receive. Dentists will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment:
Your dentist may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a claim may be prepared for you to send to your insurance carrier, in order for your insurance carrier to make payment based upon your dental benefits coverage. The information on the claim will include information that identifies you, your diagnosis and treatment or supplies used in the course of treatment.
For Health Care Operations:
Your dentist may use health information about you for operational purposes in the following ways:
Evaluate the performance of the dental team Assess the quality of care and outcomes in your cases and similar cases; and Learn how to improve our services to you Appointments:
Your dentist may use your information to provide appointment reminders or information about treatment alternatives or other dental-related benefits and services that may be of interest to you.
Fundraising:
Your dentist may use your information to contact you to raise funds for a charitable organization; or your dentist may obtain your authorization to disclose your health information to a charitable organization who needs to raise funds.
Required by Law:
Your dentist may use and disclose information about you as required by law. For example, your dentist may disclose information for the following purposes:
• For judicial and administrative proceedings pursuant to legal authority;
• To report information related to victims of abuse, neglect or domestic violence;
• To assist law enforcement officials in their law enforcement duties.
Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records may be entitled to enhanced confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records. In no event will we use or disclose these type of records, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
Public Health:
Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury or disability, or for other health oversight activities.
Decedents:
Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Organ/Tissue Donation:
Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
Research:
Your dentist may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.
Health and Safety:
Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions:
Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of protected health information.
Workers Compensation:
Your health information may be used or disclosed in order to comply with laws and regulations related to Workers Compensation.
Your Health Information Rights
You have the right to:
• Request a restriction on certain uses or disclosures of your protected health information, however, your dentist is not required to agree to a requested restriction.
• Obtain a paper copy of the Notice of Privacy upon request.
• Inspect and obtain a copy of your dental records held by your dentist upon request. Charges may apply.
• Request to amend your dental records. You must submit requests in writing to:
65-1230 Mamalahoa Hwy, Ste E-21, Kamuela, HI 96743. Waimea Smiles is not required to agree to requests.
• Request communications of your dental information by alternative means or at alternative locations.
• Revoke your authorization to use or disclose dental information except to the extent that action has already been taken.
• Receive an accounting of disclosures made of your information by your dentist other than treatment, payment or other healthcare operations. A fee may apply.
• Our office is required to give you a copy of our privacy practices. You may elect to have all of your signed forms sent to you by email. Please let us know if you would like to receive a paper copy of this notice.
Complaints
You may submit complaints to your dentist, insurance carrier and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filling a complaint.
Obligations of Your Dentist
Your dentist is required to:
• Maintain the privacy of protected health information;
• Provide you with this notice of its legal duties and privacy practices with respect to your health information;
• Abide by the terms of this notice;
• Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
• Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.
Your dentist reserves the right to change its privacy practices and to make new provisions effective for all protected health information it maintains. As notices are revised, the updated privacy practice will be displayed in office, posted to the office website and upon request made available to you via printed document or email.
If you have any questions or complaints, or if you do not want to provide your consent to your dentist, to use your protected health information for purposes of payment and/or health care operations, please submit a letter of denial to provide consent to:
Paula Ferreira
Privacy Officer
Waimea Smiles
65-1230 Mamalahoa Hwy E-21
Kamuela, Hawaii 96743