Please review it carefully.
Southglenn Endodontics/Brident Dental and Orthodontics (Southglenn Endodontics) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at Southglenn Endodontics, please contact:
Compliance & Privacy Department
I. How Southglenn Endodontics may Use or Disclose Your Health Information
Southglenn Endodontics collects health information from you and stores it in a chart and on a computer. This is your dental record. The dental record is the property of Southglenn Endodontics, but the information in the dental record belongs to you. Southglenn Endodontics protects the privacy of your health information. The law permits Southglenn Endodontics to use or disclose your health information for the following purposes:
1. Treatment. We use dental information about you to provide your dental care. We disclose dental information to our employees and others who are involved in providing the care you need. For example, we may share your information with other doctors or other health care providers who will provide services that we do not provide. Or we may share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a service for your treatment. We may also disclose your information to members of your family or others who can help you when you are sick or injured.
2. Payment. We use and disclose dental information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.
3. Regular Health Care Operations. We may use and disclose dental information about you to operate our dental offices. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for dental reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your dental information with our “business associates”, such as a billing service, or a coding and auditing firms that perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them to protect the confidentiality of your dental information. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their efforts to improve health or reduce health care costs, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.
Information provided to you.
4. Appointment Reminders. We may use and disclose dental information to contact and remind you about appointments.
5. Sign in sheet. We may use and disclose dental information about you by having you sign in when you arrive at one of our offices. The sign in sheet will contain only minimal information. We may also call out your name when we are ready to see you.
6. Notification and communication with family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts.
7. Required by law. As required by law, we may use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
8. Public health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse, elder or other abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
9. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
10. Judicial and administrative proceedings. We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
11. Law enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
12. Deceased person information. We may disclose your health information to coroners, dental examiners and funeral directors.
13. Research. We may disclose your health information to researchers conducting research that has been approved by Southglenn Endodontics’s privacy committee.
14. Public safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
15. Specialized government functions. We may disclose your health information for military, and national security purposes or to correctional institutions or law enforcement officers that have you have in their lawful custody.
16. Worker’s compensation. We may disclose your health information as necessary to comply with worker’s compensation laws.
17. Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current email address, we may use email to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate.
18. Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We may similarly describe products or services provided by this practice and tell you which health plans this practice participates in. We may also encourage you to maintain a healthy lifestyle and get recommended tests, recommend that you participate in a disease management program, provide you with small gifts, tell you about government sponsored health programs or encourage you to purchase a product or service when we see you, for which we may be paid. Finally, we may receive compensation which covers our cost of reminding you to take and refill your medication, or otherwise communicate about a drug or biologic that is currently prescribed for you. We will not otherwise use or disclose your dental information for marketing purposes or accept any payment for other marketing communications without your prior written authorization. The authorization will disclose whether we receive any compensation for any marketing activity you authorize, and we will stop any future marketing activity to the extent you revoke that authorization.
19. Health plan. We may disclose your health information to the sponsor of your health plan.
20. Change of Ownership. In the event Southglenn Endodontics is sold or merged with another organization, your health information/record will become the property of the new owner.
21. Monitoring. For patient safety reasons patients may be monitored by camera equipment. There will be no recordings made.
II. When Southglenn Endodontics May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, the Southglenn Endodontics will not use or disclose your health information without your written authorization. If you do authorize the Southglenn Endodontics to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your health information, by written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. If you tell us not to disclose information to your commercial health plan concerning your health care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request and will notify you of our decision. The Southglenn Endodontics is not required to agree to the restriction that you requested.
2. You have the right to request that you receive your health information in a specific way or at a specific location. We will comply with all reasonable requests that are submitted in writing which specify how or where you wish to receive these communications.
3. You have the right to inspect and copy your health information with limited exceptions. We may charge a reasonable fee as established by state or federal law for copies. To access your dental information, you must submit a written request detailing what information you want to access, whether you want to inspect it or get a copy of it as well as your preferred format. We will provide copies in your requested preferred format if it is readily producible, or we will provide you with an alternative format you find acceptable. We may deny your request under limited circumstances, and you have a right to appeal our decision. If your written request clearly, conspicuously and specifically asks us to send you or some other person or entity a copy of your dental record, and we do not deny the request, we will send a copy your health record as you requested and will charge you no more than what it costs us to respond to your request. We may deny your request under limited circumstances where it is believed by allowing access would be reasonably likely to cause harm. You do have a right to appeal our decision. Examples where harm might be determined to occur are a minor’s records, records of an incapacitated adult or psychotherapy notes.
4. You have a right to request that the SOUTHGLENN ENDODONTICS amend your health information that is incorrect or incomplete. The SOUTHGLENN ENDODONTICS is not required to change your health information and will provide you with information about the SOUTHGLENN ENDODONTICS’s denial and how you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your health information made by the SOUTHGLENN ENDODONTICS, except that the SOUTHGLENN ENDODONTICS does not have to account for the disclosures described in Section I of this Notice of Privacy Practices.
6. You have a right to a paper or electronic copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the Privacy Office at 714-571-3695.
IV. Changes to this Notice of Privacy Practices
SOUTHGLENN ENDODONTICS reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, the SOUTHGLENN ENDODONTICS is required by law to comply with this Notice. Revised Notices will replace all existing Notices that are posted in the facilities, on our website, or available for electronic communication.
V. Colorado Privacy Act
Use the link below to submit a request to exercise your personal data rights under the Colorado Privacy Act.
Click here to Colorado Privacy Act form
Complaints about this Notice of Privacy Practices or how the SOUTHGLENN ENDODONTICS handles your health information should be directed to the Privacy Office at 714-571-3695.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at :
https://www.hhs.gov/about/contact-us/index.html or you may also submit your complaint electronically by visiting http://www.hhs.gov/ocr/privacy/index.html
You will not be penalized for filing a complaint.