Make an Appointment

Please fill out the form below and someone from our office will be in touch to confirm your appointment.

Notice of Privacy Practices

Niraj R. Patel DDS, PLLC
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.

If you have any questions about this Notice please contact the Privacy Officer.

Jessica Mills, RDH (828)437-7070

 

Effective Date: April 14,2003                                               Revised: November 1, 2016

 

 

 

Uses and Disclosures of Protected Health Information

We may use or disclose (share) your PHI to provide health care treatment for you.

Your PHI may be used and disclosed by your physician, our office staffandothers outside of our office thatareinvolved in your care and treatment for the purpose of providing health care services to you.

EXAMPLE: Your PHI may be provided to a physician to whom you have been referred for evaluation to ensure that the physician has the necessary information to diagnose or treat you. We may also share your PHI from time-to-time to another physician orhealth careprovider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.

 

We may use and disclose your PHI to obtain payment for services.  We may provide your PHI to others in order to bill or collect payment for services. There may be services for which we share information with your health plan to determine if the service will be paid for.

PHI may be shared with the following:

EXAMPLE: You are seenatour practice for a procedure. We will need to provide a listing of services such as x-rays to your insurance company so that we can get paid for the procedure. We may at times contact your health care plan to receive approval PRIOR to performing certain procedures to ensure the services will be paid for. This will require sharing of your PHI.

 

 

 

We may use or disclose, as-needed, your PHI in order to support the business activities of this practice which are called health care operations.

EXAMPLES:

 

We may use anddisclosureyour PHI in other situations without your permission.

 

Other uses and disclosures of your health information.

Business Associates: Some services are provided through the use of contracted entities called “business associates.” We will always release only the minimum amount of PHI necessary so that the business associate can perform the identified services. We require the business associate(s) to appropriately safeguard your information. Examples of business associates include billing companies or transcription services.

Health Information Exchange: We may make your health information available electronically to other healthcare providers outside of our facility who are involved in your care.

Treatment alternatives: We may provide you notice of treatment options or otherhealth relatedservices that may improve your overall health.

Appointment reminders: We may contact you about upcoming appointments or treatment by phone, letter orpost card.

 

 

 

We may use or disclose your PHI in the following situations UNLESS you object.

entityto assist in disaster relief efforts.

 

The following uses and disclosures of PHI require your written authorization:

All uses and disclosures will require a written authorization from you or your personal representative.

Written authorization simply explains how you want your information used and disclosed. Your written authorization may be revoked at any time, in writing. Except to the extent that your doctor or this practice has used or released information based on the direction provided in the authorization, no further use or disclosure will occur.

 

Your Privacy Rights

You have certain rights related to your protected health information. All requests to exercise your rights must be made in writing. A request for the appropriate form can be made by contacting the office at your convenience. Please allow up to 72 hours for the request to be processed.

 

You have the right to see and obtain a copy of your protected health information.

This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. If requested we will provide you a copy of your records in an electronic format. There are some exceptions to records which may be copied and the request may be denied. We may charge you a reasonablecost basedfee for a copy of the records.  

 

You have the right to request a restriction of your protected health information.

You may request for this practice not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. We are not required to agreewiththese requests. If we agree to a restriction request we will honor the restriction request unless the information is needed to provide emergency treatment.

There is one exception: we must accept a restriction request to restrict disclosure of information to a health plan if you pay out of pocket in full for a service or product unless it is otherwise required by law.

 

You have the right to request for us to communicate in different ways or in different locations.

We will agree to reasonable requests. We may also request alternative address orother methodof contact such as mailing information to a post office box. We will not ask for an explanation from you about the request.

 

You may have the right to request an amendment of your health information.

You may request an amendment of your health information if you feel that the information is not correct along with an explanation of the reason for the request. In certain cases, we may deny your request for an amendment at which time you will have an opportunity to disagree.

 

 

 

 

You have the right to a list of people or organizations who have received your health information from us.

This right applies to disclosures for purposes other than treatment, payment or healthcare operations. You have the right to obtain a listing of these disclosures that occurred after April 14, 2003. You may request them for the previous six years or a shorter timeframe. If you request more than one list within a 12 month period you may be charged a reasonable fee.

 

Additional Privacy Rights

 

Complaints

 

If you think we have violated your rights or you have a complaint about our privacy practices you can contact:

            HIPAA Privacy Officer: Jessica Mills, RDH (828)437-707

 

You may also complain to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us.

If you file a complaint we will not retaliate against you for filing a complaint.

This notice was published and becomes effective on April 13, 2003.

 

 

© Copyright 2019 Foothills Family Dentistry. Developed by VanNoppen.