|APEX ENDODONTICS |
OF PRIVACY PRACTICES EFFECTIVE APRIL 14, 2003
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.
OUR PROMISE TO YOU, OUR PATIENTS
Your information is important and confidential.Our ethics and policies
require that your information be held in strict confidence.
We maintain protocols to ensure the security and confidentilality of your
personal information. We have physical security in our building, passwords
to protect databases, compliance audits, and virus/intrusion detection
software. Within our practice, access to your information is limited to
those who need it to perform their jobs.
At the offices of APEX ENDODONTICS, we are committed to treating
and using protected health information about you responsibly. This Notice
of Policies describes the personal information we collect, and how and
when we use or disclose that information. It also describes your rights
as they relate to your protected health information. This Notice is effective
April 14,2003, and applies to all protected health information as defined
by federal regulations.
UNDERSTANDING YOUR HEALTH RECORD
Each time you visit APEX ENDODONTICS, a record of your visit is made.
Typically, this record contains your symptoms, examination and test results,
diagnoses, treatment, and a plan for future care or treatment. This information,
often referred to as your health or medical record, serves as a :
Basis for planning your care and treatment,
Means of communication among the many health professionals who contribute
to your care,
Legal document describing the care you received,
Means by which you or a third -party payer can verify that services billed
were actually provided,
Tool in educating health professionals,
Source of data for medical research,
Source of information for public health officials charged to improve the
health of the state and nation,
Source of data for our planning and marketing, and
Tool by which we can assess and continually work to improve the care we
render and outcomes we achieve.
Understanding what is in your record and how your health information
is used helps you to: ensure its accuracy; better understand who, what,
when, where and why others may access your health information; and make
more informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of APEX ENDODONTICS,
the information belongs to you. You have the right to :
Obtain a paper copy of this notice of privacy policies upon request,
Inspect and obtain a copy of your health record as provided by 45CFR 164.524(reasonable
copy fees apply in accordance with state law),
Amend your health record as provided by 45CFR 164.526,
Obtain an accounting of disclosures of your health information as provided
Request confidential communications of your health information as provided
by 45CFR164.522(b), and
Request a restriction on certain uses and disclosures of your information
as provided by 45 CFR164.522(a) (however, we are not required by law to
agree to a requested restriction).
Our practice is required to:
Maintain the privacy of your health information,
Provide you with this notice as to our legal duties and privacy practices
with respect to information we collect and maintain about you,
Abide by the terms of this notice,
Notify you if we are unable to agree to a requested restriction.
Accommodate reasonable requests you may have to communicate your health
We reserve the right to change our practices and to make the
new provisions effective for all protected health information we maintain.
We will keep a posted copy of the most current notice in our facility
containing the effective date in the top, right-hand corner. In addition,
each time you visit our facility for treatment, you may obtain a copy
of the current notice in effect upon request.
We will not use or disclose your health information in a manner
other than described in the section regarding Examples Of Disclosures
For Treatment, Payment, And Health Operations, without your written authorization,
which you may revoke as provided by 45CFR 164.508(b)(5), except to the
extent that action has already been taken.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may call
If you believe your privacy rights have been violated, you can
either file a complaint with the Office for Civil Rights, U.S. Department
of Health and Human Services(OCR). There will be no retaliation for filing
a complaint with either our practice or the OCR. The address for the OCR
regional NEW JERSEY OFFICE is as follows; THE OFFICE FOR CIVIL RIGHTS,
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES, 26 FEDERAL PLAZA - SUITE
3313, NEW YORK, NY 10278 (212) 264-3313, (212) 264-3039 FAX
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS
We will use your health information for treatment. We may provide medical
information about you to health care providers, our practice personnel,
or third parties who are involved in the provision, management, or coordination
of your care.
For example: Information obtained by a nurse, physician, or other
member of your health care team will be recorded in your record and used
to determine the course of treatment that should work best for you. Your
medical information will be shared among health care professionals involved
in your care.
We will also provide your other physician(s) or subsequent health
care provider(s) (when applicable) with copies of various reports that
should assist them in treating you.
We will use your health information for payment. We may disclose
your information so that we can collect or make payment for the health
care services you receive. For example: If you participate in a health
insurance plan, we will disclose necessary information to that plan to
obtain payment for your care.
We will use your health information for regular health operations.
We may disclose your health information for our routine operations. These
uses are necessary for certain administrative, financial, legal, and quality
improvement activities that are necessary to run our practice and support
the core functions. For example: Members of the quality improvement team
may use information in your health record to assess the care and outcomes
in your case and others like it. This information will then be used in
an effort to continually improve the quality and effectiveness of the
healthcare and service we provide and to reduce healthcare costs.
Appointment Reminders: We may disclose medical information to
provide appointment reminders (e.g., contacting you at the phone number
you have provided to us and leaving a message as an appointment reminder).
Decedents: Consistent with applicable law, we may disclose health information
to a coroner, medical examiner, or funeral director.
Workers Compensation: We may disclose health information to the extent
authorized by and necessary to comply with laws relating to workers compensation
or other similar programs established by law.
Public Health: As required by law, we may disclose your health information
to public health or legal authorities charged with preventing or controlling
disease, injury, or disability.
Research: We may disclose information to researchers when their research
has been approved and the researcher has obtained a required waiver from
the Institutional Review Board/Privacy Board, who has reviewed the research
Organ Procurement Organizations: Consistent with applicable law, we may
disclose health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of organs
for the purpose of donation and transplant.
As Required By Law: We may disclose health information as required by
law. This may include reporting a crime, responding to a court order,
grand jury subpoena, warrant, discovery request, or other legal process,
or complying with health oversight activities, such as audits, investigations,
and inspections, necessary to ensure compliance with government regulations
and civil rights laws.
Specialized Government Functions: We may disclose health information for
military and veterans affairs or national security and intelligence activities.
Business Associates : There are some services provided in our organization
through contacts with business associates. Some examples are billing or
transcription services we may use. Due to the nature of business associates'
services, they must receive your health information in order to perform
the jobs we've asked them to do. To protect your health information, however,
when these services are contracted we require the business associate to
appropriately safeguard your information.
Practice Marketing : We may contact you to provide information about treatment
alternatives or other health-related benefits and services that may be
of interest to you (for example, to notify you of any new tests or services
we may be offering).
Food And Drug Administration(FDA): We may disclose to the FDA health information
relative to adverse events with respect to food, supplements, product
and product defects, or post marketing surveillance information to enable
product recalls, repairs, or replacement.
Personal Representative: We may disclose information to your personal
representative (person legally responsible for your care and authorized
to act on your behalf in making decisions related to your health care).
To Avert A Serious Threat To Health/Safety: We may disclose your information
when we believe in good faith that this is necessary to prevent a serious
threat to your safety or that of another person. This may include cases
of abuse, neglect, or domestic violence.
Communication With Family : Unless you object, health professionals, using
their best judgment, may disclose to a family member or close personal
friend health information relevant to that person's involvement in your
care or payment related to your care. We may notify these individuals
of your location and general condition.
Disaster Relief: Unless you object, we may disclose health information
about you to an organization assisting in a disaster relief effort.
For all non-routine operations, we will obtain your written authorization
before disclosing your personal information. In addition, we take great
care to safeguard your information in every way that we can to minimize
any incidental disclosures.
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