Notice of Privacy Practices

Uses and Disclosures That Do Not Require Your Authorization

Without specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment and health care operations.

• Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. For example, we may need to share information with other providers, such as your general dentist, oral surgeon or periodontist, in connection with our rendering orthodontic treatment to you.
• Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. For example, we disclose treatment information when billing an orthodontic plan for your orthodontic services. This office may disclose your protected health information to any third party payor or spouse, such as insurance companies, employers with direct reimbursement, or administrators of flexible spending accounts, in order to obtain payment of your account.
• Health Care Operations include the business aspects of running our practice. For example, patient information may be used for training purposes or quality assessment. Patient information may be given to certifying, licensing and accrediting bodies in connection with obtaining certification, licensure or accreditation, such as the American Board of Orthodontics or state dental boards.
• Internally. Texas law defines covered entity broadly, so staff members who have a role in your treatment may have access to your protected health information in this office. This office requires a confidentiality agreement from each employee.
• Family. Unless you request otherwise, we may use or disclose health information to a family member, friend, personal representative or other individual to the extent necessary to help with your orthodontic care or with payment for your orthodontic care.
• Appointment Reminders. This office may use your confidential information to remind you of appointments by sending reminder cards, by text or email where you have provided that information, or by leaving messages at home or at work. This office may also contact you to recommend treatment alternatives or to provide you with information about health related benefits and services that may be of interest to you, such as newsletters and brochures.
• Emergencies. In the event of an emergency or your incapacity, we will use our professional judgment in disclosing only the protected health information necessary to facilitate needed care.
• Public Health, Legal Proceedings, Law Enforcement and National Security. This office may disclose your health information for public health oversight activities, for lawful intelligence, counterintelligence and other national security activities, to correctional institutions or law enforcement officials, and to report suspected abuse, neglect or domestic violence as required by Texas and federal law.

Uses and Disclosures That Require Your Written Authorization

The following uses and disclosures of your protected health information will be made only with your written authorization:

• Most uses and disclosures of psychotherapy notes, if any such notes are maintained.
• Uses and disclosures of your protected health information for marketing purposes.
• Disclosures that constitute a sale of your protected health information.
• Any other use or disclosure not described in this Notice.

You may revoke such an authorization in writing at any time. We are required to honor and abide by that written request, except to the extent that we have already taken action in reliance on your authorization.

Your Rights Regarding Your Protected Health Information

You may exercise the following rights by presenting a written request to our Privacy Officer at the practice address listed below.

• The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are generally not required to agree to a requested restriction. There is one exception: if you pay for a service in full, out of pocket, and ask us not to disclose information about that service to your health plan for purposes of payment or health care operations, we must agree, unless the disclosure is otherwise required by law. If we agree to any other restriction, we must abide by it unless you agree in writing to remove it.
• The right to request to receive confidential communications of protected health information from us by alternative means or at alternative locations. We are required to accommodate only reasonable requests. Please specify in your correspondence exactly how you want us to communicate with you and, if you are directing us to send information to a particular place, the contact and address information.
• The right to access, inspect, and copy your protected health information. Texas law requires that requests for copies be made in writing, and we ask that requests to inspect your health information also be made in writing. If we maintain your information electronically, you have the right to obtain a copy in an electronic format. A reasonable fee may be assessed for copies.
• The right to request an amendment to your protected health information. We may deny your request in certain situations. If your request is denied, you will be informed in writing of the reasons for the denial.
• The right to receive an accounting of disclosures of protected health information made outside of treatment, payment and health care operations, or made on the basis of your previous authorization.
• The right to obtain a paper copy of this Notice from us upon request.

Our Duties

We are required by law to maintain the privacy of your protected health information, to provide you with notice of our legal duties and privacy practices with respect to protected health information, to abide by the terms of the Notice of Privacy Practices currently in effect, and to notify you following a breach of unsecured protected health information.

We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions to our Notice of Privacy Practices will be posted on the effective date, and you may request a written copy of the revised Notice from this office.

Complaints

You have the right to file a formal, written complaint with us at the address below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

For more information about our privacy practices, or to exercise any of the rights described above:

To file a complaint with our practice:

To file a complaint with the federal government: