Privacy
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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS
IMPORTANT TO US. If you have any questions please contact our HIPAA officer
1.Our Legal Duty
We are required by applicable federal and state laws to maintain the privacy of
your protected health information. We are also required to give you this notice
about our privacy practices, our legal duties, and your rights concerning your protected
health information. We must follow the privacy practices that are described in this
notice while it is in effect.
We reserve the right to change our privacy practices and the terms of this notice
at any time, provided that such changes are permitted by applicable law. We reserve
the right to make the changes in our privacy practices and the new terms of our
notice effective for all protected health information that we maintain, including
medical information we created or received before we made the changes.
You may request a copy of our notice (or any subsequent revised notice) at any time.
For more information about our privacy practices, or for additional copies of this
notice, please contact us using the information listed at the end of this notice.
2. Uses and Disclosures of Protected Health Information
We will use and disclose your protected health information about you for treatment,
payment, and health care operations. Following are examples of the types of uses
and disclosures of your protected health care information that may occur. These
examples are not meant to be exhaustive, but to describe the types of uses and disclosures
that may be made by our office.
Treatment: We will use and disclose your protected health information to
provide, coordinate or manage your health care and any related services. This includes
the coordination or management of your health care with a third party. We will disclose
protected health information to the dentist or physician who may be treating you.
In addition, we may disclose your protected health information from time to time
to another physician or health care provider (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.
Payment: Your protected health information will be used, as needed, to obtain
payment for your health care services. This may include certain activities that
your health insurance plan may undertake before it approves or pays for the health
care services we recommend for you.
Health Care Operations: We may use or disclose, as needed, your protected
health information in order to conduct certain business and operational activities.
These activities include, but are not limited to, quality assessment activities,
employee review activities, training of students, licensing, and conducting or arranging
for other business activities.
For example, we may use a sign-in sheet at the registration desk where you will
be asked to sign your name. We may also call you by name in the waiting room when
your doctor is ready to see you. We may use or disclose your protected health information,
as necessary, to contact you by telephone or mail to remind you of your appointment.
We will share your protected health information with third party "business associates"
that perform various activities (e.g., billing, transcription services) for the
practice. Whenever an arrangement between our office and a business associate involves
the use or disclosure of your protected health information, we will have a written
contract that contains terms that will protect the privacy of your protected health
information.
Uses and Disclosures Based On Your Written Authorization: Other uses and
disclosures of your protected health information will be made only with your authorization,
unless otherwise permitted or required by law as described below.
You may give us written authorization to use your protected health information or
to disclose it to anyone for any purpose. If you give us an authorization, you may
revoke it in writing at any time. Your revocation will not affect any use or disclosures
permitted by your authorization while it was in effect. Without your written authorization,
we will not disclose your health care information except as described in this notice.
Others Involved in Your Health Care: Unless you object, we may disclose to
a member of your family, a relative, a close friend or any other person you identify,
your protected health information that directly relates to that person's involvement
in your health care. If you are unable to agree or object to such a disclosure,
we may disclose such information as necessary if we determine that it is in your
best interest based on our professional judgment. We may use or disclose protected
health information to notify or assist in notifying a family member, personal representative
or any other person that is responsible for your care of your location, general
condition or death.
Marketing: We may use your protected health information to contact you with
information about treatment alternatives that may be of interest to you. We may
disclose your protected health information to a business associate to assist us
in these activities. Unless the information is provided to you by a general newsletter
or in person or is for products or services of nominal value, you may opt out of
receiving further such information by telling us using the contact information listed
at the end of this notice.
Coroner: We may disclose the protected health information of a deceased person
to a coroner, protected health examiner, funeral director or organ procurement organization
for certain purposes.
Public Health and Safety: We may disclose your protected health information
to the extent necessary to avert a serious and imminent threat to your health or
safety, or the health or safety of others. We may disclose your protected health
information to a government agency authorized to oversee the health care system
or government programs or its contractors, and to public health authorities for
public health purposes.
Health Oversight: We may disclose protected health information to a health
oversight agency for activities authorized by law, such as audits, investigations
and inspections. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs, other
government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a
public health authority that is authorized by law to receive reports of child abuse
or neglect. In addition, we may disclose your protected health information if we
believe that you have been a victim of abuse, neglect or domestic violence to the
governmental entity or agency authorized to receive such information. In this case,
the disclosure will be made consistent with the requirements of applicable federal
and state laws.
Food and Drug Administration: We may disclose your protected health information
to a person or company required by the Food and Drug Administration to report adverse
events, product defects or problems, biologic product deviations; to track products;
to enable product recalls; to make repairs or replacements; or to conduct post marketing
surveillance, as required.
Criminal Activity: Consistent with applicable federal and state laws, we
may disclose your protected health information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent threat to the health or
safety of a person or the public. We may also disclose protected health information
if it is necessary for law enforcement authorities to identify or apprehend an individual.
Required by Law: We may use or disclose your protected health
information to the extent that law requires the use or disclosure. The use or
disclosure will be made in compliance with the law and will be limited to the
relevant requirements of the law. You will be notified, as required by
law, of any such uses or disclosures.
Legal Proceedings: We may disclose your protected health information in response
to a court or administrative order, subpoena, discovery request or other lawful
process, under certain circumstances. Under limited circumstances, such as a court
order, warrant or grand jury subpoena, we may disclose your protected health information
to law enforcement officials.
Law Enforcement: We may disclose limited information to a law enforcement
official concerning the protected health information of a suspect, fugitive, material
witness, crime victim or missing person. We may disclose the protected health information
of an inmate or other person in lawful custody to a law enforcement official or
correctional institution under certain circumstances. We may disclose protected
health information where necessary to assist law enforcement officials to capture
an individual who has admitted to participation in a crime or has escaped from lawful
custody.
Workers’ Compensation: This facility may disclose your protected health
information as authorized to comply with workers’ compensation laws and other established
programs.
3. Your Rights
Access: You have the right to look at or get copies of your protected
health information, with limited exceptions. You must make a request in writing
to the contact person listed herein to obtain access to your protected health information.
You may also request access by sending us a letter to the address at the end of
this notice. If you request copies, we will charge you $25.00 for each page or $10.00
per hour to locate and copy your protected health information, and postage if you
want the copies mailed to you. If you prefer, we will prepare a summary or an explanation
of your protected health information for a fee. Contact us using the information
listed at the end of this notice for a full explanation of our fee structure.
Accounting of Disclosures: You have the right to receive a list of instances
in which we or our business associates disclosed your protected health information
for purposes other than treatment, payment, and health care operations, as described
in this notice of privacy practices, It excludes disclosures this facility may have
made to you, to family members or friends involved in your care or for notification
purposes. You have the right to receive specific information regarding these disclosures
that occurred after April 13, 2003. You may request a shorter time frame. The right
to receive this information is subject to certain exceptions, restrictions and limitations.
Restriction Requests: You have the right to request that we place additional
restrictions on our use or disclosure of your protected health information. We are
not required to agree to these additional restrictions, but if we do, we will abide
by our agreement (except in an emergency). Any agreement we may make to a request
for additional restrictions must be in writing signed by a person authorized to
make such an agreement on our behalf. We will not be bound unless our agreement
is so memorialized in writing.
Confidential Communication: You have the right to request that we communicate
with you in confidence about your protected health information by alternative means
or to an alternative location. You must make your request in writing. We must accommodate
your request if it is reasonable, specifies the alternative means or location, and
continues to permit us to bill and collect payment from you.
Amendment: You have the right to request that we amend your protected
health information. Your request must be in writing, and it must explain why the
information should be amended. We may deny your request if we did not create the
information you want amended or for certain other reasons. If we deny your request,
we will provide you a written explanation. You may respond with a statement of disagreement
to be appended to the information you wanted amended. If we accept your request
to amend the information, we will make reasonable efforts to inform others, including
people or entities you name, of the amendment and to include the changes in any
future disclosures of that information.
Electronic Notice: If you receive this notice on our website or by electronic
mail (e-mail), you are entitled to receive this notice in written form. Please contact
us using the information listed at the end of this notice to obtain this notice
in written form.
4.Questions and Complaints
If you want more information about our privacy practices or have questions or
concerns, please contact us using the information below. If you believe that we
may have violated your privacy rights, or you disagree with a decision we made about
access to your protected health information or in response to a request you made,
you may complain to us using the contact information below. You also may submit
a written complaint to the U.S. Department of Health and Human Services. We will
provide you with the address to file your complaint with the U.S. Department of
Health and Human Services upon request.
We support your right to protect the privacy of your protected health information.
We will not retaliate in any way if you choose to file a complaint with us or with
the U.S. Department of Health and Human Services
5. Effectiveness: This notice was published and becomes effective April
13, 2003.
Name of Contact Person: Antonio Mendez DMD
Telephone: 305-710-4691
Address: 4342 SW 74th Ave, Miami, FL 33155