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.
Coastline Dental is committed to protecting your privacy, and we have adopted privacy practices to protect the information we gather from you. We understand that medical information about you and your health is personal, and we are committed to protecting medical information about you. This Notice of Privacy Practices (“Notice”) describes the privacy practices of Coastline Dental and will tell you about the ways in which we may use and disclose medical information about you and how you can get access to this information. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information with respect to your “Protected Health Information” (as defined by the Health Insurance Portability and Accountability Act of 1996 and its regulations, as amended from time to time).
We typically use or share your health information in the following ways:
– Treat you. We can use your health information and share it with other professionals who are treating you.
– Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.
– Run our office. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
**How else can we use or share your health information?** We are allowed or required to share your information in other ways – usually to contribute to the public good, such as public health and research. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Your Rights Regarding Health Information:
– Get an electronic or paper copy of your medical record
– Ask us to correct your medical record
– Request confidential communications
– Request limits on what we use and share
– Get a list of those with whom we’ve shared information
– Get a copy of this privacy notice
– Choose someone to act for you
– File a complaint if you feel your rights are violated
Our Uses and Disclosures:
– Help with public health and safety issues
– Comply with the law
– Do research
– Respond to organ and tissue donation requests
– Work with a medical examiner or funeral director
– Address workers’ compensation, law enforcement, and other government requests
– Respond to lawsuits and legal actions
Our Responsibilities:
– Maintain the privacy and security of your protected health information.
– Inform you promptly if a breach occurs that may have compromised the privacy or security of your information.
– Abide by the terms of this Notice of Privacy Practices.
– Not share your information other than as described here unless you give us written permission.
This notice is effective as of 2003, and we are required to abide by the terms of the Notice of Privacy Practices. Changes to the terms of this notice will be made available upon request, in our office, and on our website.
**Contact Information:**
For any questions or more information about this notice or how to exercise your health information rights, you may contact our Privacy Officer, Thomas Southam, at:
Coastline Dental
31897 Del Obispo St Ste 100
San Juan Capistrano, CA 92675
Phone: (949) 661-2290
You have the right to exercise any of the actions in the above document, and the Privacy Officer will guide you through the process.
