HIPAA Notice of Privacy Practices
May 1st 2023:
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.
Scope of Notice
This Notice of Privacy Practices (“Notice”) applies to all Protected Health Information about you held or transmitted by Ghaffari Orthodontics (“we”, “our”, “us”). Protected Health Information is any individually identifiable health information about your past, present, or future physical or mental health condition or payment for healthcare or about the provision of care to you. Protected Health Information may include information about your condition or treatment, diagnostic tests and images, and related dental or other health information.
We are required by law to maintain the privacy of Protected Health Information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect.
You may request a copy of our 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.
How We May Use and Disclose Your Protected Health Information
The following categories describe the different ways that we may use and disclose your Protected Health Information without an authorization. Not every use or disclosure in a category will be listed. Your Protected Health Information may be stored in paper, electronic or other form and may be disclosed electronically and by other methods:
Treatment. We may use and disclose your Protected Health Information for your treatment. For example, we may disclose your Protected Health Information to a specialist providing treatment to you.
Payment. We may use and disclose your Protected Health Information to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your dental health plan containing certain Protected Health Information.
Healthcare Operations. We may use and disclose your Protected Health Information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, arranging for legal services, conducting training programs, reviewing the competence and qualifications of healthcare professionals, and licensing activities. We may also use your Protected Health Information to notify you about our health-related products and services, to recommend possible treatment options or alternatives that may be of interest to you, to send you patient satisfaction surveys, or to send you appointment reminders. We may make incidental disclosures of limited Protected Health Information, such as by using sign-in sheets in our waiting rooms or calling out names in our waiting rooms when calling back patients for their appointments.
Business Associates. We may disclose your Protected Health Information to one or more of our service providers, known as “business associates,” in order for them to provide services to us or on our behalf pursuant to a written business associate agreement. Our business associates are required to safeguard your Protected Health Information.
Health Information Exchanges. We may participate in one or more Health Information Exchanges (HIEs) and may electronically share your Protected Heath Information for treatment, payment, healthcare operations and other permitted purposes with other participants in the HIE. HIEs allow your health care providers to efficiently access and use your PHI as necessary for treatment and other lawful purposes.
Individuals Involved in Your Care or Payment for Your Care. We may disclose your Protected Health Information to your family or friends or any other individual identified by you when they are involved in your care or in the payment for your care. Additionally, if a person has the authority by law to make health care decisions for you, we may disclose information about you to such patient representative and treat that patient representative the same way we would treat you with respect to your Protected Health Information. We may also disclose your Protected Health Information to a public or private entity authorized by law to assist in disaster relief efforts to notify, or assist in notifying, a family member or personal representative about your location, general condition, or death.
Required by Law. We may use or disclose your Protected Health Information when we are required to do so by law, such as to report suspected abuse or neglect.
Public Health Activities. We may disclose your Protected Health Information for public health activities, such as to prevent or control disease, injury or disability, report child abuse or neglect, or notify a person of a recall, repair, or replacement of products or services.
Abuse, Neglect or Domestic Violence. If we reasonably believe that you are a victim of abuse, neglect, or domestic violence, we may disclose protected health information about you to a government authority, including a social service protective agency, authorized by law to receive reports of abuse, neglect or domestic violence.
Health Oversight Activities. We may disclose your Protected Health Information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure actions. For example, we may disclose Protected Health Information about you to the U.S. Department of Health and Human Services if it requests such information to determine that we are complying with federal privacy law.
Law Enforcement. We may disclose your Protected Health Information for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Judicial and Administrative Proceedings. We may disclose your Protected Health Information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.
Serious Threat to Health or Safety. We may disclose your Protected Health Information when permitted by law to avert a serious and imminent threat to the health or safety of a person or the public.
Specialized Government Functions. To the extent applicable, we may release your Protected Health Information for specialized government functions, including military and veterans activities, national security and intelligence activities, and correctional institutions.
Worker’s Compensation. We may disclose your Protected Health Information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Coroners, Medical Examiners, and Funeral Directors. We may release your Protected Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose your Protected Health Information to funeral directors consistent with applicable law to enable them to carry out their duties.
Research. We may use or disclose your Protected Health Information for research in limited circumstances, including when an institutional review board or privacy board has reviewed the research proposal and established a process to ensure the privacy of the requested information and approves the research.
Limited Data and De-identified Data. We may remove most information that identifies you from a set of data and use and disclose this data set for research, public health and healthcare operations, provided the recipients of the data set agree to keep it confidential. We may also de-identify your Protected Health Information and use and disclose the de-identified information for purposes permitted by law.
Other Uses and Disclosures of Protected Health Information
In any other situation not identified in this Notice, we will ask for your written authorization before using or disclosing information about you. Most uses and disclosures of Protected Health Information for marketing purposes and disclosures that constitute a sale of health information will be made only with your written authorization. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your Protected Health Information, except to the extent that we have already taken action in reliance on the authorization.
Your Protected Health Information Rights
Right to Access. You have the right to inspect and obtain copies of your Protected Health Information that we maintain or to direct us to send your Protected Health Information stored in an electronic health record to another person designated by you, with limited exceptions, as provided by 45 CFR § 164.524. You must make the request in writing at the address listed at the end of this Notice. In most cases, we will provide access to you or the person you designate within 30 days of your request. If you request information that we maintain on paper, we may provide photocopies. If you request information that we maintain electronically, you have the right to an electronic copy. We will use the form and format you request if readily producible. We will charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for postage if you want copies mailed to you. If you are denied a request for access, in certain circumstances you have the right to have the denial reviewed in accordance with the requirements of applicable law.
Right to Request Amendment. You have a right to request that we amend your Protected Health Information if you believe the information is not accurate or is incomplete, as provided by 45 CFR § 164.526. To request an amendment of your health information, you must submit your request in writing to the address listed at the end of this Notice. Your request must explain why the information should be amended. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures. You have a right to receive an accounting of certain disclosures of your Protected Health Information, as provided by 45 CFR § 164.528. To request an accounting of disclosures of your health information, you must submit your request in writing to the address listed at the end of this Notice.
Right to Request a Restriction. You have the right to request additional restrictions on certain uses and disclosures of your Protected Health Information for treatment, payment or healthcare operations, as provided by 45 CFR § 164.522(a). You must make your request in writing. We are not required to agree to your request, except we are required to agree in the case where your request is to restrict disclosures to a health plan for purposes of carrying out payment or healthcare operations, and the information pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan), has paid our practice in full.
Right to Alternative Communication. You have the right to request that we communicate with you about your Protected Health Information by alternative means or at alternative locations, as provided by 45 CFR § 164.522(b). You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request. We will accommodate all reasonable requests. However, if we are unable to contact you using the ways or locations you have requested we may contact you using the information we have.
Right to a Paper Copy of this Notice. You have a right to obtain a paper copy of this Notice upon request.
By providing my phone number(s) to the Practice, I explicitly grant consent to receive telephone calls and/or text messages from the Practice, its agents, and representatives using automated dialing systems, computer-assisted technology, or prerecorded messages, for various purposes, including but not limited to appointment and follow-up healthcare reminders, scheduling, patient accounts, assignment of benefits, and financial responsibilities. I am aware that depending on my phone plan, I may incur charges for these calls or text messages. I also agree to promptly update my phone number(s) if they change.
Changes to this Notice
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all Protected Health Information that we maintain. When we make a material change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request.
Complaints or Request for More Information
If you want more information about our privacy practices, please contact us as the address below. If you believe your privacy rights may have been violated, you can file a complaint with the Privacy Officer listed below or with the Office for Civil Rights, U.S. Department of Health and Human Services. You will not be retaliated against in any way for filing a complaint.
Privacy Officer: Shirlie Kalbaugh
Address: 100 Church Street Vienna, VA