Under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), all medical records and other individually identifiable health information of which we have knowledge must be kept confidential. All personal health information used by us or disclosed by us is covered by the Act regardless of whether this personal health information is in electronic, oral or paper form. Several new rights are granted to patients under this Act, allowing control over how your personal health information is used, how you can access it, and in some cases amend it.

This notice of Privacy Practices will be effective April 14, 2003. We are required by law to maintain the privacy of your personal health information and to provide you with notice of our legal duties and privacy practices with respect to your personal health information. We may be assessed a penalty for any misuse or unauthorized disclosures of your personal health information as regulated by HIPAA. We are bound to abide by the terms of this notice and reserve the right to make revisions to this policy. Should revisions be made a copy of the revised policy will be made available upon your request.

You will be asked to sign a consent form authorizing us to use and disclose your personal health information only for the following purposes, as defined under the Act:

• Treatment means the provision, coordination, or management of health care and related services by one or more healthcare providers, including coordination or management of health care by a healthcare provider with a third party; consultation between healthcare providers relating to a patient; or the referral of a patient for health care from one healthcare provider to another. For example, referral to an Oral Surgeon, Endodontist, or Periodontist.
• Payment means obtaining reimbursement for the provision of healthcare; determinations of eligibility of coverage; billing; claims management; collection activities; justification of charges; and disclosure to consumer reporting agencies; protected health information relating to the collection of reimbursements. For example, submitting a bill to your insurance company.
• Health care operations are any activity related to covered functions in which we participate in the function of our offices, such as conducting quality assessment activities; protocol development; case management and care coordination; auditing functions; business management and general administrative activities, including implementation of this regulation; customer service evaluations; resolution of grievances; fundraising; and marketing for which an authorization is not required. We may use a sign-in sheet at the reception area; we may call you by name in the reception area. We may contact you by mail or telephone regarding treatment, appointment reminders, billing or fundraising purposes, or other marketing activities.

We may, without prior consent, use or disclose your personal health information to carry out treatment, payment or health care operations:

• Directly to you at your request;
• In an emergency treatment situation, if we attempt to obtain such consent as soon as reasonably practicable after the delivery of such treatment, if we are required by law to treat you and attempts to obtain consent are unsuccessful, or if we attempt to obtain consent but are unable, due to barriers of communication, but we determine in our professional opinion that treatment is clearly inferred from the circumstances;
• Pursuant to and in compliance with an authorization signed by you; and
• Provided that you are informed in advance of the use and disclosure and have the opportunity to agree to or prohibit or restrict the use or disclosure. This may be an oral agreement between us and may include a directory maintained at our facility containing specific information allowed by this Act.

We may de-identify your personal health information by using codes or removing all individually identifiable health information.

All other uses and disclosures will be made only upon securing a written authorization form signed by you. You have the right to revoke this authorization, at any time, upon written notice and we will abide by that request. However, exception would be any actions already taken, relying on your authorization, and prior to revocation notice.

Under HIPAA, you have the following rights with respect to your protected health information (PHI).

• You have the right to request restrictions on certain uses and disclosures of your protected information, including restrictions placed upon disclosure to family members, close personal friends, or any other person you may identify. We are, however, not required to agree with a requested restriction;
• You have the right to receive confidential communications of your protected health information either directly from us or from us by alternative means or from alternative locations;
• You have the right to inspect and copy your protected health information;
• You have the right to amend protected health information, however, this request may be denied under certain circumstances;
• You have the right to receive an accounting of disclosures of your protected health information made by us in the six years prior to the date of the accounting request; and
• You have the right to obtain a paper copy of this notice from us, even if you have already signed the patient consent form.

If you feel your privacy rights or the provisions of this notice of privacy policies have been violated, you have the right to file a formal written complaint.

In addition to our office Privacy Practices, we also have an additional Privacy Policy for our web site.