Notice of Privacy Practices

 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

PLEASE REVIEW THIS CAREFULLY

Our Legal Duty: We are required by applicable federal and state law 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 our rights concerning your protected health information.

Your Authorization: In addition to our use of your health information for the following purposes, you may give us written authorization, to use your 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. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

Uses and Disclosures of Health Information: We use and disclose health information about you without authorization for the following purposes:

Treatment: We may use or disclose your health information for your treatment. For example, we may disclose your health information to a physician or other healthcare provider providing treatment to you.

Payment: We may use and disclose your health information to obtain payment for services we provide to you. For example, we may send claims to your dental health plan containing certain health information.

Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. For example, healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conduct training programs, accreditation, certification, licensing or credentialing activities.

To You or Your Personal Representative: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to your personal representative, but only if you agree that we may do so.

Persons Involved in Care: We may use or disclose health information to notify, or assist in the notifications of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your absences or incapacity or in emergency circumstances, we will disclose health information based on a determination using our professional judgement disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgement and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

Disaster Relief: We may use or disclose your health information to assist in disaster relief efforts.

Health-Related Products Services: We may contact you by phone, mail, email or other modes of communication to inform you about health-related products or services that may be of interest to you.

Treatment Alternatives: We may contact you by phone, mail, email or other modes of communication to inform you about or recommend possible treatment options or alternatives that may be of interest to you.

Required by Law: We may use or disclose your health information when we are required to do so by law.

Lawsuits and Legal Disputes: We may use or disclose your health information in responding to a court or administrative order, a subpoena, or a discovery request. We may also use and disclose your health information to the extent permitted by law without your authorization, for example to defend a lawsuit or arbitration.

Public Health and Public Benefit: We may use or disclose your health information to report abuse, neglect, or domestic violence; to report disease, injury and vital statistics; to report certain information to the Food and Drug Administration (FDA); to alert someone who may be at risk of contracting or spreading disease; for health oversight activities; for certain judicial and administrative proceeding; for certain law enforcement purposes; to avert a serious threat to health or safety; and to comply with workers’ compensation or similar programs.

Decedents: We may disclose health information about a decedent as authorized or required by law.

National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal official’s health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement official’s having lawful custody the protected health information of an inmate or patient under certain circumstances.

Appointment Reminders: We may contact you by phone, mail, email, or other modes of communication to provide you with appointment reminders.

Marketing of Health Information: Except for marketing information given in a face-to-face communication or promotional gifts of nominal value, we will not use without your written authorization your health information for purposes that are considered marketing under HIPAA.

Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may send us a request letter to obtain a form to request access by using the contact information listed at the end of this Notice. If you request copies, we may charge you a fee for the costs of copying your health information, and postage if you want the copies mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your 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.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations, and certain other activities, for up to six (6) years before the date of your request. You re entitled to one disclosure accounting in any twelve (12) month period at no charge. If you request any additional accountings less than 12 months later, we may charge you a reasonable, cost-based fee for responding to these additional requests.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. In most cases we are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in certain circumstances where disclosure is required or permitted, such as an emergency, for public health activities, or when disclosure is required by law.) We must comply with a request to restrict the disclosure of protected health information to a health plan for purposes of carrying out payment or healthcare operations (as defined by HIPAA) if the protected health information pertains solely to a health care item or service for which we have been paid out of pocket in full.

Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. (You must make your request in writing.) Your request must specify the alternative means or location, and provide a satisfactory explanation of how payments will be handled under the alternative means or location you request.

Amendment: You have the right to request that we amend your health information. Your request must be in writing and it must explain why the information should be amended. We may deny your request under certain circumstances.

Paper Copy of Notice: You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may ask us for a copy of this Notice at any time.

Changes to Notice: We may change our privacy practices and this Notice at any time, provided such changes are permitted applicable by law. Any received Notice will be effective for all health information that we maintain, including health information we created or received before we make the changes. If we make a significant change in our privacy practices, we will change this Notice and provide the new Notice at our practice location and on our website, and distribute it upon request.

Questions and Complaints: If you want more information about our privacy practices or have questions or concerns, or want to lodge a complaint about our privacy practices, please contact us by using the contact information listed 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 to the U.S. Department of Health and Human Services upon request.

We support your right to the privacy of your health information. We will not take retaliatory action against you if file a complaint about our privacy practices.

Privacy Officer
Email: Office@DentalWorldKapolei.com
Address: 590 Farrington Hwy, Suite 523, Kapolei, Hawaii 96707