HIPPA Privacy Policy

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your protected health information (PHI)
• Provide you with this Notice of our legal duties and privacy practices
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information
• Follow the duties and privacy practices described in this Notice

We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by law. Any changes will apply to all information we maintain. Updated notices will be posted in our office and on our website, and copies will be available upon request.

How We May Use and Disclose Your Information

We may use and disclose your PHI for the following purposes:

Treatment

We may use and share your information to provide, coordinate, or manage your dental care. For example, we may share your information with a specialist or referring provider.

Payment

We may use and disclose your information to bill and receive payment from health plans or other entities. This includes eligibility checks, claims processing, and collections.

Health Care Operations

We may use and disclose your information for business operations, including quality improvement, staff training, licensing, and accreditation.

Individuals Involved in Your Care

We may share your information with family members, friends, or others involved in your care or payment for your care, unless you object.

Public Health and Safety

We may disclose your information for public health activities, including disease prevention, reporting abuse or neglect, and responding to product recalls.

Required by Law

We will disclose your information when required by federal, state, or local law.

Law Enforcement and Legal Proceedings

We may disclose your information in response to a court order, subpoena, or other lawful process.

Health Oversight Activities

We may disclose your information to government agencies for audits, investigations, inspections, and licensure.

Research

We may use or disclose your information for approved research purposes under strict confidentiality standards.

Workers’ Compensation

We may disclose your information as authorized by laws relating to workers’ compensation.

National Security and Correctional Institutions

We may disclose information to authorized federal officials or correctional institutions as permitted by law.

Special Protections for Reproductive Health Information

We comply with federal law that provides additional protections for reproductive health care information. We will not use or disclose your PHI for purposes of investigating or imposing liability related to lawful reproductive health care unless required by law. In certain situations, we may require a signed attestation before disclosing such information.

Your Rights

You have the following rights regarding your health information:

Right to Access

You have the right to inspect and obtain a copy of your health records in paper or electronic format. You may also request that we send your records to a third party.

Right to Amend

You may request that we correct or amend your health information if you believe it is incorrect or incomplete.

Right to Request Restrictions

You may request limits on how we use or disclose your information. We are not required to agree to all requests, but we will comply when required by law.

Right to Confidential Communications

You may request that we contact you in a specific way (for example, home or office phone) or send mail to a different address.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your information.

Right to a Copy of This Notice

You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Your Choices

For certain health information, you can tell us your preferences about what we share. This includes:

• Sharing information with family or friends
• Receiving fundraising communications (you may opt out at any time)

Fundraising Communications

We may contact you for fundraising efforts. You have the right to opt out of receiving these communications at any time.

Breach Notification

If a breach of your unsecured PHI occurs, we will notify you as required by law. This notification will include details about the breach, what information was involved, and steps you can take to protect yourself.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information

Moorseville Pediatric Dentistry

Privacy Officer: Lisa Glaze
8001 Shelby Street
Indianapolis, IN 46227
Phone: 317-882-1536
Email: cadsouth@clarkdeanjones.com

You may also file a complaint with:

U.S. Department of Health and Human Services Office for Civil Rights
https://www.hhs.gov/ocr/privacy/hipaa/complaints/

Special Protections

Certain types of information, including HIV-related information, genetic information, mental health records, and substance use treatment records, may be subject to additional confidentiality protections under federal or state law. We will comply with all applicable laws regarding these protections.

This Notice applies to all records of your care maintained by Clark and Associates Dentistry.