Oral Surgery & Implant Specialists

Four Offices Serving the Tri-State Area of lowa, Nebraska & South Dakota
Dr. T.J. Holton, Dr. P.J. Vezeau, Dr. C.E. Norby, Dr. J.S. Dean & Dr. J.E. Dye

Privacy Policy

NOTICE OF PRIVACY PRACTICES for PROTECTED HEALTH INFORMATION

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!

The privacy of your health information is important to us.

We are required by law to maintain the privacy of “protected health information”, to provide you with notice of our legal duties and privacy practices with respect to protected health information, and to notify you following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice, although we reserve the right to change the terms of this privacy notice from time to time and make the revised notice effective for all protected health information we maintain.

You may request a copy of our most current privacy notice from our office.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

We may use and disclose your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services. Some information, such as HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records

Example of uses of your health information for treatment purposes:

We obtain treatment information about you and record it in your health record. During the course of your treatment, the doctor determines a need to consult with another specialist in the area. The doctor will share the information with such specialist and obtain input.

Example of uses of your health information for payment purposes:

We submit a request for payment to your health or dental insurance company. The insurance company requests information from us regarding care given. We will provide information to them about you and the care given. Payment activities also include collections, and determinations of eligibility and coverage to obtain payment from you.

Example of use of your health information for health care operations:

We obtain services from our insurers or other business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such insurers or other business associates as necessary to obtain these services.

DISCLOSURES RELATED TO INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE.

We may disclose your 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, we may disclose information about you to a patient representative. If a person has the authority by law to make health care decisions for you, we will treat that patient represenataive the same way we would treat you with respect to your health information.

OTHER USES AND DISCLOSURES OF PHI

Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or discloser of PHI for marketing, and for sale of PHI. We will also obtain your written authorization before disclosing your PHI for purposes other than those provided in this privacy notice (or as otherwise permitted or required by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.

Your Health Information Rights

Access. You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may obtain a form to request access by using the contact information listed at the end of this privacy notice. 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, on a thumb drive. 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.

Disclosure Accounting. With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with the applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit your request in writing to our office. If you request this accounting more than once in a 12 month period, we may charge you a reasonable, cost-based fee for responding to the additional requests.

Right to Request a Restriction. You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to our office. Your written request must include (1) what information you want to limit, (2) whether you want to limit our use, disclosure or both, and (3) to whom you want the limits to apply. We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care 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.

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 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.

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. If we agree to your request, we will amend your record (s) and notify you of such. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it and explain your rights.

Right to Notification of a Breach. You will receive notifications of breaches of your unsecured protected health information as required by law.

Electronic Notice. You may receive a paper copy of this privacy notice upon request, even if you have agreed to receive it electronically on our Web site or by electronic mail (email).

Questions and Complaints. If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice. 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 with 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 retaliate in any way if you choose to file a complaint with us or the U.S. Department of Health and Human Services. You may contact us in person or in writing during normal hours at Oral Surgery & Implant Specialists, 301 Oak Tree Lane, Dakota Dunes, and SD 57049. We will provide you with assistance on the steps to take to exercise your rights.

You have the right to review this privacy notice before signing the consent authorizing use and disclosure of your protected health information for treatment, payment, and health care operations purposes.

This notice

This notice is effective as of March 23, 2013.

Other Disclosures and Uses

Workers Compensation If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

Public Health Activities. We may disclose your health information for public health activities, including disclosures to:

• Prevent or control disease, injury or disability;

• Report child abuse or neglect;

• Report reactions to medications or problems with products or devices;

• Notify a person of a recall, repair, or replacement of products or devices;

• Notify a person who may have been exposed to a disease or condition; or

• Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Required by Law. We may use or disclose your health information when we are required to do so 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 officials health information required for lawful intelligence, counter intelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient.

Secretary of HHS. We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.

Law Enforcement. We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.

Health Oversight Activities. We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose your PHI 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.

Research. We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

Coroners, Medical Examiners, and Funeral Directors. We may release your PHI 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 PHI to funeral directors consistent with applicable law to enable them to carry out their duties.

Fundraising. We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving the communications.