How to Keep Your Teeth



PRIVACY POLICY

WE VALUE YOUR PRIVACY
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information.  If you have any questions contact us at any time. 
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are in conformance with applicable law. We reserve the right to make the changes in our privacy practices, and new terms of our Notice, effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and will distribute it upon request.
You may request a copy of our Notice at any time.
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, conducting 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 notification 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 absence or incapacity or in emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment 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.
Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization. Required by Law: We may use or disclose your health information when we are required to do so by law.
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 a disease; for health oversight activities; for certain judicial and administrative proceedings; 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 officials health information required for lawful intelligence, counterintelligence, 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 under certain circumstances.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
Patient Rights
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 obtain a form to request access. You may also request access by sending us a letter us. We will charge you a reasonable cost-based fee for the cost of supplies and labor of copying. If you request copies, we may charge you a fee for staff time to copy 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 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 the last six years. If you request this accounting more than once in twelve months 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 healthplan for purposes of carrying out payment or health care 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 satisfactory explanation of how payments will be handled under the alternative means or location of your 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.
CALIFORNIA DISCLOSURES
California law limits disclosure of your medical information in certain ways that would otherwise be permitted under federal law. 
1. AS REQUIRED BY LAW.  We will disclose your information to you or your authorized representative, as required by law, to:
(a) a court pursuant to an order of that court;
(b) a board, commission, or administrative agency for purposes of adjudication pursuant to its lawful authority or an investigative subpoena issued in accordance with State law;
(c) a party to a proceeding before a court or administrative agency pursuant to a subpoena, subpoena duces tecum, or notice to appear served in accordance with State law, or to any provision authorizing discovery;
(d) an arbitrator or arbitration panel, when arbitration is lawfully requested by either party, pursuant to a subpoena duces tecum, issued under State law, or to another provision authorizing discovery;
(e) a governmental law enforcement agency pursuant to a lawfully issued search warrant;
(f) a coroner, when requested in the course of an investigation by the coroner's office for certain specific purposes; and
(g) when otherwise specifically required by law.
2. OTHER PERMITTED USES AND DISCLOSURES. In the situations described below, we will disclose your medical information to:
(a) providers of health care, health care service plans, contractors or other health care professionals or facilities for purposes of diagnosis or treatment;
(b) an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor or any other person or entity responsible for paying for health care services rendered to you to the extent necessary to allow responsibility for payment to be determined and payment to be made.  If you are unable to consent to the disclosure because of a disabling medical condition and no other arrangements have been made to pay for the health care services being rendered to you, the information may also be disclosed to a governmental authority to the extent necessary to determine the your eligibility for, and to obtain, payment under a governmental program for health care services provided to you.  The information may also be disclosed to another provider of health care or health care service plan as necessary to assist the other provider or health care service plan in obtaining payment for health care services rendered by that provider of health care or health care service plan to you;
(c) a person or entity that provides billing, claims management, medical data processing, or other administrative services for providers of health care or health care service plans or for an insurer, employer, health care service plan, hospital service plan, employee benefit plan, governmental authority, contractor or any other person or entity responsible for paying for health care services rendered to you;
(d) organized committees and agents of professional societies or of medical staffs of licensed hospitals, licensed health care service plans, professional standards review organizations, independent medical review organizations and their selected reviewers, utilization and quality control peer review organizations, contractor or persons or organizations insuring, responsible for, or defending professional liability that a provider may incur, if the committees, agents, health care service plans, organizations, reviewers, contractors or persons are engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges;
(e) a provider of health care or health care service plan that has created medical information as a result of employment-related health care services to you as an employee conducted at the specific prior written request and expense of the employer may disclose to your employer that:
(1) is relevant in a law suit, arbitration, grievance, or other claim or challenge to which the employer and you as an employee are parties and in which you have placed in issue your medical history, mental or physical condition, or treatment, provided that information may only be used or disclosed in connection with that proceeding;
(2) describes functional limitations of you that may entitle you to leave from work for medical reasons or limit your fitness to perform your present employment, provided that no statement of medical cause is included in the information disclosed;
(f) a sponsor, insurer, or administrator of a group or individual insured or uninsured plan or policy that you seek coverage by or benefits from, if the information was created by the provider of health care or health care service plan as the result of services conducted at the specific prior written request and expense of the sponsor, insurer, or administrator for the purpose of evaluating the application for coverage or benefits, unless the provider of health care or health care service plan is notified in writing of an agreement by the sponsor, insurer, or administrator to the contrary;
(g) a health care service plan by providers of health care that contract with the health care service plan and may be transferred among providers of health care that contract with the health care service plan, for the purpose of administering the health care service plan;
(h) an insurance institution, agent or support organization of medical information if the insurance institution, agent, or support organization has complied with all requirements for obtaining the information pursuant to the requirements of the California Insurance Code provisions.
(i) an organ procurement organization or a tissue bank processing the tissue of a decedent for transplantation into the body of another person, but only with respect to the donating decedent for the purpose of aiding the transplant;
(j) a third party for purposes of encoding, encrypting, or otherwise anonymizing data;
(k) any entity contracting with a health care service plan or the health care service plan contractors to monitor or administer care of enrollees for a covered benefit, provided that the disease management services and care are authorized by a treating physician or to any disease management organization that complies fully with the physician authorization requirements, provided that the health care service plan or its contractor provides or has provided a description of the disease management services to a treating physician or to the health care service plan.s or contractor network of physicians, for purposes of disease management programs and services; 
(l) an employee welfare benefit plan governed by ERISA to the extent that the employee welfare benefit plan provides medical care, and may also be disclosed to an entity contracting with the employee welfare benefit plan for billing, claims management, medical data processing, or other administrative services related to the provision of medical care to persons enrolled in the employee welfare benefit plan for health care coverage, if all of the following conditions are met:
(1) the disclosure is for the purpose of determining eligibility, coordinating benefits, or allowing the employee welfare benefit plan, or the contracting entity, to advocate on the behalf of a patient or enrollee with a provider, a health care service plan, or a state or federal regulatory agency.
(2) the request for the information is accompanied by a written authorization for the release of the information consistent with CMIA.
(3) the disclosure is authorized by and made in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA).
(4) any information disclosed is not further used or disclosed by the recipient in any way that would directly or indirectly violate this part or the restrictions imposed HIPAA; and
(m) a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating with those entities.
3. DISCLOSURE TO A RELATED PARTY. We will also disclose your medical information to a family member, other relative, domestic partner, or a close personal friend, or any other person identified by you, if you agree or do not object, or we can infer from the circumstances that you do not object, or if you are incapacitated or in an emergency situation, when it is in your best interests.  In such cases, we will only disclose information directly relevant to the person's involvement with care or payment  We will use our professional judgment and experience with common practice to make reasonable inferences of your best interest in allowing a person to act on behalf of the patient to pick up filled prescriptions, medical supplies, or other similar forms of medical information.
4. NO USE FOR SALES OR MARKETING. Unless authorized by you, we will not intentionally share, sell, use for marketing, or otherwise use your medical information for a purpose not necessary to provide health care services to you.
 5. HIV TEST RESULTS. We will not disclose HIV test results or HIV status without your authorization or that of your legal representative, conservator, or other person authorized by law, except as authorized by State law or required by federal law.