Greenbrier Dental Center
1059 Eden Way North
Chesapeake, VA 23320
Phone: (757) 547-2266
Fax: (757) 547-1374
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Our Legal Duty
The Health Insurance and Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical and dental records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are properly kept confidential. HIPAA gives you, the patient, significant rights to understand and control how your health information is used.
HIPAA provides penalties for covered entities, including our Practice, that misuse protected health information (PHI). PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required by law to maintain the privacy of your PHI and to provide you with this notice of our legal duties and privacy practices regarding your PHI. We also have legal obligations to notify you in the event of a breach of unsecured PHI.
This Notice of Privacy Practices describes how we may use and disclose your PHI for treatment, payment, healthcare operations, and for other purposes permitted or required by law. It also describes your rights to access and control your PHI.
This Notice takes effect on September 23, 2013 and remains in effect until replaced.
We reserve the right to change our privacy practices and this Notice at any time as permitted by law. Updated versions may be posted on our website, mailed to you, or provided during your next appointment.
You may request a copy of our current Notice of Privacy Practices at any time by contacting our office.
How We May Use and Disclose Your Protected Health Information
Treatment
We may use or disclose your PHI to personnel in our office and to physicians or other healthcare professionals involved in your care. This includes consultations, referrals, and coordination of treatment. Authorization is required before sharing your PHI with providers not currently involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services we provide. If you pay in full for a service yourself, you may request that we not disclose information related to that service to your health insurance plan.
Healthcare Operations
We may use and disclose your PHI to support our healthcare operations, including quality improvement, staff training, accreditation, credentialing, licensing, and evaluating provider performance.
Appointment Reminders and Other Contacts
We may use your PHI to leave phone messages, send appointment reminders, postcards, letters, or communicate treatment alternatives and health-related services that may interest you.
Business Associates
We may disclose PHI to business associates who perform services on our behalf, such as billing companies or contracted healthcare professionals. They are required to protect the privacy of your information.
Family, Friends, and Representatives
We may disclose PHI to family members, close friends, personal representatives, or others involved in your care when appropriate or as permitted by law.
Abuse or Neglect
We may disclose your PHI to appropriate authorities if we reasonably believe you are a victim of abuse, neglect, domestic violence, or another crime, or when necessary to prevent a serious threat to health or safety.
Coroners, Medical Examiners, and Funeral Directors
We may disclose PHI as necessary to coroners, medical examiners, or funeral directors to carry out their duties.
National Security
Under certain circumstances, we may disclose PHI to military authorities, authorized federal officials, correctional institutions, or law enforcement as required by law.
Fundraising
We may contact you regarding fundraising activities. You have the right to opt out of receiving these communications.
Data Breach Notification
We may use or disclose your PHI as necessary to provide legally required notifications regarding unauthorized access to or disclosure of your PHI.
Required by Law
We may use or disclose your PHI whenever required by federal or state law, including court orders, mandatory reporting, government investigations, and compliance with HIPAA and HITECH regulations.
Additional Authorizations
Marketing Uses
We may only use or disclose your PHI for marketing purposes with your written authorization. You may revoke your authorization at any time.
Sale of Information
We will not sell your PHI without your written authorization. You may revoke your authorization at any time.
Other Authorized Disclosures
You may authorize us in writing to use or disclose your PHI for any purpose. You may revoke that authorization at any time. If psychotherapy notes are maintained, they will only be released when authorized or required by law. We also comply with the Genetic Information Nondiscrimination Act (GINA).
Patient Rights
Access
You have the right to inspect, receive copies of, or request electronic access to your PHI. Requests must be made in writing. Reasonable fees may apply.
Notification of a Breach
You have the right to be notified if your unsecured PHI is involved in a data breach.
Disclosure Accounting
You may request a list of certain disclosures of your PHI made during the previous three years. Additional requests within a twelve-month period may incur a reasonable fee.
Restrictions
You may request restrictions on how your PHI is used or disclosed. While we are not always required to agree, we will honor approved requests except in emergencies.
Confidential Communications
You may request that we communicate with you through alternative methods or at alternative locations.
Amendments
You may request corrections to your PHI in writing. We may deny requests under certain circumstances.
Electronic Notice
If you receive this Notice electronically, you may request a printed copy at any time.
Questions and Complaints
If you believe your privacy rights have been violated or disagree with a decision regarding your PHI, you may contact our office.
You may also file a complaint with the U.S. Department of Health and Human Services. We will provide contact information upon request.
We support your right to privacy and will never retaliate against you for filing a complaint.
Contact Information
Privacy Contact Officers
Kelly D.
Tricia R.
Dana B.
Lindsay P.
Jackie H.
Address
1059 Eden Way North
Chesapeake, VA 23320
Phone
(757) 547-2266
Fax
(757) 547-1374
Notice of Material Changes
Effective: September 23, 2013
The Practice has updated its privacy practices to comply with changes to HIPAA and the Health Information Technology for Economic and Clinical Health Act (HITECH).
Summary of changes includes:
- Marketing uses and sales of PHI require your authorization.
- Updated Patient Release of Records Authorization forms.
- Patients may opt out of fundraising communications.
- Psychotherapy notes require separate authorization when applicable.
- Patients who pay in full may request restrictions on disclosures to their health plan.
- Updated procedures for reporting breaches of unsecured PHI.
- Compliance with the Genetic Information Nondiscrimination Act (GINA).
For additional information regarding our privacy practices, please contact our office using the information listed above.