HIPPA Policy
NOTICE OF PRIVACY PRACTICES
This notice describes how health information about you as a patient may be used and disclosed, and how you can access this information. Please review it carefully. The privacy of your health information is important to us.
OUR LEGAL DUTY
Pure Orthodontics and Dentistry is required by federal and state law to maintain the privacy of your health information. This law also requires us to provide you with this notice regarding our privacy practices, our legal duties, and your rights concerning your health information. We are required to follow the privacy practices described in this notice while it is in effect. This notice takes effect January 1, 2023 and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided that applicable law permits such changes. Any changes will apply to all health information we maintain, including health information we created or received prior to any changes. We will notify you of any significant changes in our privacy practices and make the new notice available to you upon request.
You may request a paper copy of this notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
OUR USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and health care operations. Examples include:
- Treatment: We may use your health information for treatment or disclose it to another dentist, physician, or health care provider who is involved in your treatment.
- Payment: We may use and disclose your health information to obtain payment for services we provide to you. We may also disclose your health information to another health care provider or entity that is subject to the federal Privacy Rules for its payment activities.
- Health Care Operations: We may use and disclose your health information for our health care operations. This includes quality assessment, training programs, and licensing activities. We may also share your health information with other health care providers for their health care operations, such as quality assessment and improvement activities.
Your Authorization
You may provide us with written authorization to use your health information or to disclose it to anyone for any purpose. If you provide us with an authorization, you may revoke it in writing at any time. Your revocation will not affect any uses or disclosures permitted by your authorization while it was in effect.
To Your Family and Friends
We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your health care or payment for your health care. We will give you the opportunity to object to this disclosure unless you are incapacitated or in an emergency situation.
Appointment Reminders
We may use or disclose your health information to remind you of upcoming appointments via phone, postcard, or email.
Public Benefit
We may use or disclose your health information as authorized by law for the following purposes:
- As required by law
- For public health activities, including disease reporting and oversight
- To report abuse, neglect, or domestic violence
- For health oversight activities
- In response to court and administrative orders
- To law enforcement officials for law enforcement purposes
- To coroners, medical examiners, and funeral directors
- To avert a serious threat to health or safety
- In connection with certain research activities
PATIENT RIGHTS
Access
You have the right to view or obtain copies of your health information, with limited exceptions. To access your information, you must submit a written request. We may charge you a reasonable fee for copies and any alternative formats you request.
Disclosure Accounting
You have the right to request an accounting of disclosures of your health information made over the last six years. This does not include disclosures for treatment, payment, or health care operations.
Restriction
You may request additional restrictions on our use or disclosure of your health information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement in writing.
Alternative Communication
You have the right to request that we communicate with you about your health information in alternative ways or at alternative locations. You must specify your request in writing.
Amendment
You have the right to request that we amend your health information. Your request must be in writing and explain the reason for the amendment. We may deny your request under certain circumstances.
QUESTIONS AND COMPLAINTS
If you have questions or concerns about our privacy practices, please contact us using the information listed below.
If you believe that:
- We may have violated your privacy rights,
- We made an incorrect decision regarding access to your health information,
- Our response to a request to amend or restrict your health information was incorrect, or
- We should communicate with you by alternative means or locations,
You may contact us using the information listed below. You may also 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 upon request. We support your right to the privacy of your health information and will not retaliate if you choose to file a complaint.
Contact Information:
Pure Orthodontics and Dentistry
Email: info@puredds.com
Tel: (810) 695-8601
Address: 11620 S Saginaw Street
Grand Blanc, MI 48439