NOTICE OF PRIVACY PRACTICES
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
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.
I. APPLICABILITY OF NOTICE
Certain information contained your medical record is referred to as Protected Health Information (“PHI”). PHI may include your name, address, and other identifying data, as well as information about your health and the health services that you may receive or have already received. This Notice describes the privacy practices of Sanitas Dental Management LLC and/or Sanitas Dental of South Florida P.A. (together “Sanitas Dental”) and pertains to all dentists, providers, clinical staff, employees, staff, independent contractors, vendors, volunteers and agents of Sanitas Dental. It applies to all PHI about you that is maintained by Sanitas Dental, including any such information that is maintained on paper, electronically, or verbally spoken. This Notice describes how Sanitas Dental may use and disclose the information that has been collected and what rights you have with respect to your medical information.
II. OUR RESPONSIBILITIES
Sanitas Dental (“we” or “our”) is committed to maintaining the privacy and confidentiality of your health information. We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy and security of your health information. We must follow the duties and privacy practices described in this Notice and give you a copy of it. We will not use or share your information other than as described in this Notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Please let us know in writing if you change your mind.
This Notice informs you how we may use and disclose (share) health information about you for purposes described in this Notice. As required by the HIPAA Privacy Rule, we must establish policies and procedures for safeguarding PHI received, created, transmitted or maintained. You will be asked to sign an acknowledgement that you have received this Notice.
For more information, please visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
III. YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to you.
Get an Electronic or Paper Copy of Your Medical Record. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask Us to Correct Your Medical Record. You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within sixty (60) days.
Request Confidential Communications. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
Ask Us to Limit What We Use or Share. You can ask us not to use or share certain health information for treatment, payment or healthcare operations; we are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer; we will say “yes” unless a law requires us to share that information.
Get a List of Those with Whom We’ve Shared Information. You can ask for a list (an “accounting”) of the times we’ve shared your health information for six (6) years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one (1) accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within twelve (12) months.
Get a Copy of this Privacy Notice. You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you with a paper copy promptly.
Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
File a Complaint if You Feel Your Rights are Violated. You can file a complaint if you feel we have violated your rights by contacting any of the following:
Sanitas Dental
Attention:
Privacy Officer
8400 NW 33rd Street, #201 Doral, FL 33122
Email: patientprivacy@mysanitas.com
www.mysanitas.com/en
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints
We will not retaliate against you for filing a complaint.
IV. YOUR CHOICES
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
You Have Both the Right and Choice to Tell Us to share information with your family, close friends or others involved in your care; share information in a disaster relief situation; or include your information in a hospital directory (if applicable). If you are unable to tell us your preference (ie., you are unconscious), we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
We Never Share Your Information Unless You Give Us Written Permission for marketing purposes; sale of your information; or sharing of psychotherapy notes.
For fundraising we may contact you, but you can tell us not to contact you again.
V. HOW SANITAS DENTAL MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
How Do We Typically Use or Share Your Health Information? We typically use or share your health information in the following ways.
Treatment. We can use your health information and share it with other healthcare professionals who are treating you or involved with your care..
Healthcare Operations. We can use and share your health information to run our organization and improve you care and contact you when necessary.
Payment. We can use and share your health information to bill and get payment from health plans and other entities. We may also tell your health plan about a treatment you are going to receive so we can get prior payment approval or learn if your plan will pay for the treatment
Healthcare Messages (Reminders, Treatment Alternatives and Health-related Benefits and Services). We may use your health information to contact you about an upcoming appointment or medication refill. We may also make your health information available for you to access through a secure online portal. We may contact you by mail, telephone, text or email to inform you.
How Else Can We Use or Share Your Health Information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions under applicable law before we can share your information for these purposes.
For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
Health-Related Services. Only if you opt in we may use and disclose your health information to send you communications about health-related products and services available at Sanitas Dental.
Public Health and Safety Issues. We can share your health information in certain situations such as: preventing disease;; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect or domestic violence; or preventing or reducing a serious threat to anyone’s health or safety.
Research. We can use or share your information for health research.
Required by Law. We will share your health information if required by state or federal laws, including the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Organ and Tissue Donation Requests. We can share your health information with organ procurement organizations.
Medical Examiner or Funeral Director. We can share health information with a coroner, medical examiner or funeral director upon the death of an individual.
Workers’ Compensation, Law Enforcement and Other Government Requests. We can use or share health information about you: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; for special government functions such as military, national security and presidential protective services.
Lawsuits and Legal Actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.
VI. CONTACT US
Medical Records Request. To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without your written authorization (except as permitted by law). To request your health records, you will need to download, complete and sign this medical release form. The form may be accessed by visiting
[Include the applicable URL/LINK]
and it should be sent to: Sanitas Dental Medical Center, Attention:8400 NW 33rd Street, #201 Doral, FL 33122.
Request an Amendment, Accounting of Disclosures, Restrictions, Confidential Communications or a Paper Copy of this Notice. The written request should be sent to 8400 NW 33rd Street, #201 Doral, FL 33122 .
File a Complaint. If you have a question or wish to exercise your rights described in this Notice, please contact the Privacy Officer Email: patientprivacy@mysanitas.com Address: 8400 NW 33rd Street, #201 Doral, FL 33122.
This Revised Notice is effective […]