Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED, DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REIVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH IS IMPORTANT TO US.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect APRIL 14, 2003 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 such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the 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 make the new notice available upon request. You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us at (334)673-7440.

USES AND DISCOLSURES OF HEALTH INFORMATION

We use and disclose health information about you for treatment, payment and healthcare operations. For example:

• Treatment – We may use and/or disclose your health information to a physician or other healthcare provider that will be providing treatment for you.
• Payment – We may use and/or disclose your health information to obtain payment for services provided to you.
• Healthcare Operations – We may use and/or disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performances, conducting training programs, accreditation, certification, licensing or credentialing activities.
• Your Authorization – In addition to our use of your health information for treatment, payment or healthcare operations, you may give us 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.
• 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 treatment and/or care, but only if you agree that we may do so in writing.
• 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 incapacity or an emergency circumstances, we will disclose health information based on a determination using our professional judgement disclosing only health information that is directly relevant to the persons involvement in your healthcare. We will also use our professional judgement and our experience with common practice to make reasonable inferences of your best interest allowing a person to pic lip filled prescriptions, medical supplies, x-rays or other similar forms of health information.
• 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.
• Abuse or Neglect – We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health and safety of others.
• National Security – We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal official’s 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 of protected health information of inmate or patient under certain circumstance.
• Appointment Reminders – We may use or disclose your health information to provide you with an appointment reminder, such as voicemail’s, postcards and/or letters.

QUESTIONS AND COMPLANINTS:

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 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 alterative locations, you may complain to us using the contact 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. 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.

Contact Officer: Geoff M. Gaunt, D.M.D

Telephone: (334)673-7440 | Fax: (334) 673-7528

Email: ggsmiledoc@dothancosmeticdentistry.com

2431 W Main St #401, Dothan, AL 36301