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Dothan Dentist

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:

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