This notices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
The Health lnsurance Portability & Accountabiliy Act of 1996 (HIPAA) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form weather electronically on paper or orally, are Kept properly confidential This act gives you, thc patient, significant new rights to understand and control how your health insurance information is used. "HIPPA" provides penalties for covered entities that misuse personal health information.
As required by "HIPPA", we have prepared this brief explanation of how we are required to maintain the privacy of your health information. and how we may use and disclose such information. We may use and disclose your medical records only for each of the following purpose: Treatment, payment, and health care operations.
Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would teeth cleaning services.
Payments meaning such activities as obtaining reimbursements for services, confirming coverage, billing, or collection activities, and utilization review . An example of this would be sending a bill for your visit to your insurance company for payment.
Health care operations include the business aspects of running our practice, such as conducting quality assesment and improvement activities, auditing functions, cost management analysis, and customer service. An example would be an internal quality assessment. We may also distribute de identified health information by removing all references to individually identifiable information.
Appointment reminders and follow up. We may contact you to provide appointment reminders. information about treatments alternatives. or other health related services or benefits that may be of interest to you.
Business associates We may provide information to out side parties so they can perform certain functions or services on our behalf. Each Business associate must sign a contract with us before we send him or her any information. That contract requires them to protect the confidentiality of your medical information.
Treatment alternatives. We may discuss medical information to tell you about and recommend treatment alternatives that may be of interest to you
Health Related Benefits and services We may use and disclose medical information to tell you about health relatcd benifits or services that may be of interest to you.
We will disclose Medical information about you when required to do so by state, local, or federal Law.
To avert a Serious threat to health or safetyWe may use and disclose information about you when necessary to prevent a serious threat to your health and safety or that of another person.
Organ and Tissue Donation If you are an organ donor or potential recipient, we may release information to organ procurement organization as necessary to facilitate organ transplantation or donation.
Militany and veterans If you are a member of the armed forces, we may release Dental/Medical information about you as required by military command authorities.
Workers Compensation. We may release Dental/Medical information about you for workers compensation or similar programs.
Public Health Risks. We may disclose Dental/Medical information about you for public health activities. These activities may include: the prevention or control of disease, reports of births and deaths, reports of child abuse or neglect notify people of recalls and to report medication reactions.
Health Oversight Activities. We may Disclose Dental/Medical information to health oversight agencies for activities required by law. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial proceedings. We may disclose Dental/Medical information about you in response to a court or administrative order. We may also disclose information about you in response to a subpoena, discovery request, or other lawful process by someone else after reasonable efforts to notify you or obtain a protective order.
Law Enforcement. We may disclose Dental/Medical information if asked to do so by a law enforcement official, to identify or locate a suspect. witness or missing person, or a victim of a crime (with your consent
in certain circumstances), report deaths from criminal conduct, crimes on the premises, or in emergencies to report a crime.
Coroners medical Examiners and Funeral Directors. We may release Dental/Medical information to the aforementioned people in order to identify a deceased person, determine cause of death of as reasonably necessary to carry out their duties.
Inmates If you are an inmate of a correctional insitution. we may release medical information about you to the correctional institution or to law enforcement officials.
YOU HAVE THE FOLLOWING RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Right to inspect and copyYou have the right to inspect and copy Dental/Medical information that may be used to make decisions about your care.
To inspect and copy information that may be used to make decisions about your treatment you must submit a request in writing to Dr. Oksana Elariny DDS, 5508 Seminary Road, Alexandria, VA 22311. If you request a copy we may charge you for copying, mailing, and other supplies used in the reproduction of the requested information. Please note — your request may take 7-10 business days to process.
We may deny your request in certain lunited circumstances. If you are denied access to information you have the right to request that your denial be reviewed. Another licensed health care professional chose by the practice will review the request and denial. We will abide by the outcome of the review.
Right to Amend. lf you feel that Dental/Medical information we have is incorrect or incomplete, you may ask to amend the information. You have the right to request an amendment for as long as your information is kept by the practice. You should contact the office at 610-326-2772 to make an appointment to discuss this process.
Right to an Accounting of Disclosure You have the right to request an accounting of disclosures. This is a list of disclosures of Dental/Medical information about you. You should contact the office at 610-326-2772 to set up a time to discuss these procedures.
Right to request a restriction. You have the right to request restrictions or limitations on the Dental/Medical information that we use or disclose for treatment payment or health care operations. You also have the right to request we limit the amount of information that we disclose about you to someone in your care, like a family member or a friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed in an emergency. You must make your request in writing to Dr. Elariny.
Right to a paper copy of this notice. You have the right to a paper copy of this notice any time. To obtain a copy of this notice ask at the front desk.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for Dental/Medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the office. The notice will contain on the first page, in the top right-hand corner, the effective date.
COMPLAINTS
If you believe your privacy rights hase been violated, you may file a complaint with the Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the Practice officer contact us at 610-326-2772. You will not be penalizcd for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of Dental/Medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission, you many revoke that permission, in writing, at any time. lf you revoke your permission, we will no longer use or disclose Medical/Dental information about you for the reason covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.