•   Make sure that medical/dental information that identifies you is kept private;

•   Give you this notice of our legal duties and privacy practices with respect to medical/dental       information about you; and   

•   Follow the terms of notice that are currently in effect.

How We May Use & Disclose  Medical /Dental Information About You

The following categories describe different ways that we use and disclose your medical/dental information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment:

We may use medical/dental information about you to provide you with medical/dental treatment or services. We may disclose medical/dental information about you to doctors, dentists, hygienists, dental assistants, nurses, technicians, medical/dental students, allied health students, or other personnel who are involved in taking care of you. We also may disclose medical/dental information about you to people outside the practice who may be involved in your medical care or others we use to provide services that are part of your care, i.e. dental labs.

For Payment:

We may use and disclose medical/dental information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health/dental plan information about a service you received so your dental or health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

We may use and disclose medical/dental information about you for practice operations. These uses and disclosures are necessary to run the practice and make sure that all of our patients receive quality care. For example, we may use medical/dental information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical/dental information about many practice patients to decide what additional services the practice should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to dentists, medical doctors, nurses, technicians, medical students, allied health students, and other personnel for review and learning purposes. We may also combine the medical information we have with medical information from other practices to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

Appointment Reminders:

We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment of medical/dental care. We may also use a patient sign in sheet at the reception area, which identifies only that you have an appointment with our practice.

Treatment Alternatives:

We may use and disclose medical/dental information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care:

We may release medical/dental information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

Research:

Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the dental health and progress of all patients who received one medication to those who received another, for the same condition. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care in the practice.

As Required by law

We will disclose medical/dental information about you when required to do so by federal, state or local law.

To Avert a Serious Treat to Health or Safety:

We may use and disclose medical/dental information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

Organ and Tissue Donation:

If you are an organ donor, we may release medical/dental information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans:

If you are a member of the armed forces, we may release medical/dental information about you as required by military command authorities. We may also release medical/dental information about foreign military personnel to the appropriate foreign military authority.

Workers Compensation:

We may release medical/dental information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks:

We may disclose medical/dental information about you for public health activities. These activities generally include the following:

• To prevent or control disease, injury or disability;

• To report births and deaths;

• To report child or adult abuse, neglect or exploitation;

• To report reactions to medications or problems with products;

• To notify people of recalls of products they may be using;

• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities:

We may disclose medical/dental information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Law Suites & Disputes:

If you are involved in a lawsuit or a dispute, we may disclose medical/dental information about you in response to a court or administrative order. We may also disclose medical/dental information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement:

We may release medical/dental information if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons or similar process;

• To identify or locate a suspect, fugitive, material witness, or missing person;

• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

• About a death we believe may be the result of criminal conduct;

• About criminal conduct at the practice; and

• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

We may release medical/dental information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical/dental information about patients of the hospital to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities:We may release medical/dental information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical/dental information about patients of the hospital to funeral directors as necessary to carry out their duties.

Protective Services for the President and Others:

We may disclose medical/dental information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Your Rights Regarding Medical Information About You

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy:

You have the right to inspect and copy medical/dental information that may be used to make decisions about your care. Usually, this includes medical/dental and billing records.

To inspect and copy medical/dental information that may be used to make decisions about you, you must submit your request in writing to the office manager. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend:

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the practice.

To request an amendment, your request must be made in writing and submitted to the office manager. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

• Is not part of the medical information kept by or for the practice;

• Is not part of the information which you would be permitted to inspect and copy; or

• Is accurate and complete.

Right to Request Restrictions:

You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to the practice’s office manager. Your request must state a time period that may not be longer than six years and may not include dates before February 26, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). You are entitled to one accounting of disclosure without charge. We may charge you for the costs of providing subsequent lists. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

We are not required to agree to your request.

If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to the office manager.  In your request, you must  tell us(1) what information you want to limit: (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to you spouse.

Right to Request Confidential Communications:

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the practice’s office manager. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

To obtain a paper copy of this notice, ask the receptionist.

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical/dental 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 practice. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at the practice for treatment or health care services, you may review a copy of the current notice in effect.

If you believe your privacy rights have been violated, you may file a complaint with the practice (via the office manager) or with the Secretary of the Department of Health and Human Services. To file a complaint with the practice, contact the office manager at (586)977-8413. All complaints must be submitted in writing.

Other uses and disclosures of 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 to use or disclose medical/dental information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical/dental inform about you for the reasons 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.