THIS STATEMENT OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ CAREFULLY
Roots Dental collects and maintains a record of the health care services we provide you. In keeping with the Health Insurance Portability and Accountability Act (HIPAA), and the State of WA, we are dedicated to protecting your rights of privacy and the confidential information entrusted to us.
The commitment of each employee to ensure that your health information is never compromised is a principal concept of our practice. We will not disclose your protected health information unless you direct or authorize us to do so or unless it is otherwise allowed or compelled by law. We may, from time to time, amend our privacy policies and practices but will always inform you of any changes that might affect your rights.
You may see your record or get more information about it at "Your Individual Rights about Patient Health Information" section of the Notice. You may request to review and copy your personal record and you may also request that we make corrections to the record.
Our Statement of Privacy Practices is currently in effect and provides information about the use and disclosure of protected health information by Roots Dental and our employees. It is applicable in all instances wherein individually identifiable health information is collected from you and services are provided for you. Our Statement:
In synopsis form, you have a right to:
It is important that you know not only that we limit requests for your personal information to that needed to provide quality health care, implement payment activities, and conduct normal health practice operations, but understand what "Protected Healthcare Information" is. This may include your name, address, telephone number(s), Social Security Number, employment data, medical history, health records, and/or any personal information that is unique to you.
While most of the information will be collected from you, we may obtain information from third parties if it is deemed necessary. Regardless of the source, your personal information will always be protected
to the full extent of the law.
We use and disclose the information we collect from you only as allowed by the HIPAA and the state of WA. This includes when it is used and disclosed to perform treatment, obtain payment, and conduct operational activities. Your personal health information will never be otherwise given to anyone - even family members - without your written consent. You, of course, may give written authorization for us to disclose your information to anyone you choose, for any purpose.
Our Statement of Privacy Practices applies to all personal health information collected or created by Roots Dental or received from outside healthcare providers. This information may identify you, relate to your past, present or future physical or mental condition, the care provided, or any reference to payment for your health care.
For example, protected health information includes symptoms, test results, diagnoses, health information from other providers, as well as billing and payment information relating to these services. This information is protected because it is often part of your health or medical record, which we can use as:
As stated above we may, under allowed circumstances use and disclose protected health information (PHI) without your specific authorization. Examples of such instances are included below:
Treatment: We may use and disclose your PHI to provide treatment. For example, we can:
Payment: We may use your health information for payment purposes. Such instances may include:
Health Care Operations: We may use and disclose your health information to support the daily activities related to health care. Examples include:
Train Staff and Students: We may use and disclose your information to teach and train staff how to review patient health information.
Contact You for Information: Your PHI may also be used to contact you. In example, we may call you or send you a letter to remind you about your appointment, provide test results, inform you about treatment options, or advise you about other health-related benefits and services.
Business Associates. Your PHI may be used by the Roots Dental and disclosed to individuals, organizations, or companies that us or to comply with our legal obligations as described in this Notice. An example is disclosure of your PHI to consultants, attorneys or third parties to assist in our business activities. All such entities must sign a Business Associate Agreement to protect the confidentiality of your private information.
We also use and disclose your information to enhance health care services, protect patient safety, safeguard public health, ensure that our facilities and staff comply with government and accreditation standards, and when otherwise compelled or allowed by law. For example, we provide or disclose information:
YOUR RIGHTS TO OBJECT
Disclosure to Family, Friends. or Others. You may object to our disclosing your general health condition ("good", "fair", "critical", etc.) to an individual, or individuals, you have identified who have an active interest in your care, payment for your health care, or who may need to notify others about your general condition, location, or death. If you do not so indicate, we will use our best professional judgment to provide relevant protected health information to your family member, friend, or another identified person.
Other than the uses and disclosures described above, we will not use or disclose your protected health information without your written authorization. You may revoke your written authorization, at any time unless prohibited by law, or disclosure is required for us to obtain payment for services already provided, or we have otherwise relied on the authorization.
Special state and federal laws apply to certain classes of patient halth iformation. For example, additional protections may apply to information about sexually transmitted diseases, drug and alcohol abuse treatment records, mental health records, and HIV/AIDS information. When required by law, we will obtain your authorization before releasing this type of information.
You may contact Roots Dental to exercise your rights related to the use and disclosure of your protected health information. You may contact us at:
2201 James St
Bellingham, WA 98225
Attn: Dr. Clarkman
Your specific rights are listed include:
You may also contact:
U.S. Department of Health and Human Services, Office for Civil Rights:
2201 Sixth Avenue -Mail Stop RX-11
Seattle, WA 98121-1831
206-615-2290; 206-615-2296 (TTY)
Toll free: 1-800-362-1710; 1-800-537-7697 (TTY)
If it is found that your patient information is used or disclosed in a manner that is not consistent with the practices described in this notice, Roots Dental will fully investigate the matter to assess if there was a breach in the protection of your PPE. The assessment will be conducted to determine whether the information that was used or disclosed has significant risk of physical, financial, or reputational harm to you. If so, Roots Dental will notify you and Health and Human Services in writing.
We are required by law to protect the privacy of your information, to provide this Statement of Privacy Practices and to follow the privacy practices that are described herein. We reserve the right to change the privacy practices described and the right to make the revised or changed Statement effective for protected health information we already have as well as any information we may receive in the future.
We have posted a copy of our current Statement for your review and reference. Additionally, each time you visit our office for treatment or health care services, you may request a copy of our current Statement of Privacy Practices. An electronic version of the notice is posted at our website.