This notice describes how medical information about you may be used and disclosed by Family Dentist of Palm Beach, and how you can get access to this information. Please review it carefully.
With your consent, we are permitted by federal privacy law (HIPAA) to use and disclose your health information for purposes of treatment, payment, and health care operations. Protected health information (PHI) is the information we create and obtain in providing services to you, including your symptoms, examination and test results, diagnoses, and treatment, as well as billing records for those services.
Examples of how we use your information
- Treatment. A staff member records treatment information in your health record. If your case requires a specialist, we share relevant information with them and receive their input.
- Payment. We submit claims to your dental insurance company, which may request information from us about the care provided so it can process payment.
- Health care operations. We use business associates for services such as quality assessment, training, credentialing, and legal or billing review, and we share information with them as necessary to obtain those services.
Your health information rights
Your health and billing records are the physical property of our practice, but the information in them belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your health information, in writing. We are not required to agree, but we will comply with any restriction we grant. If you paid for a service out of pocket in full, we must honor your request not to disclose information about that service to your health plan.
- Inspect and copy your health record and billing record, by written request.
- Appeal a denial of access to your PHI, except in certain circumstances defined by law.
- Request that we amend your record to correct incomplete or incorrect information, by written request.
- File a written statement of disagreement if we deny your amendment request.
- Request an accounting of certain disclosures of your health information, by written request.
- Request that we communicate with you by alternative means or at an alternative location, in writing.
- Opt out of fundraising communications, if applicable.
- Revoke, in writing, any authorization you previously gave us, except to the extent we already acted on it.
To exercise any of these rights, contact our Privacy Officer using the information at the bottom of this notice.
Our responsibilities
We are required to maintain the privacy of your health information as required by law, provide you this notice of our privacy practices, abide by its terms, notify you if we cannot accommodate a requested restriction, accommodate reasonable requests for alternative communication, and notify you if you are affected by a breach of unsecured PHI. We may change our privacy practices; if we do, we will update this notice and post the revised version on our website. You may also request a paper copy at any time by contacting our office.
To request information or file a complaint
If you have questions, would like more information, or want to report a concern about how your information has been handled, contact our Privacy Officer using the information below.
You may also file a written complaint with our office, or file a complaint with the U.S. Department of Health & Human Services:
U.S. Department of Health & Human Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-Free Call Center: 1-877-696-6775
We will not require you to waive your right to file a complaint with HHS as a condition of receiving treatment, and we will not retaliate against you for filing a complaint.
Other disclosures and uses
- Notification. Unless you object, we may notify a family member, personal representative, or another person responsible for your care about your location and general condition.
- Communication with family. Using our best judgment, we may share health information relevant to a family member's or friend's involvement in your care, if you don't object or in an emergency.
- FDA. We may report adverse events or product defects related to your care to the FDA.
- Workers' compensation. We may disclose information as necessary to comply with workers' compensation laws.
- Public health and safety. We may disclose information as required by law to public health authorities, or to report abuse or neglect.
- Law enforcement and legal proceedings. We may disclose information as required by law, court order, or in certain law-enforcement circumstances.
- Health oversight. We may disclose information to health oversight agencies as permitted by law.
- Other uses. Any other use or disclosure will be made only as authorized by law or with your written authorization, which you may revoke at any time going forward.
Contact our Privacy Officer
Family Dentist of Palm Beach
Attn: Privacy Officer
11903 Southern Blvd, Ste 116
Royal Palm Beach, FL 33411
Phone: (561) 795-7668
Email: info@familydentistpalmbeach.com