Privacy Policy

This notice 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 privacy of your medical information is important to us.

CONTACT INFORMATION

For more information about our privacy practices, to discuss questions or concerns, or to get additional copies of this notice, please contact our Privacy Officer.
Telephone: (740) 938-4008
Address: 4290 Home Rd, Suite C & D
Powell, Ohio 43065

OUR LEGAL DUTY

We are required by law to protect the privacy of your protected health information (“medical information”). We are also required to send you this notice about our privacy practices, our legal duties and your rights concerning your medical information.

We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect on the date set forth at the top of this page and will remain in effect unless we replace it. We reserve the right at any time 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 any change in our privacy practices and the new terms of our notice applicable to all medical information we maintain, including medical information we created or received before we made the change in practices.

We may amend the terms of this notice at any time. If we make a material change to our policy practices, we will provide to you the revised notice. Any revised notice will be effective for all health information we maintain. The effective date of a revised notice will be noted. A copy of the current notice in effect will be available in our facility and on our website. You may request a copy of the current notice at any time.

We collect and maintain oral, written, and electronic information to administer our business and to provide products, services, and information of importance to our patients. We maintain physical, electronic, and procedural safeguards in the handling and maintenance of our patients’ medical information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction, and misuse.

USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION

Treatment:

We may disclose your medical information, without your prior approval, to another dentist or healthcare provider working in our facility or otherwise providing you treatment for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, your health information may be disclosed to an oral surgeon to determine whether surgical intervention is needed.

Payment:

We provide dental services. Your medical information may be used to seek payment from your insurance plan or from you. For example, your insurance plan may request and receive information on dates that you received services at our facility in order to allow your employer to verify and process your insurance claim.

Health Care Operations:

We may use and disclose your medical information, without your prior approval, for health care operations. Health care operations include:

•  healthcare quality assessment and improvement activities;

• reviewing and evaluating dental care provider performance, qualifications and competence, health care training programs, provider accreditation, certification, licensing and credentialing activities

• conducting or arranging for medical reviews, audits and legal services, including fraud and abuse detection and prevention; and

• business planning, development, management and general administration including customer service, complaint resolutions and billing, de-identifying medical information, and creating limited data sets for health care operations, public health activities and research.

We may disclose your medical information to another dental or medical provider or to your health plan subject to federal privacy protection laws, as long as the provider or plan has had a relationship with you and the medical information is for that provider’s or health plan’s care quality assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection and prevention.

Your Authorization:

You (or your legal personal representative) may give us written authorization to use your medical information or to disclose it to anyone for any purpose. Once you give us authorization to release your medical information, we cannot guarantee that the person to whom the information is provided will not disclose that information. You may revoke your authorization at any time, except where we have already relied on it. We will obtain your authorization prior to using your medical information for marketing, fundraising purposes, or for commercial use. Once authorized, you may opt out of these communications at any time.

Family, Friends, and Others Involved in Your Care:

We may disclose your medical information to a family member, friend, or other person involved in your care or payment for care. We will disclose only information relevant to that person’s involvement.

Health-Related Products and Services:

We may use your medical information to communicate with you about health-related products, benefits, services, payment, or treatment alternatives.

Reminders:

We may use or disclose medical information to send appointment reminders via U.S. Mail, email, or telephone. By providing your email address, you agree that reminders and breach notifications may be sent electronically. It is our policy to leave voicemail messages unless you request otherwise.

Public Health and Benefit Activities:

We may disclose medical information as required or authorized by law for public health, oversight activities, research, legal proceedings, law enforcement, national security, correctional institutions, workers’ compensation, and other lawful purposes.

Substance Use Disorder Records (SUD):

Records related to the diagnosis, treatment, or referral for treatment of a Substance Use Disorder are protected under federal law (42 CFR Part 2) and Ohio law. These records may not be disclosed without your written consent or a court order, except as otherwise permitted by law. Any disclosure made with your consent must be accompanied by a statement prohibiting redisclosure.

Additional Restrictions on Use and Disclosure:

Ohio law provides additional privacy protection for certain types of health information. In accordance with Ohio Revised Code and applicable federal law, we will not disclose information related to mental health treatment, HIV/AIDS status, substance use disorder treatment, genetic testing, or sexually transmitted diseases without your written authorization unless otherwise permitted or required by law.

Business Associates:

We may disclose information to business associates who perform services on our behalf and who are contractually required to protect your information.

Data Breach Notification:

In the event of a breach of unsecured protected health information, we will notify affected individuals in accordance with federal HIPAA regulations and Ohio law, without unreasonable delay and no later than required by law.

YOUR RIGHTS

You have the right to:

1. Inspect and obtain a copy of your health records
2. Request amendments to your health information
3. Receive an accounting of disclosures
4. Receive this Notice of Privacy Practices
5. Authorize or refuse certain uses, including marketing
6. Request confidential communications
7. Restrict disclosures
8. Submit amendment requests in writing
9. File complaints without retaliation, including with:

• Our Privacy Officer
• Ohio Attorney General’s Office
• U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, SW, Room 509F, Washington, DC 20201, 1-800-368-1019

10. Minors’ Records: Parents or legal guardians generally have the right to access a minor patient’s health information. However, Ohio law may restrict parental access for certain services when a minor is legally permitted to consent to treatment.

COMPLAINTS

If you believe your privacy rights have been violated, you may contact our Privacy Officer or file a complaint with the Ohio Attorney General’s Office or the U.S. Department of Health and Human Services.