THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Palmetto Dental Studio (“the Practice”) maintains Protected Health Information (“PHI”) about you as part of your dental records. PHI includes any information that identifies you and relates to your past, present, or future physical or mental health, the healthcare services you receive, or payment for those services.

We are required by federal law (HIPAA) to maintain the privacy of your PHI, provide you with this Notice of Privacy Practices, and follow the terms of the Notice currently in effect. This Notice describes your rights regarding your PHI and describes how we may use and disclose your information for treatment, payment, healthcare operations, and other purposes permitted or required by law.

Your Rights Under the HIPAA Privacy Rule

You have the following rights regarding your Protected Health Information:

Right to Receive a Copy of This Notice

You have the right to receive, and we are required to provide you with, a copy of this Notice. We may update this Notice at any time. Updated copies will be available at our office and, if applicable, on our website. You may request a printed copy at any visit.

Right to Authorize Uses and Disclosures

Certain uses or disclosures of your PHI require your written authorization. Examples include:

• Uses or disclosures of PHI for marketing

• Most uses or disclosures of psychotherapy notes

• The sale of your PHI

You may revoke any authorization at any time in writing, except to the extent we have already relied on it.

Right to Request Confidential Communications

You may request that we communicate with you in a specific way (e.g., by email or at an alternative address). We will accommodate all reasonable requests. Requests must be submitted to us in writing using a form provided by our office.

Right to Inspect and Obtain Copies of Your PHI

You may review or request a copy of your health record. If maintained electronically, you may request an electronic copy. We may charge a reasonable fee as permitted by state and federal guidelines.

Right to Request Restrictions of PHI

You may request, in writing, that we restrict the use or disclosure of your PHI for treatment, payment, or healthcare operations. While we may deny most requests, we must approve your request to restrict disclosure to a health plan if:

• The PHI relates to a service or treatment you (or someone on your behalf) paid for in full out-of-pocket, and

• The disclosure is for payment or operations by the health plan

Right to Request an Amendment

You may request an amendment to your PHI if you believe it is incomplete or inaccurate. We may deny your request in certain circumstances, but we will inform you of our decision in writing.

Right to an Accounting of Disclosures

You may request a list (“accounting”) of certain disclosures of your PHI made by our practice to persons or entities outside our office.

Right to Notification of a Privacy Breach

You have the right to receive written notification if a breach occurs involving your unsecured PHI and we determine through risk assessment that notification is required.

If you have questions about these rights, you may contact our Privacy Officer (information below).

How We May Use or Disclose Your PHI

The following categories describe different ways we may use or disclose your PHI. These examples are not exhaustive:

Treatment

We may use or disclose your PHI to coordinate or manage your dental care. This may include consultation with other healthcare providers, referrals, pharmacies, or specialists involved in your treatment.

Special Notices

We may use or disclose your PHI to contact you for appointment reminders, follow-up information, or to discuss treatment alternatives or health-related services offered by our office. You may opt out of certain notices in accordance with the instructions provided in each communication.

Payment

We may use or disclose your PHI to obtain payment for services, including determining eligibility, coverage, pre-authorizations, and claims processing with your insurance carrier.

Healthcare Operations

We may use or disclose PHI to support the business operations of our practice, including:

• Quality assessment

• Training staff

• Auditing

• Legal services

• Patient safety activities

• Business management and planning

Health Information Exchanges

We may use health information exchange systems or similar technologies to facilitate secure electronic sharing of PHI for treatment, payment, or healthcare operations.

Individuals Involved in Your Care

Unless you object, we may disclose PHI to family members, friends, or others you identify who are involved in your care. In emergencies or when you are unable to express your preferences, we may disclose information based on our professional judgment.

Other Permitted or Required Uses and Disclosures

We may use or disclose your PHI without your written authorization for:

• Public health activities

• Health oversight activities

• Reporting abuse or neglect

• FDA reporting

• Research (with approved protocols)

• Legal proceedings or law enforcement

• Coroners, medical examiners, or funeral directors

• Organ and tissue donation

• Criminal activity investigations

• Military or national security functions

• Worker’s compensation claims

• Compliance investigations by the Department of Health and Human Services

Privacy Complaints

You have the right to file a complaint if you believe your privacy rights have been violated. Complaints may be submitted to:

Palmetto Dental Studio – Privacy Officer
Address: 7306 W 20th Ave, Hialeah, FL 33016
Phone: +1 786-386-0494
Email: info@thepalmettodental.com

You may also file a complaint directly with the U.S. Department of Health and Human Services.

We will not retaliate against you for filing a complaint.