Our responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will notify affected individuals when required following a breach of unsecured protected health information.
- We must follow the privacy practices described in the notice currently in effect.
- We will provide a paper copy of this notice upon request, even if you agreed to receive it electronically.
How we may use and disclose health information
Treatment
We may use or disclose your health information to dentists, physicians, specialists, laboratories, pharmacies, dental professionals, and others involved in providing or coordinating your care.
Payment
We may use and disclose health information to bill and collect payment, confirm eligibility or benefits, request preauthorization, coordinate benefits, and communicate with dental or medical plans and other responsible payers.
Health care operations
We may use and disclose health information for quality improvement, staff training, credentialing, licensing, auditing, legal services, business planning, patient service, and other activities necessary to operate the practice.
People involved in your care
When appropriate, we may share information relevant to your care or payment with a family member, friend, personal representative, or another person involved in your care. We will follow your stated preferences when we can. In an emergency or when you are unable to tell us your preference, we may act in your best interest as permitted by law.
Appointment and patient-service communications
We may contact you about appointments, treatment, care coordination, benefits reviews, and health-related services. You may ask us to use a particular address, telephone number, or other reasonable communication method. Text and ordinary email may carry privacy risks; you may request an alternative method.
Other uses permitted or required by law
As permitted or required by law, we may use or disclose health information for public health and safety activities, reporting abuse or neglect, health oversight, judicial or administrative proceedings, law-enforcement purposes, workers’ compensation, organ and tissue donation, research meeting legal requirements, medical examiners and funeral directors, correctional institutions, military and veterans’ activities, national security, disaster relief, and to prevent or reduce a serious threat to health or safety.
Uses requiring your authorization
Uses and disclosures not described in this notice will be made only with your written authorization when required. Most uses of psychotherapy notes, most uses for marketing, and a sale of protected health information require authorization, subject to exceptions under law. You may revoke an authorization in writing at any time; revocation does not affect action already taken in reliance on it.
Your rights
Receive a copy of your record
You may ask to inspect or receive an electronic or paper copy of health and billing records we maintain about you, subject to limited exceptions. We may charge a reasonable, cost-based fee as permitted by law.
Request a correction
You may ask us in writing to correct health information you believe is incorrect or incomplete. We may deny the request in certain circumstances and will explain a denial in writing.
Request confidential communications
You may ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests as required by law.
Request restrictions
You may ask us not to use or disclose certain information for treatment, payment, or operations. We are generally not required to agree. If you pay in full out of pocket for a service and ask us not to disclose information about that service to a health plan for payment or operations, we will honor the request unless disclosure is required by law.
Receive an accounting of disclosures
You may request a list of certain disclosures made during the six years before your request. The accounting does not include every disclosure, such as many disclosures for treatment, payment, or health care operations. One accounting in a 12-month period is provided without charge; a reasonable fee may apply to additional requests.
Choose someone to act for you
If you have given someone medical power of attorney or the person is your legal guardian or personal representative, that person may exercise your rights when their authority has been verified.
Receive this notice
You may request a paper copy at any time. The notice is also available on this website.
Changes to this notice
We may change this notice and make the revised notice effective for health information we already maintain as well as information received in the future. A current copy will be available at the office and on this website.
Questions or complaints
Contact Asana Dental’s Privacy Officer if you have questions, want to exercise a right, or believe your privacy rights were violated:
Asana Dental
Attn: Privacy Officer
12000 US Highway 380, Suite 114
Cross Roads, TX 76227
940-365-3333
info@asanadental.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights through its HIPAA complaint process. We will not retaliate against you for filing a complaint.