Notice of Privacy Practices
This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. Effective Date: October 2013
New River Valley Dental staff follows the privacy practices described in this Notice. New River Valley Dental maintains your dental health information in records that are kept in a confidential manner, as required by law. New River Valley Dental must use and disclose or share your health information as necessary for treatment, payment, and health care operations to provide you with quality health care.
What Are Treatment, Payment, and Health Care Operations?
Treatment includes sharing information among health care providers involved in your care. For example, your health care provider may share information about your condition with the pharmacist to discuss medications, or with dental specialists or other consultants to make a diagnosis. New River Valley Dental may use your health information as required by your dental or medical insurer to obtain payment for your treatment.
How Will New River Valley Dental Use and Disclose My Health Information? Note: You will have the opportunity to refuse some of these communications about your health information, indicated by (*).
Your health information may be used for the following purposes unless you ask for restrictions on a specific use or disclosure:
Your Authorization Is Required for Other Disclosures
- Family members or close friends involved in your care or payment for treatment. *
- To refer to specialists.
- To inform you of treatment alternatives or benefits or services related to your health. *
- Appointment reminders.
- Send x-rays by email.
- Public health activities, including disease prevention, injury or disability; reporting births and deaths; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect, or domestic violence.
- Health oversight activities, such as audits, inspections, investigations, and licensure.
- Law enforcement.
- Certain research projects.
- To prevent a serious threat to health or safety.
- To military command authorities if you are a member of the armed forces or a member of a foreign military authority.
- National security and intelligence activities to authorized persons to conduct special investigations.
- Workers’ Compensation. Your medical information regarding benefits for work-related injuries and illnesses may be released as appropriate.
- Alcohol and drug abuse information has special privacy protections. New River Valley Dental will not disclose any information identifying an individual as being a patient or provide any health information relating to the patient’s substance abuse treatment unless the patient consents in writing; to carry out treatment, payment, and operations; or as required by law.
- To carry out health care treatment, payment, and operations functions through business associates, such as to install a new computer system.
. Except as described above, we will not use or disclose your medical information, unless you allow New River Valley Dental in writing to do so. For example, we will not use your photographs for presentations outside New River Valley Dental without your written permission. You may withdraw or revoke your permission, which will be effective only after the date of your written withdrawal.
You Have Rights Regarding Your Health Information
. You have the following rights regarding your health information, if requested on the form(s) provided by New River Valley Dental:
Requirements Regarding This Notice
- Right to request restriction. You may request limitations on your health information that we use or disclose for health care treatment, payment, or operations, although we are not required to comply with your request. For example, you may ask us not to disclose that you have had a particular procedure. We will release the information if necessary for emergency treatment.
- Right to confidential communications. You may request communications of your health information in a certain way or at a certain location, but you must tell us how or where you wish to be contacted.
- Right to inspect and copy. You have the right to review and obtain a copy of your medical or health record. We may charge a fee for copying, mailing, and supplies. Under limited circumstances, your request may be denied; you may request review of the denial by another licensed health care professional chosen by New River Valley Dental. New River Valley Dental will comply with the outcome of the review.
- Right to request amendment. If you believe that the health information we have about you is incorrect or incomplete, you may request an amendment on the form provided by New River Valley Dental. New River Valley Dental is not required to accept the amendment.
- Right to accounting of disclosures. You may request a list of the disclosures of your health information that have been made to persons or entities for disclosures unrelated to health care treatment, payment, or operations within the past six (6) years, but not prior to April 14, 2003. After the first request, there may be a charge.
- Right to a copy of this Notice. You may request a paper copy of this Notice at any time, even if you have been provided with an electronic copy.
. New River Valley Dental is required to post this notice, may change this Notice, and these changes will be effective for health information we have about you, as well as New River Valley Dental any information we receive in the future. Each time you register at New River Valley Dental for dental services, you may receive a copy of the Notice in effect at the time.
If you believe your privacy rights have been violated, you may file a complaint with the privacy officer at New River Valley Dental or the Secretary of the United States Department of Health and Human Services. We will not penalize or retaliate against you in any way for making a complaint to the Department of Health and Human Services.
Contact New River Valley Dental’s privacy officer at 540-951-2260 if:
- You have any questions about this Notice;
- You wish to request restrictions on uses and disclosures for health care treatment, payment, or operations; or
- You wish to obtain a form to exercise your individual rights described in paragraph 5.