NOTICE OF PRIVACY PRACTICES
This Notice of Privacy Practices describes how dental information about you may be disclosed and how you can get access to this information. Please read carefully.
The Smile Space collects and maintains a record of the health care services we provide you. In keeping with the Health Insurance Portability and Accountability Act (HIPAA), and the State of Washington, we are dedicated to protecting your rights of privacy and the confidential information entrusted to us.
The commitment of each employee to ensure that your health information is never compromised is a principal concept of our practice. We will not disclose your protected health information unless you direct or authorize us to do so or unless it is otherwise allowed or compelled by law. We may, from time to time, amend our privacy policies and practices but will always inform you of any changes that might affect your rights.
You may see your record or get more information about it at “Your Individual Rights about Patient Health Information” section of the Notice. You may request to review and copy your personal record and you may also request that we make corrections to the record.
OVERVIEW
Our Notice of Privacy Practices is currently in effect and provides information about the use and disclosure of protected health information by The Smile Space and our employees. It is applicable in all instances wherein individually identifiable health information is collected from you and services are provided for you.
Our Notice:
Defines your rights and our obligations when using your health information
Informs you about laws that provide special protections
Explains how your protected health information is used and how, under certain circumstances, it may be disclosed
Tells you how changes in this Notice will be made available to you
In synopsis form, you have a right to:
Request restricted use of your health information (please understand that we may not agree to your request)
Request that we not disclose to your health plan services for which you self-pay in full
Request that we communicate with you by alternate methods
Review and receive copies of your personal health record
Request amendments and/or changes be made to your record
Request an accounting of disclosures of your health information
File complaints related to failure to protect the privacy of your health information
Direct us not to share information with your family members
Request that you not be listed in/on our facility directory
PROTECTED HEALTHCARE INFORMATION
It is important that you know not only that we limit requests for your personal information to that needed to provide quality health care, implement payment activities, and conduct normal health practice operations, but understand what “Protected Healthcare Information” is.
This may include your name, address, telephone number(s), Social Security number, employment data, dental history, health records, and/or any personal information that is unique to you.
While most of the information will be collected from you, we may obtain information from third parties if it is deemed necessary. Regardless of the source, your personal information will always be protected to the full extent of the law.
PROTECTING YOUR PERSONAL HEALTHCARE INFORMATION
We use and disclose the information we collect from you only as allowed by HIPAA and the State of Washington. This includes when it is used and disclosed to perform treatment, obtain payment, and conduct operational activities. Your personal health information will never be otherwise given to anyone — even family members — without your written consent, unless permitted or required by law.
You may give written authorization for us to disclose your information to anyone you choose, for any purpose.
Our Notice of Privacy Practices applies to all personal health information collected or created by The Smile Space or received from outside healthcare providers. This information may identify you, relate to your past, present or future physical or mental condition, the care provided, or any reference to payment for your health care.
For example, protected health information includes symptoms, test results, diagnoses, health information from other providers, as well as billing and payment information relating to these services. This information is protected because it is often part of your health or dental record, which we can use as:
A method of communication among health professionals who contribute to your care
A legal record describing the care you received
A means by which you can verify that services billed were provided
A tool to educate health professionals
A source of data for dental research
A source of information for public health officials
A source of information for facility planning
A tool to assess and improve the care we provide
A method by which we can provide a better understanding of your record
A method by which we can ensure your record’s accuracy
A system to assist you to more clearly understand the circumstances and conditions in which others may have access to your personal information
A tool for us to make more informed decisions when authorizing disclosures to others
USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
As stated above, we may, under allowed circumstances, use and disclose protected health information (PHI) without your specific authorization.
Treatment
We may use and disclose your PHI to provide treatment. For example, we can:
Use your information to determine appropriate tests, therapies, or treatment
Provide your information to staff members to better understand your healthcare needs
Disclose your PHI to another provider involved in your care
Payment
We may use your health information for payment purposes, including:
Preparation of claims
Billing insurance
Collection activities
Health Care Operations
We may use and disclose your health information to support daily health care operations such as quality improvement, administrative review, and compliance activities.
Train Staff and Students
We may use and disclose your information to teach and train staff how to review patient health information.
Contact You for Information
We may contact you regarding appointments, test results, treatment options, or health-related services.
Business Associates
Your PHI may be disclosed to individuals or organizations assisting in business activities. All must sign agreements to protect your information.
ADDITIONAL USES AND DISCLOSURES
We also use and disclose your information to enhance health care services, protect patient safety, safeguard public health, ensure compliance with government standards, and when otherwise compelled or allowed by law.
We may disclose information:
To the FDA regarding regulated products
To government oversight agencies
To public health authorities
To employers for work-related evaluations
To workers’ compensation programs
To report abuse or neglect
To prevent serious threats to health or safety
To organ procurement organizations
To law enforcement
For court orders or subpoenas
To coroners or medical examiners
For national security functions
To the U.S. Department of Health and Human Services
For military command authorities when applicable
SPECIAL FEDERAL PRIVACY PROTECTIONS
Reproductive Health Care Information
Federal law provides special protections for protected health information related to lawful reproductive health care.
We are prohibited from using or disclosing such information to investigate or impose liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive health care, or to identify any person for such purposes.
When certain requests are made for reproductive health information, we may be required to obtain a signed attestation confirming the request is not for a prohibited purpose before disclosure. We will refuse disclosures prohibited by federal law.
Substance Use Disorder Treatment Records (42 CFR Part 2)
Federal law provides heightened confidentiality protections for certain records from federally assisted substance use disorder treatment programs (“Part 2 Programs”).
If we receive or maintain Part 2 records:
• Information disclosed under general consent may be used for treatment, payment, or healthcare operations
• Information disclosed under specific consent will be used only as authorized
• Records may not be used or disclosed in legal proceedings without specific consent or a qualifying court order
These protections are stricter than standard HIPAA rules.
YOUR RIGHTS TO OBJECT
Disclosure to Family, Friends, or Others: You may object to our disclosing your general health condition to individuals involved in your care or payment. If you do not indicate your preference, we may use professional judgment to share relevant information.
USE AND DISCLOSURE REQUIRING YOUR AUTHORIZATION
Other than the uses described in this Notice, we will not use or disclose your protected health information without your written authorization.
We must obtain authorization before:
• Using or disclosing PHI for marketing (with limited exceptions)
• Selling your protected health information
• Any other use not described in this Notice
You may revoke authorization in writing at any time unless prohibited by law or action has already been taken in reliance on it.
ADDITIONAL PROTECTION OF YOUR PATIENT HEALTH INFORMATION
Special state and federal laws apply to certain classes of health information, including sexually transmitted diseases, drug and alcohol treatment, mental health records, and HIV/AIDS information. When required, we will obtain authorization before release.
YOUR INDIVIDUAL RIGHTS ABOUT PATIENT HEALTH INFORMATION
You may contact:
The Smile Space
2911 2nd Avenue Suite 106
Seattle, Washington 98121
Attn: Dr. Lee
206-294-5712
Your rights include:
Request restricted use
Request non-disclosure to health plans when self-paying in full
Request confidential communications
Inspect and receive copies
Request amendment
Receive accounting of disclosures
File complaints
You may also contact the U.S. Department of Health and Human Services Office for Civil Rights (Seattle Regional Office).
BREACH NOTIFICATION
If your unsecured protected health information is used or disclosed in a manner not permitted by law, we will investigate and notify you as required by federal regulations.
PRIVACY NOTICE CHANGES
We are required by law to protect your information, provide this Notice, and follow its terms. We reserve the right to change this Notice and make revisions effective for all information we maintain.
Copies are available in our office and on our website.