This statement of privacy practices describes how dental information about you may be disclosed and how you can get access to this information. Please read carefully.
Inspired Orthodontics, DDS, PLLC 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 protect 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.
Our Statement of Privacy Practices is currently in effect and provides information about the use and disclosure of protected health information by Inspired Orthodontics, DDS, PLLC 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 Statement:
In synopsis form, you have a right to:
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.
We use and disclose the information we collect from you only as allowed by the 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. You, of course, may give written authorization for us to disclose your information to anyone you choose, for any purpose.
Our Statement of Privacy Practices applies to all personal health information collected or created by Inspired Orthodontics, DDS, PLLC 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:
As stated above we may, under allowed circumstances use and disclose protected health information (PHI) without your specific authorization. Examples of such instances are included below:
Treatment: We may use and disclose your PHI to provide treatment. For example, we can:
Payment: We may use your health information for payment purposes. Such instances may include:
Health Care Operations: We may use and disclose your health information to support the daily activities related to health care. Examples include:
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: Your PHI may also be used to contact you. In example, we may call you or send you a letter to remind you about your appointment, provide test results, inform you about treatment options, or advise you about other health-related benefits and services.
Business Associates: Your PHI may be used by Inspired Orthodontics, DDS, PLLC and disclosed as needed to individuals, organizations, or companies to comply with our legal obligations described in this Notice. An example is disclosure of your PHI to consultants, attorneys, or third parties to assist in our business activities. All such entities must sign a Business Associate Agreement to protect the confidentiality of your private information.
We also use and disclose your information to enhance health care services, protect patient safety, safeguard public health, ensure that our facilities and staff comply with government and accreditation standards, and when otherwise compelled or allowed by law. For example, we provide or disclose information:
Disclosure to Family, Friends, or Others. You may object to our disclosing your general health condition (“good”, “fair”, “critical”, etc.) to an individual, or individuals, you have identified who have an active interest in your care, payment for your health care, or who may need to notify others about your general condition, location, or death. If you do not so indicate, we will use our best professional judgment to provide relevant protected health information to your family member, friend, or another identified person.
Special state and federal laws apply to certain classes of patient health information. For example, additional protections may apply to information about sexually transmitted diseases, drug and alcohol abuse treatment records, mental health records, and HIV/AIDS information. When required by law, we will obtain your authorization before releasing this type of information.
You may contact Inspired Orthodontics, DDS, PLLC to exercise your rights related to the use and disclosure of your protected health information.
You may contact us at:
Inspired Orthodontics, DDS, PLLC
509 Olive Way Suite 840
Seattle, WA 98101
Attn: Inspired Orthodontics
Your specific rights are listed below and include:
The right to request restricted use: You may request in writing that we not use or disclose your information for treatment, payment, and/or operational activities except when authorized by you, when required by law, or in emergency circumstances. We are not legally required to agree to your request. If you request that we restrict the use of your private information, we will provide you with written notice of our decision about your request.
The right to request non-disclosure to health plans:You have the right to request in writing that health care items or services for which you self-pay for in full in advance of your visit not be disclosed to your health plan.
The right to receive confidential communications: You have the right to request that we communicate with you about dental matters in a particular way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the address above. We will grant all reasonable requests. Your request must specify how or where you wish to be contacted.
The right to inspect and receive copies: In most cases, you have the right to inspect and receive a copy of certain health care information including certain dental and billing records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
The right to request an amendment to your record: If you believe that information in your record is incorrect or that important information is missing, you have the right to request in writing that we make a correction or add information. In your request for the amendment, you must give a reason for the amendment. We are not required to agree to the amendment of your record, but a copy of your request will be added to your record.
The right to know about disclosures: You have the right to receive a list of instances in which we have disclosed your health information. Certain instances will not appear on the list, such as disclosures for treatment, payment, or health care operations or when you have authorized the use or disclosure. Your first accounting of disclosures in a calendar year is free of charge. Any additional request within the same calendar year requires a processing fee.
The right to make complaints: If you believe that we have violated your privacy, or you disagree with a decision we made about access to your records, you may file a complaint directly to Inspired Orthodontics using the contact information above. Neither Inspired Orthodontics, nor any employee of Inspired Orthodontics, DDS, PLLC will retaliate against anyone for filing a complaint.
You may also contact:
U.S. Department of Health and Human Services,
Office for Civil Rights:
2201 Sixth Avenue – Mail Stop RX-11
Seattle, WA 98121-1831
206-615-2290; 206-615-2296 (TTY)
Toll free: 1-800-362-1710; 1-800-537-7697 (TTY)
If it is found that your patient information is used or disclosed in a manner that is not consistent with the practices described in this notice, Inspired Orthodontics, DDS, PLLC will fully investigate the matter to assess if there was a breach in the protection of your PHI. The assessment will be conducted to determine whether the information that was used or disclosed has significant risk of physical, financial, or reputational harm to you. If so, Inspired Orthodontics, DDS, PLLC will notify you and Health and Human Services in writing.
We are required by law to protect the privacy of your information, to provide this Statement of Privacy Practices and to follow the privacy practices that are described herein. We reserve the right to change the privacy practices described and the right to make the revised or changed Statement effective for protected health information we already have as well as any information we may receive in the future.
We have posted a copy of our current Statement for your review and reference. Additionally, each time you visit our office for treatment or health care services, you may request a copy of our current Statement of Privacy Practices. An electronic version of the notice is posted on our web site.