On your first visit to our office you will be asked to review and sign our Health Insurance Portability and Accountability Act, (HIPPA), form.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY! USES AND DISCLOSURES:
TREATMENT: Your health information may be used by staff members or disclosed to other health care professional for the purpose of evaluating your health, diagnosing medical condition and providing treatment.
PAYMENT: Your health information may be used to seek payment from your insurance ( health/dental) or from credit card companies that you may use to pay for services.
HEALTH CARE OPERATIONS: Your health information may be used as necessary to support the day-to-day activities and management of The Center for Oral and Maxillofacial Surgery.
LAW ENFORCEMENT: Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting.
PUBLIC HEALTH REPORTING: Your health information may be disclosed to public health agencies as required by law, (we are required to report certain communicable diseases).
OTHER USES & DISCLOSURES REQUIRE YOUR AUTHORIZATION: disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change you mind after authorizing a use or disclosure of your information, you must submit a written revocation of the authorization However, your decision to revoke the authorization will not affect or undo any use of disclosure of information that occurred before you notified us of your decision to revoke your authorization.
INDIVIDUAL RIGHTS: You have certain rights under the federal privacy standards. These include:
- The right to request restriction of the use and disclosure of your protected health information
- The right to receive confidential communication concerning your medical condition and treatment.
- The right to inspect and copy your health information.
- The right to amend or submit corrections to your protected health information.
- The right to receive an accounting of how and to whom your protected health information has been disclosed.
- The right to receive a printed copy of this notice.
We, the Center for Oral and Maxillofacial Surgery, are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.