Notice of Health Information Practices

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Introduction

At Valencia Endodontic Associates, LLC, we are committed to treating and using protected health information about you responsibly.  This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information.  It also describes your rights as they relate to your protected health information.  This Notice is effective October 16, 2003, and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information

Each time you visit Valencia Endodontic Associates, LLC, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.  This information, often referred to as your health or medical record serves as a:

Basis for planning your care and treatment

Means of communication among the many health professionals who contribute to your care.

Legal document describing the care you received

Means by which you or a third party payer can verify that services billed were actually provided

A tool in educating health professionals

Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of Valencia Endodontic Associates, LLC, the information belongs to you.  You have the right to:

Obtain a paper copy of this notice of information practices upon request

Inspect and copy your health record as provided for in 45CFR 164.524, (Missouri law allows us to charge a $15 handling fee and 35 cents per page to copy your records, payable prior to receiving your copy)

Amend your health record as provided in 45CFR 164.528

Obtain an accounting of disclosures of your health information as provided in 45CFR 164.528

Request communications of your health information by alternative means or at alternative locations.

Request a restriction on certain uses and disclosures of your information as provided by 45CFR 164.522

Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

Valencia Endodontic Associates, LLC, is required to:

Maintain the privacy of your health information

Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you

Abide by the terms of this notice

Notify you if we are unable to agree to a requested restriction

Accomodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.  Should our information practices change, we will mail a revised notice to the address you’ve supplied us, or if you agree, we will email the revised notice to you.

We will not use or disclose your health information without your authorization, except as described in this notice.  We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the practice’s Privacy Officer, Sharon at 816-561-9666.

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office of Civil Rights, U.S. Department of Health and Human Services.  There will be no retaliation for filing a complaint with either the Privacy Officer or the Office of Civil Rights.  The address for the OCR is listed below:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Indepence Avenue, S.W.

Room 509F, HHH Building

Washington D.C.  20201

Use and Disclosures of Health Information

We use and disclose health information about you for treatment, payment, and healthcare operations.  For example:

Treatment:  We may use or disclose your health information to a physician or other health care provider providing treatment to you.

Payment:  We may use and disclose your health information to obtain payment for services we provide to you.

Healthcare Operations:  We may use and disclose your health information in connection with our healthcare operations.  Healthcare operations include quality assessment and improvement activities, review the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization:  In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.  If you give us an authorization, you may revoke it in writing at any time.  Your revocation will not affect any use or disclosures permitted by our authorization while it is in effect.  Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.

To Your Family and Friends:  We must disclose your health information to you, as described in the Patient Rights section of this notice.  We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.

Persons Involved In Care:  We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death.  If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures.  In the event of your incapacity, or emergency circumstances, we will disclose health information based on a determination using our professional judgement disclosing only health information that is directly relevant to the person’s involvement in your healthcare.  We will also use our professional judgement and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

Marketing Health Related Services:  We will not use your health information for marketing communications without your written authorization.

Required By Law:  We may use or disclose your health information when we are required to do so by law.

Abuse or Neglect:  We may disclose your health information to appropriate authorities if we reasonably believe that your are a possible victim of abuse, neglect, or domestic violence or a possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health and safety of others.

National Security:  We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmate or patent under certain circumstances.

Appointment Reminders:  We may use or disclose your health information to provide you with appointment reminders (such as voicemail, email, text messages, postcards, or letters)