NOTICE OF PRIVACY PRACTICES
Date of last revision: February 17, 2015
Effective Date: Immediately
This information is made available on request by a patient.
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.
THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE GENERATED BY THE PRACTICE, WHETHER MADE BY THE PRACTICE OR AN ASSOCIATED FACILITY.
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your doctor, Oral Facial Surgery In statute (OFSI) office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the doctor’s practice, and any other use required by law.
Treatment: OFSI will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a doctor to whom you have been referred to ensure that the doctor has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a surgery may require that your relevant protected health information be disclosed to the health plan to obtain approval for payment of the surgery.
Healthcare Operations: OFSI may use or disclose, as needed, your protected health information in order to support the business activities of your doctor’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients in our office.
We may use a sign in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when your doctor is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: as required by federal, state, or local law; public health issues as required by law; to avert a serious threat to health or safety; emergency situations; Food and Drug Administration requirements; legal proceedings; law enforcement; if you are an organ donor, for organ or tissue donation; Workers’ Compensation; for coroners, medical examiners, and funeral directors; and information about inmates can be released to law enforcement officials or correctional institutions with custody.
Other Permitted and Required Uses and Disclosures Will Be Made Only with Your Consent, Authorization or Opportunity to object unless required by law.
You may revoke this authorization, at any time, in writing, except to the extent that your doctor or the doctor’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Emergency Situations: In addition, OFSI may disclose medical information about you to an organization assisting in a disaster relief effort or in an emergency situation so that your family can be notified about your condition, status and location.
CHANGES TO THIS NOTICE
Oral Facial Surgery Institute reserves the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we may receive from you in the future. We will post a copy of the current notice in the Practice. The notice will contain on the first page, in the top right-hand corner, the date of last revision and effective date. In addition, each time you visit the Practice for treatment or health care services you may request a copy of the current notice in effect.
Protection of Your Information
Reasonable care will be taken to keep pertinent records current, complete and accurate, if you see any inaccuracy in your billing statements, or in any other communication from OFSI, we would appreciate your assistance in making corrections by contacting us. You have the right to request corrections to your records.
You have the right at any time to request restrictions on what we may disclose or to inspect the information before we disclose it. In addition, you may ask for copies of your protected health information at any time. Finally, you have the right to receive an account of disclosures of your protected health information.
You have the right to revoke any authorizations given, and to opt out of communications such as fundraising communications.
You have the right to restrict disclosures to your health plan when you request, in writing, that we not disclose such information and you have paid for the service in full out of your own pocket, unless otherwise required or permitted by law. We are not required to agree to all requested restrictions. This includes the right to request a paper prescription. It is your responsibility to notify your health plan of the restriction.
Safeguards in Place at Oral Facial Surgery Institute
At OFSI we have administrative, technical and physical safeguards in place to ensure privacy.
- Policies and procedures for handling information.
- Limited access to facilities where information is stored.
- Requirements for third parties to comply with privacy laws.
Our Commitment to You
You are a valued patient, and the information you provide to us is safe and used responsibly. We will continue to maintain your privacy and provide you with information about how we share your nonpublic personal health and financial information.
Above all, we value your trust and your confidence in our ability to manage and protect your important personal information.
Telephone: 314-251-6725 Fax: 314-251-6726