APEX ENDODONTICS, PC.
NOTICE OF PRIVACY PRACTICES EFFECTIVE APRIL 14, 2003
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.
OUR PROMISE TO YOU, OUR PATIENTS
Your information is important and confidential.Our ethics and policies
require that your information be held in strict confidence.
We maintain protocols to ensure the security and confidentilality of
your personal information. We have physical security in our building,
passwords to protect databases, compliance audits, and virus/intrusion
detection software. Within our practice, access to your information
is limited to those who need it to perform their jobs.
At the offices of APEX ENDODONTICS,
PC. we are committed to treating and using protected health
information about you responsibly. This Notice of Policies 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 April 14,2003,
and applies to all protected health information as defined by federal
UNDERSTANDING YOUR HEALTH RECORD
Each time you visit APEX ENDODONTICS, PC., 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,
Tool in educating health professionals,
Source of data for medical research,
Source of information for public health officials charged to improve
the health of the state and nation,
Source of data for our planning and marketing, and
Tool by which we can assess and continually work to improve the care
we render and outcomes we achieve.
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 APEX
ENDODONTICS, PC., the information belongs to you. You have
the right to :
Obtain a paper copy of this notice of privacy policies upon request,
Inspect and obtain a copy of your health record as provided by 45CFR
164.524(reasonable copy fees apply in accordance with state law),
Amend your health record as provided by 45CFR 164.526,
Obtain an accounting of disclosures of your health information as provided
Request confidential communications of your health information as provided
by 45CFR164.522(b), and
Request a restriction on certain uses and disclosures of your information
as provided by 45 CFR164.522(a) (however, we are not required by law
to agree to a requested restriction).
Our practice 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.
Accommodate reasonable requests you may have to communicate your health
We reserve the right to change our practices
and to make the new provisions effective for all protected health information
we maintain. We will keep a posted copy of the most current notice in
our facility containing the effective date in the top, right-hand corner.
In addition, each time you visit our facility for treatment, you may
obtain a copy of the current notice in effect upon request.
We will not use or disclose your health
information in a manner other than described in the section regarding
Examples Of Disclosures For Treatment, Payment, And Health Operations,
without your written authorization, which you may revoke as provided
by 45CFR 164.508(b)(5), except to the extent that action has already
FOR MORE INFORMATION OR TO REPORT
If you have questions and would like additional information, you may
contact Angela Short at
If you believe your privacy rights have
been violated, you can either file a complaint with Angela Short, or
with the Office for Civil Rights, U.S. Department of Health and Human
Services(OCR). There will be no retaliation for filing a complaint with
either our practice or the OCR. The address for the OCR regional office
for Georgia is as follows; Office for Civil Rights U.S. Department of
Health and Human Services Atlanta Federal Center, Suite 3B70 61 Forsyth
Street, SW., Atlanta Georgia, 30303-8909
EXAMPLES OF DISCLOSURES
FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS
We will use your health information for treatment. We may provide medical
information about you to health care providers, our practice personnel,
or third parties who are involved in the provision, management, or coordination
of your care.
For example: Information obtained by
a nurse, physician, or other member of your health care team will be
recorded in your record and used to determine the course of treatment
that should work best for you. Your medical information will be shared
among health care professionals involved in your care.
We will also provide your other physician(s)
or subsequent health care provider(s) (when applicable) with copies
of various reports that should assist them in treating you.
We will use your health information for
payment. We may disclose your information so that we can collect or
make payment for the health care services you receive. For example:
If you participate in a health insurance plan, we will disclose necessary
information to that plan to obtain payment for your care.
We will use your health information for
regular health operations. We may disclose your health information for
our routine operations. These uses are necessary for certain administrative,
financial, legal, and quality improvement activities that are necessary
to run our practice and support the core functions. For example: Members
of the quality improvement team may use information in your health record
to assess the care and outcomes in your case and others like it. This
information will then be used in an effort to continually improve the
quality and effectiveness of the healthcare and service we provide and
to reduce healthcare costs.
We may disclose medical information to provide appointment reminders
(e.g., contacting you at the phone number you have provided to us and
leaving a message as an appointment reminder).
Decedents: Consistent with applicable law, we may disclose
health information to a coroner, medical examiner, or funeral director.
Workers Compensation: We may disclose health information
to the extent authorized by and necessary to comply with laws relating
to workers compensation or other similar programs established by law.
Public Health: As required by law, we may disclose
your health information to public health or legal authorities charged
with preventing or controlling disease, injury, or disability.
Research: We may disclose information to researchers
when their research has been approved and the researcher has obtained
a required waiver from the Institutional Review Board/Privacy Board,
who has reviewed the research proposal.
Organ Procurement Organizations: Consistent with applicable
law, we may disclose health information to organ procurement organizations
or other entities engaged in the procurement, banking, or transplantation
of organs for the purpose of donation and transplant.
As Required By Law: We may disclose health information
as required by law. This may include reporting a crime, responding to
a court order, grand jury subpoena, warrant, discovery request, or other
legal process, or complying with health oversight activities, such as
audits, investigations, and inspections, necessary to ensure compliance
with government regulations and civil rights laws.
Specialized Government Functions: We may disclose health
information for military and veterans affairs or national security and
Business Associates : There are some services provided
in our organization through contacts with business associates. Some
examples are billing or transcription services we may use. Due to the
nature of business associates' services, they must receive your health
information in order to perform the jobs we've asked them to do. To
protect your health information, however, when these services are contracted
we require the business associate to appropriately safeguard your information.
Practice Marketing : We may contact you to provide
information about treatment alternatives or other health-related benefits
and services that may be of interest to you (for example, to notify
you of any new tests or services we may be offering).
Food And Drug Administration(FDA): We may disclose to the FDA health
information relative to adverse events with respect to food, supplements,
product and product defects, or post marketing surveillance information
to enable product recalls, repairs, or replacement.
Personal Representative: We may disclose information
to your personal representative (person legally responsible for your
care and authorized to act on your behalf in making decisions related
to your health care).
To Avert A Serious Threat To Health/Safety: We may
disclose your information when we believe in good faith that this is
necessary to prevent a serious threat to your safety or that of another
person. This may include cases of abuse, neglect, or domestic violence.
Communication With Family : Unless you object, health
professionals, using their best judgment, may disclose to a family member
or close personal friend health information relevant to that person's
involvement in your care or payment related to your care. We may notify
these individuals of your location and general condition.
Disaster Relief: Unless you
object, we may disclose health information about you to an organization
assisting in a disaster relief effort.
For all non-routine operations, we will
obtain your written authorization before disclosing your personal information.
In addition, we take great care to safeguard your information in every
way that we can to minimize any incidental disclosures.