YOUR PRIVACY AT COLORADO DENTAL CO.

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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.

Protected health information about you is obtained as a record of your contacts or visits for healthcare services with Colorado Dental Co. This information is called “protected health information” (i.e., name, address, phone, etc.) that may identify you and relate you to your past, present or future physical or mental health condition and related healthcare services.

Colorado Dental Co. is required by law to maintain the privacy of protected health information and to follow the terms of this notice. This notice describes certain patient rights and how we use and disclose your protected health information to provide your treatment, obtain payment for services, receive and manage our health care operations and for other purposes that are permitted or required by law.

This notice has been drafted to be consistent with what is known as the Privacy Rule (45 CFR Parts 160 and 164) and any of the terms not defined in this notice should have the same meaning as they have in the Privacy Rule. We are also required to comply with any federal or state laws that impose stricter standards than the uses and disclosures described in this notice.

We reserve the right to change the terms of our notice, at any time. New versions of this notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with a revised notice of privacy practices.

Your Rights Under the Privacy Rule

You have the following rights regarding protected health information that we maintain about you. Please feel free to discuss any questions with our staff.

You have the right to receive, and we are required to provide you with a copy of this notice of privacy practices by requesting a copy in writing at the address listed on this website.

You have the right to obtain a paper copy of this notice at any time, even if you have already received an electronic notice. You also have the right to authorize other uses and disclosures. This means we will not use or disclose your protected health information other than as specified in this notice, unless you authorize the use or disclosure in writing. You may revoke an authorization at any time, in writing, except to the extent that our office has taken an action in reliance on the use or disclosure indicated in the authorization. To exercise any of the rights below, you must submit a written request to our privacy manager at the office address listed on this website.

You have the right to designate a personal representative. This means you may designate a person with the delegated authority to consent to or authorize the use or disclosure of protected health information.

You have the right to inspect and receive a copy of your protected health information. This means you may inspect and obtain a copy of protected health information about you that is used to make decisions about you, such as health and billing records. Your request may be denied for certain reasons permitted by applicable law.

You have the right to request a restriction of your protected health information. This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations. You may also request that any part of your protected health information be withheld from family members or friends who may be involved in your care or for notification purposes as described in this notice of privacy practices. We may deny your request for a restriction.

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted and specify information on how payment will be handled.

You may have the right to have us amend your protected health information. This means you may request an amendment to your protected health information for as long as we maintain this information. In certain cases, we may deny your request for an amendment.

You have the right to request an account of certain disclosures. This means that you may request a listing of disclosures of protected health information that we have made, except for disclosures made for purposes of treatment, payment, health care operations or for other purposes excluded from the accounting requirement. The first list you request within a 12-month period will be free. For additional lists, we may charge you a fair and appropriate fee for providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

How We May Use or Disclose Protected Health Information

The following categories describe different ways that we use and disclose protected information, consistent with the requirements of applicable law. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed.

For Treatment – We may use protected health information to provide you with health care treatment or services. We may disclose your protected health information for purposes of treatment, which includes providing, coordinating, or managing your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your protected health information, as necessary, to a pharmacy that would fill your prescriptions.

For Payment – We may use or disclose your protected health information to obtain payment for our services. This may include certain activities that your dental insurance plan may undertake before it approves or pays for the dental care services, we recommend for you such as determining eligibility or coverage for insurance benefits, reviewing services providing to you for dental necessity, and undertaking utilization review activities.

For Health Care Operations – We may use or disclose your protected health information to support the business activities of our practice. Health care operations include, but are not limited to, business planning and development, quality assessment and improvement, dental review arranging for legal services and auditing functions. It also includes education, provider credentialing, certification and underwriting, rating, or other insurance related activities. Additionally, it includes business administrative activities such as customer service, compliance with privacy requirements, internal grievances procedures, due diligence in connection with the sale or transfer of assets and creating de-identified information. We may also call you by name in the waiting room when your dentist is ready to see you.

For Treatment Alternatives and Appointment Reminders – We may use or disclose your protected health information to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. We may contact you to provide information about health-related benefits and services offered by our office.

To Others Involved in Your Dental Care and for Disaster Relief Purposes – With your consent, we may disclose to a member of your family, a relative, or close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your dental care. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, general condition or death. Further, we may use or disclose your protected health information to disaster relief agencies so they may assist in notifying those involved in your care of your location and general condition. If you are not present or able to agree or object to these rules or disclosures, then we may, using professional judgment, determine whether the disclosure is in the best interest. In this case, only the protected health information that is relevant to your dental care will be disclosed.

As Required by Law – We may use or disclose your protected health information to the extent that law requires the use or disclosure, including when disclosure is required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of the Privacy Rule.

For Public Health – We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.

For Communicable Diseases – We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

For Health Oversight – We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. In Case of Abuse or Neglect – We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected information if we believe that you have been a victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information.

For Legal Proceedings – We may disclose protected health information during any judicial or administrative proceedings in response to an order of the court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

To Law Enforcement – We may disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.

To Coroners, Medical Examiners and Funeral Directors – We may disclose protected health information to a coroner or medical examiner for identification purposes, determining causes of death for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to funeral directors, as authorized by law, to permit the funeral director to carry out their duties.

For Organ, Eye or Tissue Donation – We may use or disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

To Avert a Serious Threat to Health or Safety – We may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to health or safety of a person or the public. We may also disclose protected health information if it is necessary for the law enforcement authorities to identify or apprehend an individual.

For Military Activity and National Security – When the appropriate conditions apply, we may use or disclose protected health information of individuals who are armed forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the department of veterans affairs of your eligibility for benefits, or (3) to a foreign military authority if you are a member of that foreign military service. We may also release protected health information about you to authorized federal officials for intelligence, counterintelligence, to provide protection to the President, other authorized persons or foreign heads of state, to conduct special investigations and for other national security activities.

For Worker’s Compensation – We may disclose your protected health information as authorized to comply with worker’s compensation laws and other similarly legally established programs.

When an Inmate – If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official, if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

For Research – Under certain circumstances, we may use and disclose protected health information about you for research purposes. All research projects, however, are subject to a special approval process. With your consent, we may disclose protected health information about you under certain conditions to people preparing to conduct a research project. For example, we may help potential researchers look for patients with specific health needs, so long as the protected health information they review does not leave our facility.

Business Associates – We contract with individuals and entities, referred to as Business Associates, to perform various functions on our behalf or to provide types of services described in this notice. For Business Associates to perform their functions or services, we may disclose protected health information to them, but only after they have agreed in writing to safeguard the information. Examples of Business Associates may include our billing company.

Questions and Complaints

If you want more information about our privacy practices or have questions or concerns, please contact us at the address or phone number provided on this website.

If you are concerned that we may have violated your privacy rights, you disagree with a decision we made about access to your health information, or in response to a request you made to amend or restrict the use or disclosure of your health information, or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed on this website.

You also may submit a written complaint to the U.S. Department of Health and Human Services.  We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

We support your right to the privacy of your health information.  We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.