Notice of Privacy Practices
This notice describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your frights to access and control your protected health information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services. Please review this notice carefully. The privacy of your health information is very important to us.
Our Legal Duty
We are required by applicable and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect. The effective date for this notice is April 14, 2003. It will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, when such changes are permitted by applicable law. We reserve the right to make changes to our privacy practices and the terms of this Notice, which is effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
Uses and Disclosures Of Protected Health Information
Your protected health information may be used and disclosed by your dentist, our 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. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the dental practice.
The following are examples of the types of uses and disclosures of your protected health information that the dental office is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office. Such uses and disclosures include:
Treatment: We may use or disclose your protected health information to provide, coordinate, or manage your dental care and any related services. This includes the coordination or management of your health care with a third party. We will also disclose protected health information to other dentists who may be treating you. In addition, we may disclose your protected health information from time-to-time to another dentist or health care provider who, at the request of your dentist, becomes involved in your care by providing assistance with your health care diagnosis or treatment, e.g., a laboratory or specialist.
Payment: Your protected health information will be used, as needed, to obtain payment of your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you. Such services include, but are not limited to, making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of your dentist’s practice.
For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your dentist. We may also call you by name in the waiting room when your dentist is ready to see you. We may use or disclose your protected health information to remind you of an appointment via telephone or mail.
We will share your protected health information with third party “business associates” that perform various activities for the practice, e.g. billing, transcription services, etc. Whenever an arrangement between our office and a business associate involves the use of disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
We may use and disclose your protected health information, as necessary, to conduct quality assessments and improvement activities, to review health care professionals’ competence and qualifications; to evaluate practitioner and provider performance; to conduct training programs; and for accreditation, licensing, certification, and credentialing activities.
Your Authorization: Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice. You may revoke your authorization at any time, in writing. Your revocation will not affect any use or disclosures permitted by your authorization while it was 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.
Others Involved In Your Health Care: Unless you object, 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, 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 emergency circumstances or your incapacity to agree or object, we will disclose protected health information based on a determination using our professional judgment, disclosing only health information that is directly relevant to the person’s involvement in your healthcare and only that which is in your best interest. We may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care. We will also use our professional judgment 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.
Emergencies: We may use or disclose your protected health information in an emergency treatment situation. We must present to you our Notice of Privacy Practices as soon as it is reasonably practicable after the delivery of treatment. If your dentist or another dentist in the practice is required by law to treat you, she/he may still use or disclose your protected health information to treat you, and you will be provided our Notice of Privacy Practices as soon as reasonably practicable after the delivery of treatment. We must make a good faith effort to obtain a written acknowledgement of the receipt of this notice to you, or document our good faith efforts to obtain such acknowledgement and the reason(s) why the acknowledgement of was not obtained.
Marketing Health-Related Services: We will not use your health information for marketing communication without your written authorization.
Required By Law: We may disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
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. The disclosure will be made for the purpose of controlling disease, injury, or disability. We may also disclose your protected health information to a foreign government agency that is collaborating with the public health authority, when directed by the public health authority.
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.
Health Oversight: We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority, which is authorized by law to receive reports of child abuse or neglect. We may disclose your protected health information to appropriate authorities if we reasonably believe that you are possible victim of abuse, neglect, domestic violence, or other crimes. We may also disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. In such cases, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Legal Proceedings: We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such a disclosure is expressly authorized), in certain conditions, in response to a subpoena, discovery request, or other lawful process.
Law Enforcement: We may disclose your protected health information for law enforcement purposes, as long as applicable legal requirements are met. These law enforcement purposes include, but are not limited to, (1) legal processes required by law, (2) limited information requests for identification and location purposes, (3) information pertaining to victims of a crime, and (4) suspicion that death has occurred as a result of criminal conduct.
Coroners, Funeral Directors, & Organ Donation: We may disclose your protected health information to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose your protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out her/his duties. We may disclose your protected health information in reasonable anticipation of death for organ or tissue donation purposes.
Criminal Activity: Consistent with federal and state laws, we may use or 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 the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
National Security and Military Activity: We may disclose your protected health information to military authorities or Armed Forces personnel when appropriate conditions apply. We may disclose, to authorized state and federal officials, health information required for lawful intelligence, counterintelligence, and national security activities. We may also disclose protected health information for the determination of benefits eligibility through the Department of Veteran Affairs and to foreign military authorities. We may disclose your protected health information to a correctional institution or law enforcement officials if we are directed to do so by proper authorities if you are an inmate of a correctional facility.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
Access: You have the right to examine or obtain copies of your health information, with limited exceptions, for as long as we maintain the protected health information. A “designated record set” contains dental and billing records and any other records that your dentist and the practice use for making decisions about you. Under federal law, however, you may not inspect or coy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to laws, which prohibit access to such protected health information. Requests for access may be denied. If you receive a denial, you may have a right to have this decision review. Please contact our Privacy Officer if you have questions about access to your dental records.
(Your request for access to your protected health information must be made in writing. You may obtain a form to request access by using the contact information listed at the end of this Notice. We will charge you a reasonable cost-based fee for expense such as copies and staff time. You may also request access by sending us a letter to the address at the end of this Notice. If you request copies, we will charge you for each page, for staff time to locate and copy your health information, and for postage if you want the copies mailed to you. Contact us using the information listed at the end of this Notice for a full explanation of our fee structure.)
Disclosure Accounting: You have the right to receive a list of instances in which we have disclosed your protected health information for purposes, other than treatment, payment, healthcare operations and certain other activities as described in this Notice of Privacy Practices. You have a right to receive specific information regarding such disclosures that occurred after, and not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost based fee for responding to these additional requests. The right to receive this information is subject to certain exceptions, restrictions, and limitations.
Amendments: You may have a right to have your dentist amend your protected health information. This means you may request an amendment of your protected health information in a designated record set for as long as we maintain this information. (Your request must be in writing, and it must explain why the information should be amended.) In certain cases, we may deny your request for amendment, in which case you have a right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact us using the information listed at the end of this Notice if you have questions about amending your dental record.
Restrictions: You have the right to request that we place additional restrictions on our use or disclosure of your health information. Your request must be made in writing and it must be mailed to the address listed at the end of this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. Your request must be made in writing and it must be mailed to the address listed at the end of this Notice. Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location.
Questions and Complaints
If you want more information about our privacy practices, or if you have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights; if you disagree with a decision we made about access to your health information; if you disagree with our response to a request you made to amend or restrict the use or disclosure of your health information; or if you feel we have violated an agreement to communicate with you by alternative means or at alternative locations, you may complain to using the contact information listed at the end of this Notice. You may also 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 protected health information. We will not retaliate against you in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. Please feel free to contact us using the following information. You can contact us via mail, email, telephone, or fax.
Submit questions, Requests, and Complaints to:
Total Care Dental & Orthodontics
Attn: Grievance Coordinator
5703 S. Vermont Ave
Los Angeles, CA 90037
Telephone: (323) 751-5600
Fax: (888) 699-6623 Attn: Privacy Officer
This site is not intended for children under the age of 13. We will not knowingly collect personally identifiable information via this site from visitors in this age group. We encourage parents to talk to their children about their use of the Internet and the information they disclose to Web sites.
Information You Provide
Some areas of this site may ask you to submit personally identifiable information in order for you to benefit from the specified features (such as newsletter subscriptions, tips/pointers, order processing, or resume submission) or to participate in a particular activity (such as sweepstakes or other promotions). You will be informed what information is required and what information is optional.
Passive Information Collection
This site may use and combine such passively collected anonymous information to provide better service to site visitors, customize the site based on your preferences, compile and analyze statistics and trends, and otherwise administer and improve the site for your use. Such information is not combined with personally identifiable information collected elsewhere on the site unless you have consented.
More Information About Cookies
A “Cookie” is a bit of information that a Web site sends to your Web browser that helps the site remember information about you and your preferences.
“Session Cookies” are temporary bits of information that are used to improve navigation, block visitors from providing information where inappropriate (the site “remembers” previous entries of age or country of origin that were outside the specified parameters and blocks subsequent changes), and collect aggregate statistical information on the site. They are erased once you exit your Web browser or otherwise turn off your computer.
“Persistent Cookies” are more permanent bits of information that are placed on the hard drive of your computer and stay there unless you delete the cookie. Persistent cookies store information on your computer for a number of purposes, such as retrieving certain information you have previously provided (such as passwords), helping to determine what areas of the Web site visitors find most valuable, and customizing the Web site based on your preferences on an ongoing basis. Persistent cookies placed by this site on your computer may hold personally identifiable information, but only if you have registered or have otherwise consented to the retention of personally identifiable information you have provided at the site. Otherwise, our site’s server only knows that an unidentified visitor with your cookie has returned to the site.
You can set your browser to accept all cookies, to reject all cookies, or to notify you whenever a cookie is offered so that you can decide each time whether to accept it. To learn more about cookies and how to specify your preferences, please search for “cookie” in the “Help” portion of your browser.
A site may use Internet Protocol (IP) addresses. An IP address is a number assigned to your computer by your Internet service provider so you can access the Internet and is generally considered to be non-personally identifiable information, because in most cases an IP address is dynamic (changing each time you connect to the Internet), rather than static (unique to a particular user’s computer). The IP address can be used to diagnose problems with a server, report aggregate information, determine the fastest route for your computer to use in connecting to a site, and administer and improve the site.
“Internet Tags” (also known as single-pixel GIFs, clear GIFs, invisible GIFs, and 1-by-1 GIFs) adhere smaller than cookies and tell the Web site server information such as the IP address and browser type related to the visitor’s computer. Tags may be placed both on online advertisements that bring people to the site and on different pages of the site. Such tags indicate how many times a page is opened and which information is consulted.
“Navigational Data” (log files, server logs, and clickstream data) are used for system management, to improve the content of the site, market research purposes, and to communicate information to visitors.
Use and Disclosure of Information
Except as otherwise stated, we may use information collected via this site to improve the content of our site, to customize the site to your preferences, to communicate information to you (if you have requested it), for our marketing and research purposes, and for any other purpose specified. In addition, we may make full use of all information acquired through this site that is not in personally identifiable form.
(iii) to respond to law enforcement requests or where required by applicable laws, court orders, or government regulations.
Access, Correction, and Deletion
To keep personally identifiable information that you provide via this site accurate, current, and complete, please contact us as specified below and we will take appropriate steps to update or correct such information in our possession, or to delete your information from our contact list.
This site takes reasonable steps to protect personally identifiable information as you transmit it to our site and to protect such information from loss, misuse, and unauthorized access, disclosure, alteration, or destruction. You should keep in mind that no Internet transmission is ever completely secure or error-free. In particular, e-mail sent to or from this site may not be secure.
Links to Other Web Sites
How to Contact Us
Keivan Sarraf, DDS, Inc.
5703 S. Vermont Ave.
Los Angeles, CA 90037