Overview
This Notice describes how medical information about you may be used and disclosed by David Eugene DDS and how you can access this information. Please review it carefully.
Your Rights Regarding Your Health Information
You have the following rights regarding health information we maintain about you:
- Right to Inspect and Copy: You may request to inspect and obtain a copy of your health records.
- Right to Amend: You may request an amendment to your records if you believe they are inaccurate or incomplete.
- Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your health information.
- Right to Request Restrictions: You may request restrictions on how we use or disclose your information for treatment, payment, or operations.
- Right to Request Confidential Communications: You may request that we communicate with you in a certain way or at a certain location.
- Right to a Paper Copy of This Notice: You may request a paper copy of this Notice at any time.
How We May Use and Disclose Your Health Information
For Treatment
We may use your health information to provide, coordinate, and manage your dental care. For example, we may share information with a specialist to whom you are referred for consultation.
For Payment
We may use and disclose your health information to bill and collect payment for the services we provide. For example, we may provide information to your insurance company to obtain payment for services.
For Healthcare Operations
We may use your health information for our practice operations, such as quality assessment, staff training, and licensing.
Other Permitted and Required Uses and Disclosures
- As Required By Law: We may disclose information when required by federal, state, or local law.
- Public Health Risks: We may disclose information for public health activities such as reporting disease or adverse reactions.
- Law Enforcement: We may disclose information to law enforcement officials in certain circumstances.
- Family Members: We may disclose information to family members or friends involved in your care, with your permission.
- Appointment Reminders: We may use your information to send appointment reminders via SMS, phone, or email.
Your Authorization
For uses and disclosures not described above, we will obtain your written authorization before using or disclosing your health information. You may revoke an authorization at any time in writing.
Our Responsibilities
- Maintain the privacy of your health information as required by law
- Provide you with this Notice of our legal duties and privacy practices
- Notify you following a breach of your unsecured health information
- Abide by the terms of the Notice currently in effect
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Contact Information
For more information about our privacy practices or to exercise any of your rights, please contact our Privacy Officer: