Your Rights, Your Information, and Our Responsibilities.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At Thomas Orthodontics, we are committed to protecting the privacy of your dental and health information. We are required by applicable federal and state law, including the Health Insurance Portability and Accountability Act (HIPAA), to maintain the privacy of your "protected health information" (PHI).
We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices that are described in this Notice while it is in effect.
We use and disclose health information about you for treatment, payment, and healthcare operations. For example:
We may use or disclose your health information to a dentist, physician, or other healthcare provider providing treatment to you. This includes coordination with your general dentist regarding your orthodontic care, referrals to oral surgeons for extractions, or consultations with periodontists.
We may use and disclose your health information to obtain payment for services we provide to you. This includes submitting claims to your dental insurance plan, verifying insurance eligibility and coverage, and handling collections of outstanding balances.
We may use and disclose your health information in connection with our healthcare operations. This includes quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, or credentialing activities.
In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time.
We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.
We may use or disclose your health information when we are required to do so by law. This includes disclosures for:
You have the right to look at or get copies of your health information, with limited exceptions. You must make a request in writing to obtain access to your health information. We will charge you a reasonable cost-based fee for expenses such as copies and staff time.
You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations, and certain other activities, for the last 6 years.
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).
Exception for Self-Payment: We must agree to your request to restrict disclosure of your health information to a health plan if the disclosure is for the purpose of carrying out payment or healthcare operations and is not otherwise required by law, and the information pertains solely to a healthcare item or service for which you (or someone other than the health plan) have paid our practice in full.
You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. (You must make your request in writing).
You have the right to request that we amend your health information. (Your request must be in writing, and it must explain why the information should be amended.) We may deny your request under certain circumstances.
In the event of a breach of your unsecured protected health information, we will provide you with notification as required by law (including the specific requirements of the Florida Information Protection Act).
If you want more information about our privacy practices or have questions or concerns, please contact us.
Contact Officer: Dr. Brian W. Thomas
Telephone: (813) 948-9494
Address: 21521 Village Lakes Shopping Center Dr., Land O Lakes FL 34639
You also may submit a written complaint to the U.S. Department of Health and Human Services. 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.
Download Official PDFIn addition to our HIPAA Notice of Privacy Practices regarding your medical information, Thomas Orthodontics collects non-medical information through our website to improve user experience and for marketing purposes.
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