This notice describes how medical information about you may be used and disclosed and
how you can get access to this information. Please review carefully.
INTRODUCTION:
Shining Dental PLLC. understands that your medical information is private and
confidential. Further we are required by law to maintain the privacy of "protected
health information". "Protected Health information" includes any individually.
Identifiable information that we obtain from you or others that relate to you pass, or
future physical or mental health, the health care you received, or payment for your
health care.
As required by law, this notice provides you with the information about your rights
and our legal duties and privacy practices with respect to the privacy of protected
health information. This notice also discusses the used and disclosures we will make
of your protected health information. We must comply with the provisions of this notice
as currently in effect. Although we reserve the right to change the terms of this
notice from time to time and to make the revised notice effective for all protected
health information we maintain.
PERMITTED USED AND DISCLOSURES:
We can use or disclose your protected health information for purposes of treatment,
payment and health care operations. For each of these categories of use and disclosure,
we have provided a description and an example below. However, not every particular use
of disclosure in every category will be listed.
TREATMENT means the provisions, coordination or management of your health care;
including consultations between health care providers regarding your care and referrals
for health care from one health care provider to another.
PAYMENT means the activities we undertake to obtain reimbursement for the health
care provided to you, including billing, collections, claims management, determination
of eligibility and coverage and utilization review activities. For example, prior to
providing health care services, we may need to. provide information to your Third-Party
Payer about your medical condition to determine whether the proposed course of
treatment will be covered. When we subsequently bill the Third Party Payer for the
services rendered to you, we can provide the Third Party Payer with information
regarding your care if necessary to obtain payment. Federal or State lay may require
us to obtain a written release for you prior to disclosing certain specially protected
health information for payment purposed, and we will ask you to sign a release when
necessary under applicable law.
HEALTH CARE OPERATIONS means the support functions of our practice related to
treatment and payment, such as quality assurance activities, case management, receiving
and responding to patient comments and complaints, physician review, compliance
programs, audits, business planning, development, management and administrative
activities. For example, we may use your protected health information to evaluate the
performance of our staff when caring for you. We may also combine health information
about many patients to decide what additional services we should offer, what services
are not needed and whether certain new treatments are effective. In addition, we may
remove .information that identifies you from your patient information so that others
can use the de-identified information to study health care and health delivery without
learning who you are.
OTHER USES AND DISCLOSURES OF PROTECTED INFORMATION
In addition to using and disclosing your information for treatment, payment and health
care operations, we may use your protected health information in the following ways:
If a phone call is made to my home, I give permission to leave a message on my
answering machine. In addition, I give permission to disclose information to the
following person(s):