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We hold the right to make changes in our privacy practices and term of this notice at any time. Special emphasis is to be placed to make sure that the changes made are permissible by the law. We also have the right to make changes in our privacy practices and the new terms of our notice that is effective for all medical health-related information.
We will disclose and use your protected health information about the treatment, health care operations, payment, etc. Some examples of the types of disclosures and uses of your protected health information are being given below. Going through them will give you a clear idea about the topic.
Your protected health information can be used by us to coordinate, provide or manage your health care and related services. The personal credentials enable us to handcraft a treatment plan that perfectly suits your needs. We also use health-related information to manage or coordinate your health care with a third party. For example, we would disclose your health information to a health agency that provides quality care to you. The physicians treating you can also get the information from us.
To add on, we disclose information to a physician or health care providers from time to time, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician
Your protected health information can be disclosed (if needed) to conduct certain operational and business activities. These activities include employee review activities, quality assessment activities, licensing, training of students, and conducting other business activities. You need to realize that the activities are not just confined to the mentioned areas.
For example, you will be asked to sign your name on a sign-in sheet at the registration desk. Next, we may call you by name when your turn to see the doctor arrives. We can disclose or use the protected health information (if required) to get in touch with you via mail or telephone to inform you about the appointment.
We will also share your protected health information with “third party” business associates that perform several activities i.e transcription and billing services for the practice. When an arrangement between our office and a business associate involves the disclosure or use of your protected health information, we will have a written contract that consists of terms and conditions that will ensure the privacy of your protected health information.
The protected health information can be used or disclosed, if necessary, to make you aware of the treatment alternatives or other health-related benefits and services that can be of great help. Your protected health information can also be utilized for marketing activities. For example, your address or name can be used to send you a newsletter about the services or practices we have to offer. We can also send you information about services and products that we believe can be of benefit to you. In case you do not need anything, contact us to not send these materials to you.
Disclosures and use of information based on your written authorization: Other disclosures or uses of your protected health information can only be made with your authorization unless otherwise required or permitted by law as described in the section below.
You can give us written authorization to use or disclose your protected health information for any need. You might revoke the authorization any time you want by giving it to us in writing. Just know that revocation will never have an impact on the use or disclosure permitted by your authorization while it was in effect. We will never disclose your health care information as described in the notice without your written authorization.
Access: You have the right to both get and look at the protected health information with limited exceptions. For that, you need to contact the listed person to obtain access to your protected health information. You can also request access to your protected health information. 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 $25.00 for each page or$10.00 per hour to locate and copy your protected health information, and postage if you want the copies mailed to you. If you prefer, we will prepare a summary or an explanation of your protected health information for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Restriction Requests: You have the right to receive a list of instances in which we or our business associates disclosed your protected health information for purposes other than treatment, payment, health care operations, and certain other activities after April 14, 2003. After April 14, 2009, the accounting will be provided for the past six(6) years. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your protected health information, a description of the protected health information we disclosed, the reason for the disclosure, and certain other information. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Confidential Communication: You have the right to request that we communicate with you in confidence about your protected health information by alternative means or to an alternative location. You must make your request in writing. We must accommodate your request if it is reasonable, specifies the alternative means or location, and continues to permit us to bill and collect payment from you.
Amendment: You have the right to request that we amend your protected health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information you want to be amended or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted to be amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people or entities you name, of the amendment and to include the changes in any future disclosures of that information.
Electronic Notice: If you receive this notice on our website or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the information listed at the end of this notice to obtain this notice in written form.
If you want more information about our privacy practices or have questions or concerns, please contact us using the information below. If you believe that we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information or in response to a request you made, you may complain to us using the contact information below. 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 protect the privacy of your protected 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
Name of Contact Person: Dr. Sam Harouni, DDS
Address: 350 S Beverly Dr #160b, Beverly Hills, CA 90212, United States
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