This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This information will include Protected Health Information (PHI), as that term is defined in privacy regulations issued by the United States Department of Health and Human Services pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Please review it carefully.
Our practice respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so or unless the law authorizes us or requires us to do so.
The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.
Protected Health Information:
Protected health information means individually identifiable information:
- Transmitted by electronic media;
- Maintained in any medium described in the definition of electronic media; or
- Transmitted or maintained in any other form or medium
Examples of Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations
- Information obtained by a physician or office staff will be recorded in your medical record and used to help decide what care may be right for you.
- We may also provide information to others providing you care. This will help them stay informed about your
- Written patient permission is required to use or disclose PHI for payment purposes, including to your health insurance plan if you decide to pursue reimbursement for services. Information provided to your insurance company may include your diagnoses, procedures performed, or recommended care.
- For health care operations:
- We use your medical records to assess quality and improve services
- We may use and disclose medical records to review the qualifications and performance of our health care provider(s)
- We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services
- We may use and disclose your information to conduct or arrange for services including: medical quality review by your health plan; accounting, legal, risk management, and insurances services; and audit functions including fraud and abuse detection and compliance programs.
Your Health Information Rights
The health and billing records we create and store are the property of Tonya A. Loving, DDS, PLLC. The protected health information in it, however, generally belongs to you. You have a right to:
- Receive, read, and ask questions about this Notice of Privacy Practices (“Notice”)
- Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request but we will work to comply with any request granted.
- Request and receive from us a paper copy of the most current Notice
- Request that you be allowed to see and get a copy of your protected health information. You must make this request in writing.
- Have us review a denial of access to your health information—except in certain circumstances
- Ask us to change your health information. You must make this request in writing. You may write a statement of disagreement if your request is denied.
- When you request, we will give you a list of disclosures of your health information. The list will not include disclosures to third-party payors. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
- Ask that your health information be given to you by another means or at another location. You must make this request in writing.
- Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. You may not be able to cancel an authorization if its purpose was to obtain insurance.
We are required to:
- Keep your protected health information private
- Give you this Notice
- Follow the terms of this Notice
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by phoning and asking for it or by visiting our office.
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of you protected health
Tonya A. Loving, DDS, PLLC
6415 E. Lake Sammamish Pkwy. SE, Suite 100
Issaquah, WA 98029
Tel: (425) 392 4222
If you believe your privacy rights have been violated, you may discuss your concerns with our office or file a complaint with:
The U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
Tel: (202) 619 0257 or (877) 696 6775
We respect your right to file a complaint. If you complain, we will not retaliate against you.
Other Disclosures and Uses of Protected Health Information
Notification of Family and Others
- Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. This would be limited to your name and general health condition (for example, “critical”, “poor”, “fair”, “good” or similar statements). In addition, we may disclose health information about you to assist in disaster relief efforts.
You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.
We may use and disclose your protected health information without your authorization as follows:
- With Medical Researchers—if the research has been approved and has policies to protect the privacy of your health information
- To the Food and Drug Administration (FDA) relating to problems with medications, supplements, and products
- To Comply With Workers’ Compensation Laws—if you make a workers’ compensation claim
- For Public Health and Safety Purposes as Allowed or Required by Law: to prevent or reduce a serious, immediate threat to the health and safety of a person or the public; to prevent or control disease, injury, or disability; or to report vital statistics such as births or deaths
- To Report Suspected Abuse or Neglect to public authorities
- To Correctional Institutions if you are in jail or prison, as necessary, for your health and the health and safety of others
- For Law Enforcement Purposes such as when you are the victim of a crime
- For Health and Safety Oversight Activities. For example, we may share health information with the Department of Health.
- For Disaster Relief Purposes. For example, we may share health information with disaster relief agencies to assist in notification of your condition to family or others.
- For Work-Related Conditions That Could Affect Employee Health. For example, an employer may ask us to assess health risks on a job site.
- To the Military Authorities of U.S. and Foreign Military Personnel. For example, the law may require us to provide information necessary to a military mission.
- In the Course of Judicial Proceedings at your request or as directed by a court order or subpoena
- For Specialized Government Functions. For example, we may share information for national security purposes
- To Coroners, Medical Examiners, Funeral Directors. We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by law, so that they may carry out their jobs.
- Organ and Tissue Donations. If you are an organ donor, we may use or disclose PHI to organizations that help procure, locate, and transplant organs in order to facilitate an organ or tissue donation and transplantation.
- Incidental Disclosures. We may use or disclose PHI incident to a use or disclosure permitted by the HIPAA Privacy Act so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary information.
- Limited Data Set Disclosures. We may use or disclose a limited data set (PHI that has certain identifying information removed) for purposes of research, public health, or health care operations. This information may only be disclosed for research, public health, and health care operations purposes. The person receiving the information must sign an agreement to protect the information.
Certain federal and state laws that provide special protections for certain kinds of personal health information call for specific authorizations from you to use or disclose information. When your personal health information falls under these special protections, we will contact you to secure the required authorizations to comply with federal and state laws such as:
- Sexually Transmitted Diseases
- Drug and Alcohol Abuse Treatment Records
- Mental Health Services for Minors
- Communicable and Certain Other Diseases Confidentiality
- Confidentiality of Alcohol and Drug Abuse Patients
If we need your health information for any other reason that has not been described in this notice, we will ask for your written authorization before using or disclosing any identifiable health information about you. In addition, if you choose to sign an authorization to disclose information, you can revoke that authorization at a later time to stop any future use or disclosure.
Other Uses and Disclosures of Protected Health Information
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your authorization.