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Southern Laser Dentistry HIPAA Privacy Practices Agreement

 

Our Commitment to Your Privacy

 

Southern Laser Dentistry is committed to protecting the privacy, confidentiality, integrity, and security of your health information.

Federal law, including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), establishes requirements regarding the use and disclosure of Protected Health Information (“PHI”) and provides patients with certain rights regarding their health information.

This document explains how Southern Laser Dentistry may use and disclose your health information, your rights regarding that information, and our responsibilities for protecting it.

Nothing in this document is intended to waive or limit any right provided to you under HIPAA or other applicable federal or state law.

 

PROTECTED HEALTH INFORMATION

 

Protected Health Information, or “PHI,” generally includes individually identifiable health information that relates to your past, present, or future physical or mental health or condition, the health care provided to you, or payment for health care.

PHI maintained by Southern Laser Dentistry may include, as applicable:

  • Personal and demographic information;

  • Medical and dental histories;

  • Diagnoses and clinical findings;

  • Treatment plans;

  • Clinical notes;

  • Dental charts;

  • Periodontal records;

  • Radiographs and X-rays;

  • Cone beam computed tomography (CBCT) images;

  • Intraoral scans and photographs;

  • Laboratory and pathology information;

  • Prescription information;

  • Referral information;

  • Insurance and benefit information;

  • Billing and payment records;

  • Appointment information;

  • Communications concerning your care; and

  • Other information maintained as part of your dental or health record.

 

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

 

Southern Laser Dentistry may use or disclose your Protected Health Information as permitted or required by applicable law.

 

Treatment

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We may use and disclose your health information to provide, coordinate, or manage your dental and related health care.

This may include communication with dentists, physicians, specialists, pharmacies, dental laboratories, imaging facilities, referral providers, and other health care professionals involved in your care.

For example, information may be shared with a specialist when a referral is necessary or with a dental laboratory when fabrication of a restoration, appliance, denture, crown, bridge, or other dental product is required.

 

Payment

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We may use and disclose health information when reasonably necessary to obtain or facilitate payment for services provided to you.

This may include:

  • Verifying insurance eligibility;

  • Determining benefits;

  • Obtaining predeterminations or prior authorizations;

  • Submitting insurance claims;

  • Correcting or appealing claims;

  • Coordinating benefits;

  • Responding to insurance-company requests;

  • Processing payments;

  • Billing;

  • Collection activities; and

  • Other lawful payment-related activities.

 

Health Care Operations

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We may use and disclose health information for lawful health care operations, including:

  • Quality assessment and improvement;

  • Staff training;

  • Professional review;

  • Credentialing;

  • Compliance activities;

  • Internal audits;

  • Patient-service activities;

  • Business management;

  • Legal and regulatory compliance;

  • Information technology and security;

  • Practice administration;

  • Fraud and abuse prevention; and

  • Other activities necessary to operate Southern Laser Dentistry.

 

YOUR PRIVACY RIGHTS

 

Subject to limitations and exceptions established by law, you have certain rights concerning your Protected Health Information.

 

Right to Access Your Health Information

 

You may request to inspect or obtain a copy of certain health information maintained about you in our designated record set.

This may include medical and dental records and billing records maintained by or for Southern Laser Dentistry.

Requests will be processed in accordance with applicable federal and state requirements.

 

Right to Request an Amendment

 

If you believe information in your health record is incorrect or incomplete, you may request that Southern Laser Dentistry amend the information.

We may deny an amendment request under circumstances permitted by law.

A denial of an amendment request does not necessarily prevent you from submitting a written statement regarding your disagreement when applicable.

 

Right to Request Restrictions

 

You may request restrictions on certain uses or disclosures of your Protected Health Information.

Southern Laser Dentistry is generally not required to agree to every requested restriction.

However, where required by law, we will comply with an applicable restriction.

 

Right to Request Confidential Communications

 

You may request that Southern Laser Dentistry communicate with you regarding your health information through a particular method or at a particular location.

Reasonable requests for confidential communications will be handled in accordance with applicable law.

 

Right to an Accounting of Certain Disclosures

 

You may request an accounting of certain disclosures of your Protected Health Information made by Southern Laser Dentistry during the period permitted by applicable law.

Certain disclosures are excluded from accounting under HIPAA.

 

Right to Obtain a Copy of This Notice

 

You may request a paper copy of Southern Laser Dentistry’s current Notice of Privacy Practices at any time, even if you previously received or accessed the Notice electronically.

 

Right to a Personal Representative

 

You may authorize another person to act as your personal representative regarding your Protected Health Information.

Southern Laser Dentistry may require appropriate documentation establishing that person’s authority before recognizing the individual as your personal representative.

 

Right to File a Complaint

 

You may file a complaint if you believe your privacy rights have been violated.

Southern Laser Dentistry will not retaliate against you for filing a good-faith privacy complaint or exercising a privacy right provided by law.

 

COMMUNICATION WITH YOU

 

Southern Laser Dentistry may contact you regarding matters associated with your care and the administration of your account, as permitted by law.

Communications may concern:

  • Appointments;

  • Appointment confirmations;

  • Scheduling or rescheduling;

  • Treatment;

  • Follow-up care;

  • Referrals;

  • Prescriptions;

  • Treatment plans;

  • Insurance;

  • Billing;

  • Outstanding balances;

  • Patient forms;

  • Clinical instructions; and

  • Other matters related to your dental care.

 

Communication may occur through methods such as telephone, voicemail, text message, email, postal mail, patient portal, or other communication systems used by the practice, as permitted by law and consistent with applicable communication preferences.

 

Patients may request reasonable confidential communication methods.

Patients are responsible for notifying Southern Laser Dentistry when contact information or communication preferences change.

 

FAMILY MEMBERS, CAREGIVERS, AND OTHERS INVOLVED IN YOUR CARE

When permitted by law, Southern Laser Dentistry may disclose information relevant to your care or payment for your care to a family member, caregiver, personal representative, or other individual involved in your care.

The amount and type of information disclosed will be determined according to the circumstances and applicable law.

 

Where authorization or other legal authority is required, Southern Laser Dentistry will obtain or verify the appropriate authorization or authority before disclosure.

 

MINORS AND PERSONAL REPRESENTATIVES

 

The privacy rights of minors and the authority of parents, guardians, and other personal representatives are governed by applicable federal and South Carolina law.

Depending on the circumstances, a parent or legal guardian may generally exercise certain privacy rights on behalf of a minor.

There are circumstances in which a minor may have independent privacy rights or in which a parent or guardian may not automatically have access to particular health information.

Southern Laser Dentistry may request documentation establishing guardianship, power of attorney, personal representative status, or other legal authority when appropriate.

 

ELECTRONIC COMMUNICATION

 

Southern Laser Dentistry uses reasonable administrative, physical, and technical safeguards designed to protect health information.

Electronic communication may include:

  • Email;

  • Text messaging;

  • Electronic appointment reminders;

  • Patient portals;

  • Electronic forms;

  • Electronic insurance communications;

  • Electronic prescriptions;

  • Electronic referrals; and

  • Other approved electronic systems.

 

Electronic communications may carry privacy and security risks depending upon the technology, device, network, or service involved.

Patients should notify Southern Laser Dentistry if a telephone number, email address, mailing address, or other contact method changes or is no longer private or secure. 

 

PHOTOGRAPHS, RADIOGRAPHS, SCANS, AND CLINICAL IMAGES

Southern Laser Dentistry may create, receive, maintain, and use clinical documentation when appropriate for diagnosis, treatment, payment, health care operations, or documentation of care.

This may include:

  • Dental X-rays;

  • Panoramic radiographs;

  • CBCT scans;

  • Intraoral photographs;

  • Extraoral photographs;

  • Digital impressions;

  • Intraoral scans;

  • Treatment photographs;

  • Diagnostic images; and

  • Other clinically appropriate records.

 

These materials may become part of your dental or health record and will be protected in accordance with applicable privacy requirements.

The use of identifiable patient photographs, videos, testimonials, or other Protected Health Information for advertising, public social media, promotional materials, or other purposes requiring authorization will be handled separately and will not be authorized solely by this Privacy Practices Agreement.

BUSINESS ASSOCIATES AND SERVICE PROVIDERS

 

Southern Laser Dentistry may use third-party companies and professionals to perform services on behalf of the practice.

Depending upon their role, these organizations may need access to Protected Health Information.

 

Examples may include:

  • Practice-management software providers;

  • Electronic health record providers;

  • Information technology companies;

  • Cloud storage and backup providers;

  • Billing and claims-processing services;

  • Dental laboratories;

  • Record-storage companies;

  • Record-destruction services;

  • Accountants;

  • Attorneys;

  • Consultants;

  • Compliance providers;

  • Payment-processing services; and

  • Other organizations supporting practice operations.

 

When required by HIPAA, Southern Laser Dentistry will maintain appropriate agreements with business associates requiring them to appropriately safeguard Protected Health Information.

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USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW

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Certain circumstances permit or require Southern Laser Dentistry to disclose health information without obtaining a separate written authorization.

Depending upon the circumstances and applicable legal requirements, these may include:

 

Public Health Activities

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Information may be disclosed for legally authorized public health activities.

 

Abuse, Neglect, or Domestic Violence

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Information may be disclosed to appropriate governmental authorities when authorized or required by law.

 

Health Oversight Activities

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Information may be disclosed to authorized health oversight agencies for activities such as audits, investigations, inspections, licensing, disciplinary proceedings, and other legally authorized oversight activities.

Judicial and Administrative Proceedings

Information may be disclosed in response to certain court orders, subpoenas, discovery requests, or other lawful processes when applicable legal requirements have been satisfied.

 

Law Enforcement

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Information may be disclosed for certain law-enforcement purposes when permitted or required by law.

 

Serious Threats to Health or Safety

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Information may be disclosed when necessary and legally permitted to prevent or reduce a serious and imminent threat to the health or safety of a person or the public.

 

Workers’ Compensation

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Information may be disclosed as authorized or required by workers’ compensation laws or similar programs.

 

Coroners and Medical Examiners

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Information may be disclosed to coroners, medical examiners, or other authorized individuals when permitted by law.

 

Organ and Tissue Donation

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Information may be disclosed to authorized organizations involved in organ, eye, or tissue donation when applicable.

 

Research

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Health information may be used or disclosed for research when the applicable requirements of federal and state law have been satisfied.

 

Governmental Functions

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Certain information may be disclosed for specialized governmental functions when authorized by law.

 

Required by Law

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Southern Laser Dentistry may use or disclose Protected Health Information when another law requires the use or disclosure.

 

Nothing in this Notice is intended to expand our authority to disclose information beyond what applicable law permits or requires.

USES REQUIRING SEPARATE AUTHORIZATION.

 

Certain uses or disclosures of Protected Health Information require a separate written authorization. When an authorization is legally required, Southern Laser Dentistry will obtain the appropriate authorization before making the use or disclosure.

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A separate authorization may be required for certain:

  • Marketing activities;

  • Uses of identifiable patient photographs or videos for promotional purposes;

  • Patient testimonials;

  • Public social-media content;

  • Disclosures of records to third parties at the patient’s direction;

  • Sales of Protected Health Information; and

  • Other uses or disclosures requiring authorization under applicable law.

 

When applicable, an authorization may generally be revoked in writing, subject to legal limitations and actions already taken in reliance on the authorization.

FUNDRAISING AND MARKETING

 

Southern Laser Dentistry will comply with applicable HIPAA requirements concerning fundraising and marketing communications.

Protected Health Information will not be used or disclosed for activities requiring a patient authorization unless the required authorization has been obtained.

 

Clinical photographs, testimonials, treatment results, or other identifiable patient information will not be considered authorized for public advertising or promotional use merely because the information was created during treatment.

 

OUR RESPONSIBILITIES

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Southern Laser Dentistry is required to comply with applicable privacy and security requirements governing Protected Health Information.

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Our responsibilities include:

  • Maintaining the privacy of Protected Health Information as required by law;

  • Maintaining appropriate administrative, physical, and technical safeguards;

  • Following applicable privacy policies and procedures;

  • Providing patients with applicable privacy rights;

  • Training appropriate workforce members regarding privacy and security requirements;

  • Limiting uses and disclosures when required by law;

  • Maintaining appropriate relationships and agreements with business associates;

  • Investigating suspected privacy or security incidents as appropriate;

  • Maintaining required documentation;

  • Complying with applicable breach-notification requirements; and

  • Following the privacy practices described in the Notice currently in effect.

 

BREACH NOTIFICATION

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Southern Laser Dentistry maintains policies and procedures for responding to suspected or confirmed privacy and security incidents.

If a breach of unsecured Protected Health Information occurs and applicable law requires notification, Southern Laser Dentistry will provide the required notification to affected individuals and any other parties or governmental agencies required by law.

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CHANGES TO OUR PRIVACY PRACTICES

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Southern Laser Dentistry reserves the right to modify its privacy practices and revise its Notice of Privacy Practices as permitted by law.

When a revision is made, the current Notice will be made available as required by applicable law.

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Patients may request the current version of the Notice at any time.

QUESTIONS, REQUESTS, AND PRIVACY COMPLAINTS

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Patients may contact Southern Laser Dentistry regarding:

  • Questions about privacy practices;

  • Requests for access to records;

  • Requests for amendments;

  • Requests for restrictions;

  • Requests for confidential communications;

  • Requests for an accounting of certain disclosures;

  • Questions regarding authorization or release of information; or

  • Privacy complaints.

 

Southern Laser Dentistry Privacy Contact

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Practice: Southern Laser Dentistry
Privacy Officer/Contact: Southern Laser Dentistry
Address: 2089 Woodruff Rd, Greenville, SC 29607
Telephone: (864) 288-8388
Email: office@southernlaserdentistry.com

 

Patients may also file a privacy complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, as permitted by law.

Southern Laser Dentistry will not retaliate against any patient for filing a privacy complaint or exercising a privacy right.

 

IMPORTANT PRIVACY NOTICE

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Your privacy is an important part of your care.

Southern Laser Dentistry uses Protected Health Information only as permitted or required by applicable law and maintains safeguards designed to protect the confidentiality, integrity, and availability of patient information.

 

Questions regarding this Notice, your privacy rights, or the handling of your health information should be directed to Southern Laser Dentistry’s designated Privacy Contact

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