[Yogi Dental Center] NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Our Commitment to Your Privacy
[Yogi Dental Center] (“we,” “our,” “the practice”) is legally required to protect the privacy of your health information. This information is called “Protected Health Information” or “PHI” and includes your demographic data, medical history, test results, insurance information, and any other information we collect that relates to your past, present, or future physical or mental health.
We are required by law to:
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Maintain the privacy of your PHI.
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Provide you with this Notice of our legal duties and privacy practices.
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Follow the terms of the Notice that is currently in effect.
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Notify you if a breach of your unsecured PHI occurs.
II. How We May Use and Disclose Your Health Information (Without Authorization)
The following categories describe different ways we may use and disclose your PHI without your written authorization.
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For Treatment: We may use and share your PHI with dentists, hygienists, specialists, doctors, and other healthcare providers who are involved in your care. For example, we may send your X-rays to a specialist you are being referred to.
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For Payment: We may use and disclose your PHI to bill and collect payment from you, your health plan, or another third party. For example, we may send a claim to your dental insurance plan that includes information about your diagnosis and treatment.
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For Health Care Operations: We may use and disclose your PHI for our business operations. This includes activities like quality assessment, employee training, managing our practice, audits, and legal services.
III. Other Permitted Uses and Disclosures Without Your Authorization
We may also use or disclose your PHI in the following situations:
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Appointment Reminders: We may contact you to remind you of an appointment (e.g., by phone, voicemail, text, or email).
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Treatment Alternatives: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you (e.g., information about a new service we offer).
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Individuals Involved in Your Care: We may share your PHI with a family member, relative, or close friend who is involved in your care or payment for your care, as long as you do not object.
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As Required by Law: We will disclose PHI when required by federal, state, or local law.
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Public Health Activities: We may disclose PHI for public health purposes, such as reporting diseases.
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Health Oversight Activities: We may disclose PHI to a health oversight agency for activities like audits, investigations, inspections, and licensure.
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Lawsuits and Legal Actions: We may disclose PHI in response to a court order, subpoena, or other lawful process.
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Law Enforcement: We may disclose PHI to law enforcement officials as required by law.
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Workers’ Compensation: We may disclose PHI as necessary to comply with workers’ compensation laws.
IV. Uses and Disclosures That Require Your Written Authorization
Other uses and disclosures not covered in this Notice will be made only with your written permission (an “Authorization”). This includes:
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Marketing: We will not use or disclose your PHI for marketing purposes without your written Authorization. For example, we will not accept payment from a third party to send you their marketing materials.
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Sale of PHI: We will not sell your PHI without your written Authorization.
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Patient Testimonials & Images: We will not use your name, photo, video, or any personal story for our website, social media, or any other advertising without your specific, written Authorization.
You may revoke your Authorization at any time, in writing, but this will not affect any actions we took in reliance on your permission before we received your revocation.
V. Your Rights Regarding Your Protected Health Information
You have the following rights regarding your PHI:
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Right to Inspect and Copy: You have the right to inspect and get a copy of your health and billing records. You must submit your request in writing. We may charge a reasonable, cost-based fee.
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Right to Request an Amendment: If you believe that PHI we have is incorrect or incomplete, you may ask us to amend it. Your request must be in writing and provide a reason. We may deny your request in certain situations.
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Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI (for purposes other than treatment, payment, or operations) in the six years prior to your request.
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Right to Request Restrictions: You have the right to request a restriction on how we use or disclose your PHI. You also have the right to restrict disclosures to a health plan for services you have paid for “out-of-pocket” in full. We are not legally required to agree to other restriction requests, but if we do, we will abide by that agreement.
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Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location (e.g., only at your cell phone). Your request must be in writing.
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Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this Notice at any time.
VI. Advertising, Marketing, and Website Policy
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Patient Testimonials: We value our patients’ feedback. If you provide a testimonial for our website or social media (e.g., Google, Yelp), we are grateful. When we respond to public reviews, we will do so in a general, confidential manner that does not confirm you are a patient or disclose any of your PHI. Any patient story, “before and after” photo, or video used in our marketing is shared only after that individual has provided specific, written, HIPAA-compliant Authorization.
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Truth in Advertising: All our advertising, including “special offers” or descriptions of our services, is intended to be truthful, accurate, and not misleading, in accordance with Federal Trade Commission (FTC) guidelines. All offers are subject to the provider’s professional judgment and a clinical determination of medical/dental necessity.
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Website Tracking: Our website may use cookies or analytics tools (like Google Analytics) to understand how visitors use our site. This data is generally anonymous. However, submitting information through our online “Contact” or “Appointment Request” forms may transmit personal information. We use secure methods for these forms to protect your data. Use of our website tracking tools is not intended to collect or transmit PHI to third-party advertisers.
VII. Changes to This Notice
We reserve the right to change this Notice and our privacy practices. A revised Notice will be effective for all PHI we already have, as well as any we receive in the future. The current Notice will be posted in our office and on our website.
VIII. Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
To file a complaint with us, please contact:
Address: 30 Scotland Road, Orange, NJ 07050 Telephone: 973-673-1311