Notice of Privacy Practices

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your dental and health records

You can ask to see or get a copy of your records and other health information we have about you, on paper or electronically. Ask us how. We'll provide a copy or a summary, usually within 15 working days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your records

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no, but we'll tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, by mobile phone only) or to send mail to a different address. We will say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say no if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.

Get a list of those we've shared information with

You can ask for a list (accounting) of the times we've shared your health information for six years before the date you ask, who we shared it with, and why. It includes all disclosures except those for treatment, payment, operations and certain others (such as any you asked us to make). We'll provide one list a year for free and may charge a reasonable, cost-based fee if you ask for another within 12 months.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. Ask at the front desk.

Choose someone to act for you

If you've given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We'll make sure the person has this authority before we act.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights, using the contact information at the end of this notice, or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us.

• You have the right and choice to tell us to share information with your family, close friends or others involved in your care, or in a disaster relief situation. If you can't tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest.
• In these cases we never share your information unless you give us written permission: marketing purposes (including photos of your smile on our website), and sale of your information.
• We do not do fundraising.

Our uses and disclosures

How we typically use or share your health information

• To treat you. We use your information and share it with other professionals who are treating you. Example: a specialist we refer you to.
• To run our practice. We use your information to run the practice, improve your care and contact you when necessary. Example: appointment reminders.
• To bill for your services. We use and share your information to bill and get payment from health plans or other entities. Example: we give your dental insurer information about your treatment so it will pay for your services.

How else we can use or share your health information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good. We have to meet many conditions in the law before we can share it for these purposes:

• Help with public health and safety issues, such as reporting suspected abuse, neglect or domestic violence, and preventing a serious threat to anyone's health or safety.
• Do research, under strict conditions.
• Comply with the law, including if the Department of Health and Human Services wants to see that we're complying with federal privacy law.
• Respond to organ and tissue donation requests, and work with a medical examiner or funeral director (for example, dental records used for identification).
• Address workers' compensation, law enforcement and other government requests, as the law allows.
• Respond to lawsuits and legal actions, in response to a court or administrative order or a subpoena.

Washington law can give your information more protection than federal law. Where it does, we follow the stricter rule.

Records of substance use disorder treatment

If we receive records about you from a substance use disorder treatment program covered by federal law (42 CFR Part 2), those records have extra protection. We will not use or share them, or testimony about them, in any civil, criminal, administrative or legislative proceeding against you unless you give written consent or a court orders it after giving you notice and a chance to be heard. If you have given general consent for these records to be used for treatment, payment and operations, we may use and share them as this notice describes, and you can revoke that consent in writing.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing.

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on this website.

Questions and complaints

Privacy officer: Rachel Johnson, Cascade Dental, 1200 Glacier View Way, Orting, WA 98360 · (206) 555-0142 · hello@cascadedental.example

U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201 · 1-877-696-6775 · hhs.gov/ocr/complaints