私隐实务通知

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  请仔细审阅.  如果您对本通知有任何疑问，请致电714-845-8605国外正规买球app官方版下载的“隐私官”.

We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services or payment of health care services.

This Notice was published and became effective on January 1, 2020.  We are required to abide by the terms of this Notice currently in effect.  We may change the terms of this Notice at any time.  新的通知将对我们当时保留的所有受保护的健康信息有效.  You may obtain a copy of any revised Notice by accessing our website, 打电话给我们的隐私国外正规买球app官方版下载人，并要求将修改后的副本通过邮件发送给您, or asking for one at the time of your next appointment.

未经您的授权使用和披露受保护的健康信息 

联络您:  我们可能会使用您受保护的健康信息与您国外正规买球app官方版下载，提醒您预约, inform you about treatment options, or advise you about other health-related benefits and services. 

治疗:  We may use and disclose your protected health information to provide, coordinate or manage your health care and any related services.  This includes coordinating your health care with a third party, consulting with another health care provider, or referring you to another health care provider.  例如, your dentist may need to know if you have other health problems that might complicate your treatment and therefore may request your medical record from another health care provider that has provided treatment to you. 如本文所述，我们也可能与其他提供商共享您的健康信息.  The disclosure of your health information to other providers may be done electronically through a health information exchange such as Care Everywhere, that allows providers involved in your care to access some of your health information to coordinate services and treatment for you.

付款:  我们可能会使用和披露您受保护的健康信息，以获取或支付您的牙科服务费用.  这可能包括与负责付款的个人或实体共享信息, 比如你的健康保险公司.  Your insurance company or 健康计划 may need your information for activities such as determining eligibility or coverage for insurance benefits and reviewing services provided to you.  例如, 我们可能会向你的保险公司提供有关你的牙科手术的信息，这样你的保险公司就会支付你的护理费用.

操作:  我们可能会为我们的医疗保健业务使用或披露您受保护的健康信息, 例如，支持我们的业务活动，并确保提供高质量的牙科护理.  Some of these activities involve quality assessments, 同事或员工评审, training health care professionals, licensing and accreditation activities, 数据聚合, compliance- or audit-related activities, and business planning and development.  例如, 我们可能会使用您的信息来评估我们的牙医和工作人员在为您提供护理方面的表现.  We may also disclose your protected health information to another provider, 健康计划, 或者在某些医疗保健业务中与你有或曾经有过关系的医疗保健信息交换所.

商业伙伴:  我们可能会向提供服务的第三方披露您受保护的健康信息, such as billing or legal services.  We have written contracts with third parties requiring them to protect the privacy of your protected health information.

治疗 Alternatives and Health-Related Products and Services:  We may use or disclose your protected health information to provide you with information about certain products or services including to describe our participation in a dentist network or 健康计划 network, products or services we provide or include in a plan of benefits, 还有其他治疗方法, 治疗方法, 牙医或护理机构.

家人和朋友:  We may disclose your protected health information to individuals, 比如家人和朋友, who are involved in your care or who help pay for your care.  We may do this if you tell us we can do so, 或者如果你知道我们正在与这些人分享你的信息，而你不反对.  If you are unavailable or unable to tell us your preference, we may also disclose your information if, based on our professional judgment, 我们相信，披露这些信息符合您的最大利益，您不会反对.  例如, we may assume you agree to disclosure of your information to your spouse if your spouse comes with you into the exam room or allow your spouse to pick up prescriptions, 牙科用品和x光片.

如果你是未成年人, 在某些情况下，您也有权阻止父母访问您的健康信息, 如果州法律允许的话. 您可以按本通知顶部的电话国外正规买球app官方版下载您的牙科医生或我们的隐私主任.

未经授权使用和披露受保护的健康信息  我们可能会在某些其他情况下未经您的授权使用或披露您受保护的健康信息, such as when required by law or for public health and safety purposes.  我们将遵守适用于这些情况的法律要求和限制.    

按法律规定:  我们可能会在联邦政府要求的时候使用或披露您受保护的健康信息, 州或地方法律.

公共卫生活动:  We may disclose your protected health information to a public health authority for public health activities such as to prevent or control disease, injury or disability; to respond to or report suspected abuse or neglect, non-accidental physical injuries, 药物反应, or problems with products; and to comply with medication or product recalls.

卫生监督活动:  我们可能会向健康监督机构披露您受保护的健康信息, such as government agencies that oversee the health care system, 政府项目, or compliance with civil rights laws, for oversight activities such as audits, 调查, 检查及发牌.

诉讼与争议:  We may use or disclose your protected health information in response to a court or administrative order in an administrative or judicial proceeding, 或者是回应传票, discovery request or other legal process. 

执法:  我们可能出于执法目的使用或披露您受保护的健康信息, so as to respond to legal processes, 识别或定位嫌疑人, provide information about crime victims, report crimes occurring on our premises, and report suspected crimes in a medical emergency.

Coroners, Medical Examiners and Funeral Directors:  We may disclose your protected health information to a coroner or medical examiner to identify a deceased person or determine the cause of death or for other lawful activities, 或者给葬礼承办人, as necessary to allow him/her to carry out his/her activities.

器官及组织捐赠:  If you are an organ or tissue donor, 我们可能会将您受保护的健康信息披露给处理器官采购或器官移植的组织, eye or tissue donation or transplantation.

研究:  We may use and disclose your protected health information in preparation for research or for research if and as approved by an institutional review board or privacy board.

Serious Threat to Health or Safety; Disaster Relief:  We may disclose your protected health information to appropriate individuals or organization when and as necessary to prevent a serious threat to the health and safety of a person (including yourself) or of the public.  We may also disclose your protected health information to identify, 找到或通知你的家人或在灾难中对你负责的人.

军人和退伍军人:  We may disclose your protected health information as required by military command or another government authority if you are a member of the armed forces.

National Security; Intelligence Activities; Protective Service:  我们可能会向联邦官员透露受保护的健康信息, 反情报和其他法律授权的国家安全活动, including activities related to the protection of the President, other authorized persons or foreign heads of state, or related to the conduct of special 调查.

工人的补偿:  We may disclose your protected health information for workers’ compensation or similar work-related injury programs, to the extent permitted or required by law.

犯人:  We may disclose your protected health information to a correctional institution (if you are an inmate) or a law enforcement official (if you are in that official’s custody) as necessary (i) for the institution to provide you with health care; (ii) to protect your or others’ health and safety; or (iii) for the safety and security of the correctional institution.

在您的授权下使用和披露受保护的健康信息

All uses and disclosures of your protected health information not covered by this Notice will be made only with your written authorization.  例如，未经您的书面授权，我们不会出售您受保护的健康信息.  Federal and state laws may provide additional protections or further limit how we may use or disclose your protected health information.  We will comply with these laws and, 在必要的时候, 请求您授权使用或披露您受保护的健康信息.  受保护的健康信息可能受到特别保护的例子包括心理治疗记录, 遗传信息, 心理健康信息, HIV/AIDS test results or information, reproductive health information, sexually transmitted or other communicable disease information, and alcohol or substance use disorder information.  

您可以随时以书面形式通知我们的隐私国外正规买球app官方版下载人，撤销任何授权.  If you revoke your authorization, 在授权允许的情况下，我们将不再使用或披露您受保护的健康信息, except to the extent we have already relied on the authorization.  

YOUR RIGHTS WITH RESPECT TO PROTECTED HEALTH INFORMATION

对于您受保护的健康信息，您拥有以下权利.  您可以通过向我们的隐私国外正规买球app官方版下载人提交书面请求来行使这些权利.  Please contact our Privacy 国外正规买球app官方版下载 with any questions about these rights.

查阅及复制权.  您可以查看并获取保存在牙科病历中的受保护健康信息的副本, 包括临床和账单记录以及我们用来对您做出决定的任何其他记录.  我们可能会向您收取费用，以支付复制、邮寄和相关用品的费用.

We may refuse to allow you to inspect or copy certain records, such as information compiled for legal actions and proceedings.  如果我们拒绝您的请求，您可能有权要求对此决定进行复审. 

要求限制的权利.  您可以要求我们不为特定治疗使用或披露您受保护的健康信息的任何部分, payment or health care operations-related purpose.  You may also request that any part of your protected health information not be disclosed to particular family members or friends who may be involved in your care. 

We are not required to agree to a restriction that you may request, unless you request to restrict the disclosure of your protected health information to a 健康计划 for payment or health care operations-related purposes and the protected health information relates only to a health care item or service for which you have paid in full and not through insurance.  If we agree to the requested restriction, 我们仍可能根据紧急治疗的需要使用或披露您受保护的健康信息.  

Right to Request Confidential Communications.  您可以要求我们通过其他方式或在其他地点与您沟通.  例如, you may request that we contact you using your work phone number, rather than a home phone number.  我们将接纳合理的要求，而不要求对要求作出解释, but we may require you to provide additional information to ensure we can contact you and arrange for billing and payment. 

修改权.  您可以要求修改您受保护的健康信息，以纠正错误或遗漏.  In certain cases, we may deny your request for an amendment.  If we deny your request for an amendment, you have the right to file a statement of disagreement with us.  We may prepare a rebuttal to your statement and, 如果我们这样做了, we will provide you with a copy of any such rebuttal. 

Right to an Accounting of Disclosures.  You may request an accounting of certain disclosures of your protected health information made within a period up to six years prior to your request.  This accounting does not include disclosures made to you or with your authorization; for treatment, payment or health care operations; to family members or friends involved in your care or for notification purposes; and certain other disclosures.  接收此信息的权利受到某些例外、限制和限制. 

违约通知权.  If we or one of our service providers improperly uses or discloses your protected health information in a way that compromises the privacy or security of that information (a “breach”), we will notify you as required by law.

Right to Paper Copy of This Notice.  You may receive a paper copy of this Notice upon request, even if you have agreed to accept this Notice electronically.

问题或投诉

We take our obligations to protect your privacy seriously.  如果您对本声明有任何疑问，请国外正规买球app官方版下载的隐私国外正规买球app官方版下载人.  If you believe your privacy rights have been violated, you may submit a complaint to us via our Privacy 国外正规买球app官方版下载 at the number at the top of this form or the Secretary of the U.S. Department of Health and Human Services.  You will not be penalized for filing a complaint.