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 INFORMTION PLEASE REVEIW IT CAREFULLY.

The Health Insurance Portability & Accountability Act of 1995 (HIPAA) requires all health care records and other individually identifiable health information used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information. As required by HIPAA, we have prepared this explanation of how we rae required to maintain the privacy of your health information and how we may use an disclose your health information.

Without specific written authorization, we are permitted to use and disclose you health care records for the purposes of treatment, payment, and health care operations.

• Treatment means providing, coordination, or managing health care and related services by one or more health care providers. For example, we may need to share information with other providers or specialists involved in the continuation of your care.
• Payment means such activities as obtaining reimbursement for services, confirmation coverage, billing or collection activities, and utilization review. FOr example, we disclosed treatment information when billing a dental plan for your dental services.
• Health Care Operations include the business aspects of running our practice. FOr example, patient information may be used for training purposes, or quality assessment.

Unless you request otherwise, we may use or disclose health information to a family member, friend, or other personal representative to the extent necessary to help with your healthcare or with payment of your healthcare. In addition, we may use your confidential information to remind you of appointments by sending reminder postcards and/or leaving messages at home and/or work. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.