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Notice of Privacy Policy

Notice of Privacy Policy 

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.  

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that health providers keep your medical and dental information private. The HIPAA Privacy Rule state that health providers must also post in a clear and prominent location, and provide patients with a written Notice of Privacy Policy. 

The privacy practices described are currently in effect. We reserve the right to change our privacy practices and the terms of this  Notice at any time, provided such changes are permitted by law. If any changes are made, a new Notice will be displayed in our office and provided to patients. You may request a copy of our Notice at any time. Additional information may be obtained from our HIPAA  coordinator listed in our written HIPAA plan.

Our Legal Responsibility 

As your health care provider, we are legally required to protect the privacy of your health information, and to provide you with this  Notice about our legal duties, privacy practices, and your rights with respect to your health information. This requirement applies to  all patients served by Clay and Associates DDS, PLC.  

Your Protected Health Information 

Throughout this Notice, we will refer to your protected health information as PHI. Your PHI includes data that identifies you and  reports about the care and service you receive at COD. For example, it includes information about your diagnosis, medication,  insurance status and policy number, payment information, social security, address, and other demographic information. 


Changes to this Notice 

We are required to follow the terms of the Notice currently in effect. We reserve the right to change the terms of this Notice and our privacy policies and practices. Any changes will apply to your past, current, or future PHI. When we make an important change to our policies, we will change this Notice and post a new Notice on our website. We will post the notice as required by law and will have an available copy of the revised Notice in the places where we provide dental services. The notice will contain the effective date on the last page. You may also request a copy of our current Notice at any time. 


Uses and Disclosures of PHI Without Your Authorization 

We are allowed by law to use and share your health information with others without your consent for many reasons. The following examples describe the categories of our uses and disclosures we may make without your permission. Please note that not every use or disclosure in each category is listed and these are general descriptions only. Where state or federal law restricts one of the described uses or disclosures, we follow the requirements of such law. 

  • Treatment: We may use and disclose medical information about you to physicians, nurses, technicians, physicians in training,  or other healthcare professionals who are involved in your care. For example, if you are being treated for a knee injury, we may disclose your PHI to the Department of Rehabilitation Therapies. Different healthcare professionals, such as pharmacists, lab technicians, and x-ray technicians, also may share information about you in order to coordinate your care. In addition, we may send information to another dentist or physician who referred you to Clay and Associates DDS, PLC. At all times, we will comply with any regulations that apply. 

  • Payment: We may use and disclose your PHI in order to bill and collect payment for the treatment and services we provided to you. For example, we may provide PHI to an insurance company or third-party payor in order to obtain approval for treatment or admission to the hospital. We may also share your health information with another doctor, dentist, or hospital that has treated you so that they can bill you, your insurance company, or a third party. 

  • Healthcare operations: We may use and disclose your PHI as part of our routine operations. For example, we may use your  PHI to evaluate the quality of health care services you received or to evaluate the performance of health care professionals who cared for you.  

  • Business associates: We may share your health information with others called “business associates,” who perform services on our behalf. The business associate must agree in writing to protect the confidentiality of the information. For example, we may share your health information with a billing company that bills for the services we provide.  

  • Appointment reminders and health-related benefits or services: We may use your PHI to provide appointment reminders or to give you information about treatment alternatives or other healthcare services. If you provide us with a mobile number, we may contact you by phone or text message at that number for treatment-related purposes or appointment reminders, wellness checks, registration instructions, etc. We will identify Clay and Associates DDS, PLC as the sender of the information. With your consent, we may contact you on your mobile phone for other certain purposes.  

  • Public health activities: We may disclose medical information about you for public health activities. These activities may  include disclosures: 

    • To a public health authority authorized by law to collect or receive such information for the purpose of preventing or  controlling disease, injury, or disability 

    • To appropriate authorities authorized to receive reports of child abuse and neglect 

    • To FDA-regulated entities for the purpose of monitoring or reporting the quality, safety, or effectiveness of FDA-regulated products 

    • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease  or condition 

    • With parent or guardian permission, send proof of required immunization to a school 

  • Law enforcement: We may disclose certain medical information to law enforcement authorities for law enforcement purposes such as: 

    • As required by law, including reporting certain wounds and physical injuries 

    • In response to a court order, subpoena, warrant, summons, or similar process 

    • To identify or locate a suspect, fugitive, material witness, or missing person 

    • About the victim of a crime if we obtain the individuals’ agreement or under certain circumstances, if we are unable  to obtain the individual’s agreement 

    • To alert authorities of a death we believe may be the result of criminal conduct 

    • Information we believe is evident of criminal conduct occurring on our premises 

    • In emergency circumstances to report a crime; the location of a crime or victims of the identity, description, or  location of the person who committed the crime 

  • Abuse, neglect, or domestic violence: We may notify the appropriate government authority if we believe you have been a  victim of abuse, neglect, or domestic violence. Unless such disclosure is required by law, we will only make this disclosure if  you agree 

  • Judicial and administrative proceedings: If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to notify you of the request or to obtain an order from the court protecting the information requested. 

  • Health oversight activities: We may disclose PHI to a health oversight agency for audits, investigations, inspections,  licensure, and other activities, as authorized by law. For example, we may disclose PHI to the FDA, state Medicaid fraud control, or the US Department of Health and Human Services Office for Civil Rights.  

  • Deceased individuals: Following your death, we may disclose medical information to a coroner, medical examiner, or funeral director as necessary for them to carry out their duties and to a personal representative (for example, the executor of your estate). We may also release your medical information to a family member or other person who acted as a personal representative or was involved in your care or payment for care before your death, if relevant to such person’s involvement unless you have expressed a contrary preference.  

  • Workers’ compensation purposes: We may disclose PHI about you as authorized by law for workers’ compensation or similar programs that provide benefits for work-related injuries or illness. 

  • Threats to health or safety: Under certain circumstances, we may use or disclose your medical information to avert a serious threat to health and safety and if we, in good faith, believe the use or disclose is necessary to prevent or lessen the threat and is to a person reasonably able to prevent or lessen the threat or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime.  

  • Incidental uses and disclosures: There are certain incidental uses or disclosures of your information that occur while we are providing service to you or conducting our business. For example, after surgery, the assistant or doctor may need to use your name to identify family members that may be waiting for you in a waiting area.  

  • Required by law: We will use and disclose your information as required by federal, state, or local law.  Uses and Disclosures for Which You Have the Opportunity to Object 

  • Disclosures to family, friends, or others: We may provide your PHI to a family member, friend, or other person you tell us is involved in your care or involved in the payment of your health care, unless you object in whole or in part. This could include sharing information with your family or friend so they can pick up a prescription.  


Uses and Disclosures Requiring Your Authorization 

There are many uses and disclosures we will make only with your written authorization. These include:

  • Uses and disclosures not described above 

  • Marketing: We will not use or disclose your medical information for marketing purposes without your authorization. • Sale of medical information: We will not sell your medical information to third parties without your authorization.  

If you provide authorization, you may revoke it at any time by giving us notice in accordance with our authorization policy and the instructions on the authorization. Your revocation will not be effective for uses and disclosures made in reliance on your prior authorization. 

Your Rights Regarding PHI 

You have the right to: 

  • Request restrictions: You can ask us not to share certain PHI for treatment, payment, or health care operation purposes. For example, when you have paid for your services out of pocket in full, at your request we will not share information about those services with your health/dental plan as long as such disclosure is not required by law. If we accept your request, we will document any limits in writing and follow them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. 

  • Request confidential communications: You can ask that we send PHI to you at a different address or contact you about your health information in a certain way. We will say ‘yes’ to reasonable requests that provide specific directions for the alternative. You do not need to provide a reason for your request.  

  • Inspect and copy: You have the right to inspect and obtain a copy of much of the medical information that we maintain about you, with some exceptions. Usually, this information includes the medical record and billing records but also includes records used to make decisions about you. There are certain conditions in which we may deny your request. If we maintain the medical information electronically, and you ask for an electronic copy, we will provide the information to you n the form and format you request. If we cannot produce it in another readable electronic format you request, we will product it in another form we both agree to. If you direct us to transmit your medical information to another person or office, we will do so, provided your signed, written direction that clearly designates the recipient and location for delivery. To see or obtain a  copy of medical or billing information, please contact our office manager.  

  • Paper copy of this Notice: You can ask for a paper copy of this Notice at any time, even if you have asked to receive it electronically. You may request a paper copy from our front office. 

  • Notification in case of breach: We are required by law to notify you of a breach of your unsecured medical information. We will provide such notification to you without unreasonable delay but in no case later than 60 days after we discover the breach. 

  • How to exercise these rights: All requests to exercise these rights must be in writing. We will respond to your request on a timely basis in accordance with our written policies and as required by law.  


Revocation of Permission 

If you provide us with permission to use or disclose your medical information, you may revoke that permission at any time. Please send your request in writing to Release of Information to our front office. 

If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written revocation. We are unable to take back any disclosures previously made with your permission.  


Complaints and Questions 

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the US  Department of Health and Human Services. You will not be penalized for filing a complaint, and your care will not be compromised.


Contact Information 

  • For requesting a restriction, requesting an inspection or copy of your records, or revoking your permission to disclose your  medical information: 

    • Clay and Associates DDS, PLC

  • ​To file a complaint with the Secretary of the US Department of Health and Human Services 

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