Dental & Maxillofacial Radiography and Photography

 
 

 

 

Privacy Policy

NOTICE OF PRIVACY PRACTICE

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 PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

We are required by applicable federal and state law, including the Health Insurance Portability & Accountability Act of 1996 (HIPAA), to maintain the privacy of your Health information. We are also required to provide you this notice about our privacy practices our legal duties and your rights concerning your health information.

You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information at the bottom of this form.

We reserve the right to change our privacy practice and the terms of this notice at any given time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes.

We may use and disclose health information about you for the following purposes: Treatment, Payment and Health Care Operations:

  1. Treatment: We may use your health information to treat you or disclose your health information to a physician or other health care provider providing treatment to you.
  2. Payment: We may use and disclose your health information to obtain payment for services we provide.
  3. Health Care Operations: We may use and disclose your health information in connection with the normal course of operation of our practice, Health care operations may also include quality assessment activities, performance evaluations, conducting training programs, accreditation, and certification, licensing or credentialing activities.

Any other uses or disclosures of your health information will only be made with your written authorization or in response to legal requirements such as disaster relief, court orders suspected abuse, neglect, or domestic violence, or in certain instances affecting national security.

We may use or disclose your health information when we are required to do so by law.

We will not use your health information for marketing communications without your written authorization.

You have the following rights with respect to your protected health information which you may exercise by written request using the contact information above:

  1. The right to request additional restrictions on the use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement which must be in writing.
  2. The right to inspect and copy your protected health information.
  3. The right to request amendments to your protected health information.
  4. The right to receive an accounting of disclosures of your personal health information for other treatment, payment, health care operations or pursuant to other authorized disclosures as stated above.
  5. The right to obtain a copy of this notice.

If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or is response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed below. You also may submit a written complaint to the U.S. Department of Health and Human Services upon request.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

This Privacy Policy takes effect April 14, 2003 and will remain in effect until we replace it.

Orange Coast Dental X-ray Lab
19012 Brookhurst Street
Huntington Beach, CA 92646
(714) 964-6440

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