You can get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable fee.
You can ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Please know that our practice management software does not allow us to make any changes after the date of service. We will make an entry of your request but we are unable to actually make any changes.
You may request confidential communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
You may 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 to your request, and we may say “no” if it would affect your care. MINORS: In the case of a minor child where the parents are divorced, unless otherwise advised by written court order or divorce degree, we will assume that each parent has the authority to authorize treatment, receive information regarding the child’s treatment, can make appointments for the child, as the natural parent of the child. The parent that brings the child will also be responsible for any financial payments due at the time of service. If we are provided a copy of the divorce degree we will abide by that order. We may or may not advise the other parent that a request for information has been made.
If you pay for a service or health care item out- of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your benefit provider.. We will say “yes” unless a law requires us to share that information
You may get a list of those with whom we’ve shared information
You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable fee if you ask for another one within 12 months.
You may get a copy of this privacy notice
You may receive a written copy of this notice
You may choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
You may file a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting us or by contacting the Office of Civil Rights.
In certain situations, or conditions, you can tell us your choices about what we can share. If you have a clear preference for how we share your information in the situations described below, talk to us and let us know. Tell us what you want us to do, and we will follow your instructions.
If you are not able to tell us your preference or in the event of an emergency, we may go ahead and share your information if we believe it is in your best interest.We may also share yourinformation when needed to lessen a serious and imminent threat to health or safety.
We use your information to treat you
We can use your health information and share it with other professionals who are treating you including other dentist and healthcare professionals such as medical physicians, emergency personnel etc.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary and as necessary. This includes providing information to labs. We can also contact you via telephone, cell phone, leave a message and through text messages.
We can bill for our services
We can use and share your health information to seek payment from health plans, benefit providers or other entities
How else we can use your information?
We are may also use your information in other situations or ways that usually affect the public good.
We can share health information about you for certain situations such as:
We take patient privacy very seriously and attempt to take every precaution and safeguard to protect our patient’s health information. However, if we find that there has been a breach or misuse of your information, we will notify you as soon as possible that your information may have been compromised or misused.
Our Privacy and Security Officer is:
Dr. Donghyun Noh, DMD
555 Providence Highway, Unit 2,
Walpole, MA 02081