Brand Name

HIPAA

HIPAA Privacy Notice

This Notice Describes How Medical Information About You May Be Used and Disclosed and How You can Get Access to this Information.

Please Review it Carefully

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice will remain in effect until we replace it. You may request a copy of our Notice at any time. for more information about our privacy practices, or for additonal copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION

We use information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the qualitiy of care and service that you receive.

HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT

We may use information about your health when discussing your treatment with other dentists or other healthcare professionals providing treatment to you.

-The provision, coordination, or management of healthcare and related services by healthcare providers. – Consultation between health care providers relating to the patient. – The referral of a patient for healthcare from one healthcare provider to another, or appointment reminders and recall information.

FOR PAYMENT

We may use and disclose your health information to others for purposes of processing and receiving payment for treatment and/or services provided to you. This may include: – Billing and collection activities and related data processing. – Actions by a health plan or insurer to determine eligibility, pre-authorization for treatment or fulfill its responsibilities for coverage, adjudication or subrogation of health benefit claims. – Disclosure to consumer reporting agencies of information relating to collection of payments.

APPOINTMENTS, TREATMENT AND QUALITY ASSURANCE

We may use your information to provide appointment reminders or recall notices (such as voicemail messages, emails, postcards or letters) or information about treatment alternatives or other health-related benefits, products and services that may be of interest to you.

TO YOU, YOUR FAMILY AND FRIENDS

We must disclose your health information to you, as described in the Your Health Information Rights section of this Notice. We may disclose your health information to a family member, friend, or any other person to the extent necessary to help with your healthcare or with payment for your healthcare, but ONLY if you agree and authorize us to do so.

PERSONS INVOLVED IN CARE

We may use or disclose health information to notify, or assist in the notification of (Including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location or your general condition. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing ONLY health information that is directly relevant to the person’s involvement in your healthcare.

YOUR HEALTH INFORMATION RIGHTS

You have the following rights with respect to your protected health information which you can exercise by presenting a written request to the Privacy Officer: – The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, friends or any other person identified by you. – The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations. -The right to inspect and copy your protected health information. – The right to obtain a paper copy of this notice from us upon request. We reserve the right to change our privacy practices and the terms of this Notice at any 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. In the event we make a material change in our privacy practices, we will change this Notice and provide it to you at your next visitor it can be viewed on our website.

QUESTIONS

If you should have any questions about this Notice, please contact:

Privacy Officer:
Mark I. Khaimov, P.C.
184 Centre Street
Nutley, NJ 07110
Tel: 973-798-2639
Fax: 973-798-2640

DISCLAIMER: The information on this website is provided by MK Periodontics & Implant Dentistry and Dr. Mark Khaimov for informational purposes only and should not be considered medical advice.

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