The Dental Sedation Center Notice of Privacy Practices
Effective August 1, 2005
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.
Who Will Follow This Notice?
This notice describes the practices of The Dental Sedation Center and the practices that will be followed by all workforce members who handle your medical information.
Our Pledge Regarding Your Protected Health Information
The Dental Sedation Center understands that medical information about you and your health is personal. We are committed to protecting medical information about you.
We maintain our records and conduct our treatment environment with a goal of providing the highest level of protection for your medical information, while still providing you with the highest level of medical care.
This notice applies to all of the records of your medical care that are received or created by The Dental Sedation Center.
Your other medical treatment providers (e.g., doctors, hospitals, home health agencies) may have different policies or notices regarding the use and disclosure of your medical information.
This notice will tell you about the ways in which we may use and disclose medical information about you.
Your medical information, also referred to as protected health information, is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health and related health care services.
In this notice, we also describe your rights and certain obligations regarding the use and disclosure of your protected health information.
We are required by law to:
- Make sure that medical and other information that identifies you (protected health information) is kept private.
- Give you this notice of our legal duties and privacy practices with respect to protected health information about you.
- Follow the terms of the notice that is currently in effect.
Uses and Disclosures for Treatment, Payment, and Health Care Operations
By becoming a patient at The Dental Sedation Center, you give consent for us to use your protected health information for certain activities, including treatment, payment, and health care operations (often referred to as “TPO”).
We may use and disclose protected health information about you so that our medical professionals can treat you. For example, we may use your past medical information to diagnose your present condition, or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care.
We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide. For example, we will submit protected health information about you to your insurance company in order to receive payment for services we have provided.
We may also use and disclose protected health information about you for The Dental Sedation Center’s health care operations. For example, we may use your protected health information to evaluate how we can better meet your needs, or we may provide protected health information about you to an auditor who reviews our books so that we can keep our license to provide medical services in CA.
Other Uses and Disclosures of Your Protected Health Information
The following uses of your protected health information may be made without any additional authorization from you. (Not every use or disclosure is listed, but all uses and disclosures made by us are only those permitted under the law.)
- Licensure proceedings by the American Board of Plastic Surgery.
Uses and Disclosures for Appointment Reminders
We may use and disclose your medical information to contact you as a reminder that you have an appointment at the office.
If you request that such communications be made confidentially, please contact our office in writing at:
9025 Wilshire Blvd #307
Beverly Hills, CA 90211
We will accommodate all reasonable requests.
Uses and Disclosures to Others Involved in Your Healthcare
We may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your medical care.
If you are unable to agree or object, we may disclose such information as necessary if we determine it is in your best interests based on our professional judgment.
We may also notify a family member, personal representative, or any other person responsible for your care about your location, general condition, or death.
We may also use or disclose your protected health information to assist in disaster relief efforts.
Uses and Disclosures in Emergency Situations
We may use or disclose your protected health information in an emergency treatment situation.
If this happens, your physician will attempt to obtain your acknowledgment of this Notice as soon as reasonably practicable after treatment.
Uses and Disclosures for Health‑Related Benefits or Services
From time to time, we may use and disclose protected health information to tell you about certain health‑related benefits or services that may be of interest to you.
Uses and Disclosures Required by Law
We will use or disclose protected health information about you when required to do so by federal, state, or local law.
You will be notified, if the law requires us to do so, of any such uses or disclosures.
We must also make disclosures to you and, when required, to the Secretary of Health and Human Services to determine our compliance with the law.
Uses and Disclosures Related to Communicable Diseases
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading the disease.
Disclosures for Health Oversight Activities
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These activities allow the government to monitor the health care system, government programs, and civil rights laws.
Disclosures of Abuse or Neglect
We may disclose your protected health information to a public health authority authorized by law to receive reports of child abuse or neglect.
We may also disclose information if we believe you have been a victim of abuse, neglect, or domestic violence, as allowed under CA law.
Disclosures to the Food and Drug Administration (FDA)
We may disclose your protected health information to persons or companies required by the FDA to:
- Report adverse events
- Report product defects
- Enable recalls
- Track products
- Conduct post‑market surveillance
Disclosures for Lawsuits and Disputes
We may disclose protected health information about you in response to:
- A court order
- An administrative order
- A subpoena
- A discovery request
- Other lawful processes
We will ensure that proper attempts have been made to notify you or otherwise protect your information.
Disclosures to Law Enforcement
We may release protected health information if asked by law enforcement in response to:
- A court order
- Subpoena
- Warrant
- Summons
- Similar lawful processes
Other disclosures may relate to national security, intelligence activities, or protection of the President.
Disclosures to Coroners, Funeral Directors, and for Organ Donation
We may disclose protected health information to coroners, medical examiners, funeral directors, or organ donation agencies when necessary to carry out their duties.
Disclosures for Research
We may disclose your protected health information to approved researchers when protocols are in place to protect your privacy. We may also disclose a limited set of information, as allowed by law.
Disclosures Related to Criminal Activity
We may disclose protected health information if necessary to prevent or lessen a serious threat to the public or an individual.
We may also assist law enforcement in identifying a suspect, witness, or victim.
Disclosures for Workers’ Compensation
We may disclose protected health information for Workers’ Compensation or similar programs that provide benefits for work‑related injuries.
Your Rights Regarding Protected Health Information
Right to Inspect and Copy
You have the right to inspect and copy protected health information used to make decisions about your medical care.
Requests must be submitted in writing. A fee may apply for copying or mailing.
Right to Request Restrictions
You may request restrictions on how we use or disclose your protected health information.
We are not required to agree, but if we do agree, we will follow the restriction unless needed for emergency treatment.
Requests must be submitted in writing.
Right to Confidential Communications
You may request confidential communications by alternative means (for example, by mail only or at your workplace).
Requests must be submitted in writing to:
9025 Wilshire Blvd #307
Beverly Hills, CA 90211
We will accommodate all reasonable requests.
Right to Amend
You may request an amendment to your protected health information if you believe it is incorrect or incomplete.
Only the entity that created the information is responsible for amending it. For details, contact (310) 271‑7727.
Right to an Accounting of Disclosures
You may request an accounting of disclosures of your protected health information for up to six years prior to your request.
Requests must be made in writing and cannot include dates before August 1, 2005.
Right to a Paper Copy of This Notice
You may request a paper copy of this notice at any time.
A copy is also available at: www.dentalsedationcenter.com
Changes to This Notice
We reserve the right to modify this notice and make the changes effective for all current and future protected health information.
The most current notice will always be available on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Office Manager at (310) 271‑7727 or with the Secretary of Health and Human Services.
You will not be penalized for filing a complaint.
Other Uses of Protected Health Information
Other uses not covered by this notice will only be made with your written authorization.
You may revoke this authorization in writing at any time, but we cannot undo disclosures already made.
Questions?
If you have questions about this notice, please contact the Office Manager at:
(310) 271‑7727