This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Hinsdale Dental, LLC (“we,” “us,” or “our”) is required by law to maintain the privacy of your protected health information (“PHI”) and to provide you with this Notice of our legal duties and privacy practices.
Our Legal Duties
We are required by law to:
- Maintain the privacy and security of your protected health information
- Provide you with this Notice of our legal duties and privacy practices
- Follow the terms of the Notice currently in effect
- Notify you if a breach occurs that may have compromised the privacy or security of your information
How We May Use and Disclose Your Information
We may use and disclose your protected health information without your written authorization for the following purposes:
Treatment
We may use your information to provide, coordinate, or manage your dental or medical care.
Payment
We may use and disclose your information to bill and collect payment from you, your insurance company, or other third parties.
Healthcare Operations
We may use and disclose your information for administrative, operational, and quality improvement activities.
Appointment Reminders and Communication
We may contact you to remind you of appointments, follow up on treatment, or provide information about treatment options and services.
Individuals Involved in Your Care
We may share information with a family member or other person involved in your care unless you object.
Required by Law
We may disclose your information when required to do so by federal, state, or local law.
Public Health and Safety
We may disclose information for public health activities or to prevent a serious threat to health or safety.
Uses and Disclosures Requiring Authorization
Other uses and disclosures not described in this Notice will be made only with your written authorization.
You may revoke your authorization at any time in writing. A revocation will not apply to information we have already used or disclosed in reliance on your authorization.
Your Rights Regarding Your Health Information
You have important rights regarding how your health information is used and disclosed, including the rights listed below:
Inspect and Obtain a Copy
Request access to your health records. We may charge a reasonable, cost-based fee as permitted by law.
Request an Amendment
Request correction of inaccurate or incomplete information in your record.
Request Restrictions
Request limits on certain uses and disclosures. We are not required to agree to all requested restrictions, but we will comply with a request to restrict disclosure of information to a health plan when you have paid out of pocket in full for the item or service, as required by law.
Request Confidential Communications
Request that we contact you in a specific way (for example, only by mail, only at a specific phone number, or only at work). We will accommodate reasonable requests.
Receive an Accounting of Disclosures
Request a list of certain disclosures we have made of your information, as permitted by law.
Obtain a Paper Copy of This Notice
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
How to Exercise Your Rights
To exercise any of the rights described in this Notice, please submit your request in writing to the contact information listed below. We may ask you to complete a form and verify your identity before processing your request.
Changes to This Notice
We reserve the right to change this Notice at any time. The revised Notice will be effective for all information we maintain and will be posted on our website and available at our office.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services.
You will not be penalized for filing a complaint.
Contact Information
Hinsdale Dental, LLC
101 S Garfield St
Hinsdale, IL 60521
Phone: (630) 323-5200
Email: info@hinsdaledental.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
