Privacy NoticePrivacy Practices 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.
Essentials Dental is committed to providing you with the highest quality of care in an environment that protects your privacy and the confidentiality of your health and dental information. To that end, this notice explains our privacy practices as well as your rights, regarding your health and dental information. Your Rights
When it comes to your health and dental information, you have certain rights. This section explains your rights and how to exercise them. Specifically, you have the right to:
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your dental 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, cost-based fee. Ask us to correct or amend your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete.
We may say “no” to your request, but we will tell you why in writing, usually within 60 days of your request.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 requestsAsk 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 these requests. For example, we may say “no” if it would affect your care.
If you pay for a service or dental 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 health insurer. We will say “yes” unless a law requires us to share that information.Obtain a list of those with whom we’ve shared your information
You can ask us for a list (accounting) of the instances we have shared your health information for six years prior to the date you ask, with whom we shared it, and why.
We will include all the disclosures except for those about treatment, payment, or health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting per year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
We will provide you with a paper copy promptly.Choose someone to act for you
If you have given someone health care power of attorney or if someone is your legal guardian, that person (your “personal representative”) can exercise your rights and make choices about your health information.
If someone has been appointed to act for you, a copy of the document appointing that person must be provided to us. We will make reasonable efforts to ensure the person has this authority and can act for you before we take any action.File a complaint if you feel your rights are violated
Protecting your confidential information is important to us. If you feel we have violated your rights, please contact us using the information at the end of this Notice.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, SW, Washington, DC 20201, calling 1.877.696.6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint either to NM or to the Office for Civil Rights.
Please ask us how to accomplish any of the above items by contacting us using the information at the end of this Notice. You may have to complete a form and submit your request in writing. For example, to obtain a copy, amend or restrict your dental records, or to receive a listing of disclosures you must fill out a form.Your ChoicesFor certain information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
Share information with your family, close friends or others involved in your care.
Share information in a disaster relief situation.
If you are not able to tell us your preference (for example, if you are unconscious), we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. We never share your information unless you give us written authorization:
Sale of your information In the case of fundraising:
We may contact you for fundraising purposes to support Essentials Dental and its mission, but you can tell us not to contact you again for this purpose. How Essentials Dental May Use and Share Your Health Information
Essentials Dental may, without your written permission, use your health information within Essentials Dental and share or disclose your dental information to others outside Essentials Dental in the following ways:
For treatment, payment, and healthcare operations Essentials Dental may use and disclose your health information without your written authorization for treatment, payment, and health care operations.
Essentials Dental may use your dental information and share it with other professionals who are treating you.
Note, however, that we may ask for your written permission if certain kinds of information are being disclose.
Essentials Dental may keep your information electronically using Open Dental an electronic record system. In
addition, many dentists and doctors across the United States also use Open Dental.
Essentials Dental may use and share your dental information to bill and get payment from dental plans or other
entities. For example, we may send dental information about you to your dental insurance plan so it will pay for
your services. We may also disclose your information to other providers for their payment activities.
Essentials Dental may use and disclose your health information to run our organization, improve your care, and
contact you when necessary. For example, we use dental and health information to manage your treatment and
services, including to contact you to remind you that you have an appointment for medical care. We may also
disclose information to doctors, hygienists, clinicians, dental assistants, and other authorized personnel for
educational and learning purposes.Essentials Dental may disclose your health information without your written permission:
With some limited exceptions, to you or someone who has the legal right to act on your behalf (your personal representative).
To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected.
When required by law.
Other purposes for which Essentials Dental is allowed or required to use or disclose your information to others without your written permission in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: hhs.gov/ocr/privacy/ hipaa/understanding/consumers/index.html.
To help with public health and safety issues Essentials Dental may share health information about you for certain
situations such as:
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
To respond to lawsuits and legal actions Essentials Dental may disclose dental and/or health information about you in
response to a court or administrative order, or non-sensitive information in response to a subpoena if there is a
qualified protective order or satisfactory assurances.
To business associates Essentials Dental may disclose your information to our “business associates” — individuals or
companies that provide services to Essentials Dental. For example, a business associate would include the company
that administers the billing claims for Essentials Dental, a software vendor, or other service providers. Essentials
Dental requires that business associates keep your information safe.
To parents and legal guardians of minors Essentials Dental may share a minor’s health and dental information with his
or her parents or guardians unless such disclosure is otherwise prohibited by law. For example, a minor’s parents may
discuss treatment with the care team. Note, however, that if a minor is emancipated, married, pregnant or a parent, we
will not share information with the minor’s parents or guardians. Additional State and Federal Requirements Some Illinois and federal laws provide additional privacy protection of your health information. These include: Sensitive health information.
Some types of health information are particularly sensitive, and the law, with limited exceptions, may require that we obtain your written permission or in some instances, a court order, to use or disclose that information. Sensitive health information includes information dealing with mental health and developmental disabilities, HIV/AIDS, alcohol and drug abuse treatment, genetic testing, and genetic counseling. Prior to receiving care from Essentials Dental, a patient signs, where required by law, a consent to allow Essentials Dental to use and disclose sensitive dental and health information in the same way that the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) allows us to use and share non-sensitive dental and health information for treatment, payment and operations as described in this Notice. For example, Essentials Dental may use and share sensitive dental health information in order to better coordinate care for patients.Information used in certain disciplinary proceedings.
State law may require your written permission if certain dental and/or health information is to be used in various review and disciplinary proceedings by state health oversight boards (such as the Department of Professional Regulation). Information used in certain litigation proceedings.
State law may require your written permission for certain providers to disclose information in certain legal proceedings. Disclosures to certain registries.
Some laws require your written permission if we disclose your information to certain state-sponsored registries. Essentials Dental is committed to following all state and federal legal requirements. Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this Notice and offer you a written copy of it.
We will not use or share your information other than as described here unless you tell us we can do so in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. Changes to This Notice
We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request and at many of the offices where we treat patients, and on our website. However, any changes to the terms will not change Essentials Dentals commitment to complying with applicable laws and ensuring the privacy of patient information. Who Will Follow This Notice?
If you have any questions about this Notice, or any complaints, please contact Essentials Dental at 630-893-1300.
EFFECTIVE DATE OF THIS NOTICE This Notice is effective as of March 1st, 2022.