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Privacy Practices
This notice describes how medical information about patients may be used and
disclosed and how patients can get access to this information. This is The
Health Insurance Portability and Accountability Act ("HIPAA") document.
Benjamin T. Watson, III, DDS, PLC
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
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 takes effect March 10, 2003, and
will remain in effect until we replace it.
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.
Before we make a significant change in our privacy practices, we will change
this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about
our privacy practices, or for additional 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 and disclose health information about you for treatment, payment, and
healthcare operations. For example:
Treatment: We may use or disclose your health information to a physician
or other healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain
payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information
in connection with our healthcare operations. Healthcare operations include
quality assessment and improvement activities, reviewing the competence or
qualifications of healthcare professionals, evaluating practitioner and provider
performance, conducting training programs, accreditation, certification, licensing
or credentialing activities.
Your Authorization: In addition to our use of your health information
for treatment, payment or healthcare operations, you may give us written authorization
to use your health information or to disclose it to anyone for any purpose.
If you give us an authorization, you may revoke it in writing at any time.
Your revocation will not affect any use or disclosures permitted by your authorization
while it was in effect. Unless you give us a written authorization, we cannot
use or disclose your health information for any reason except those described
in this Notice.
To Your Family and Friends: We must disclose your health information
to you, as described in the Patient Rights section of this Notice. We may disclose
your health information to a family member, friend or other person to the extent
necessary to help with your healthcare or with payment for your healthcare,
but only if you agree that we may 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, your general condition, or death. 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. We will also use our professional judgment and our experience
with common practice to make reasonable inferences of your best interest in
allowing a person to pick up filled prescriptions, medical supplies, x-rays,
or other similar forms of health information.
Marketing Health-Related Services: We will not use your health information
for marketing communications without your written authorization.
Required by Law: We may use or disclose your health information when
we are required to do so by law.
Abuse or Neglect: We may disclose your health information to appropriate
authorities if we reasonably believe that you are a possible victim of abuse,
neglect, or domestic violence or the possible victim of other crimes. We may
disclose your health information to the extent necessary to avert a serious
threat to your health or safety or the health or safety of others.
National Security: We may disclose to military authorities the health
information of Armed Forces personnel under certain circumstances. We may disclose
to authorized federal officials health information required for lawful intelligence,
counterintelligence, and other national security activities. We may disclose
to correctional institution or law enforcement official having lawful custody
of protected health information of inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose your health information
to provide you with appointment reminders (such as voicemail messages, postcards,
or letters).
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health
information, with limited exceptions. You may request that we provide copies
in a format other than photocopies. We will use the format you request unless
we cannot practicably do so. (You must make a request in writing to obtain
access to your health information. You may obtain a form to request access
by using the contact information listed at the end of this Notice. We will
charge you a reasonable cost-based fee for expenses such as copies and staff
time. You may also request access by sending us a letter to the address at
the end of this Notice. If you request copies, we will charge you $0.50 for
each page, $ 0 per hour for staff time to locate and copy your health information,
and postage if you want the copies mailed to you. If you request an alternative
format, we will charge a cost-based fee for providing your health information
in that format. If you prefer, we will prepare a summary or an explanation
of your health information for a fee. Contact us using the information listed
at the end of this Notice for a full explanation of our fee structure.)
Disclosure Accounting: You have the right to receive a list of instances
in which we or our business associates disclosed your health information for
purposes, other than treatment, payment, healthcare operations and certain
other activities, for the last 6 years, but not before April 14, 2003. If you
request this accounting more than once in a 12-month period, we may charge
you a reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional
restrictions on our use or disclosure of your health information. We are not
required to agree to these additional restrictions, but if we do, we will abide
by our agreement (except in an emergency).
Alternative Communication: You have the right to request that we communicate
with you about your health information by alternative means or to alternative
locations. (You must make your request in writing.) Your request must specify
the alternative means or location, and provide satisfactory explanation how
payments will be handled under the alternative means or location you request.
Amendment: You have the right to request that we amend your health
information. (Your request must be in writing, and it must explain why the
information should be amended.) We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice on our Web site or by
electronic mail (e-mail), you are entitled to receive this Notice in written
form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions
or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you
disagree with a decision we made about access to your health information or
in response to a request you made to amend or restrict the use or disclosure
of your health information or to have us communicate with you by alternative
means or at alternative locations, you may complain to us using the contact
information listed at the end of this Notice. You also may submit a written
complaint to the U.S. Department of Health and Human Services. We will provide
you with the address to file your complaint with the U.S. Department of Health
and Human Services upon request.
We support your right to the privacy of your health information. We will not
retaliate in any way if you choose to file a complaint with us or with the
U.S. Department of Health and Human Services.
Contact Officer: Benjamin T. Watson, III, DDS
Telephone: 757.873.3322 Fax: 757.873.8407
E-mail: MCVUR [at] aol [dot] com
Address: 729 Thimble Shoals Blvd., 7E, Newport News, VA 23606
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