THIS NOTICE DESCRIBES HOW DENTAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective January 1, 2015
The American Society of Implant and Reconstructive Dentistry LLC (“ASIRD”) is required by law to protect the privacy of your health information. We are also required to send you this notice, which explains how we may use personally identifiable information about you and when we can give out or “disclose” that information to others. You also have rights regarding your health information that are described in this notice. We are required by law to abide by the terms of this notice.
The terms “information,” “health information,” or “personal health information” in this notice include any information we maintain that reasonably can be used to identify you and that relates to your physical or mental health condition, the provision of health care to you, or the payment for such health care. We will comply with the requirements of applicable privacy laws related to notifying you in the event of a breach of your health information.
We have the right to change our privacy practices and the terms of this notice. If we make a material change to the privacy practices contained in this notice, we will provide to you either a revised notice or information about the material change and how to obtain a revised notice. We will provide you with this information either by direct mail or electronically, in accordance with applicable law. In all cases, we will post the revised notice on our Website, www.asird.org. We reserve the right to make any revised or changed notice effective for information we already have and for information we receive in the future.
ASIRD collects and maintains oral, written and electronic information to administer our business and to provide products, services and information of importance to customers. We maintain physical, electronic and procedural security safeguards in the handling and maintenance of customer information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction or misuse.
How We Use or Disclose Information
We must use and disclose your health information to provide that information:
- to you or someone who has the legal right to act for you (your personal representative) in order to administer your rights as described in this notice; and
- to the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected
We have the right to use and disclose health information to provide that information:
- For Evaluation of Treatment by Member Health Care Providers that you Request to Receive Such Information. We may use or disclose health information to aid in your treatment or the coordination of your care. For example, we will disclose information to your surgeons/dentists to help them provide evaluaton and if you consent dental care to you.
- For Health Care Operations. We may use or disclose health information as necessary to operate and manage our business activities. For example, we might analyze data to determine how we can improve our services.
We may use or disclose your health information for the following purposes under limited circumstances:
- As Required by Law. We may disclose information when required to do so by law.
- To Persons Involved With Your Care. We may use or disclose your health information to a person involved in your care, such as a family member, when you are incapacitated or in an emergency, or when you agree or fail to object when given the opportunity. If you are unavailable or unable to object, we will use our best judgment to decide if the disclosure is in your best interests. Special rules apply regarding when we may disclose health information to family members and others involved in a deceased individual’s care.
- For Public Health Activities such as reporting or preventing disease outbreaks to a public health authority.
- For Reporting Victims of Abuse, Neglect or Domestic Violence to government authorities that are authorized by law to receive such information, including a social service or protective service agency.
- For Health Oversight Activities to a health oversight agency for activities authorized by law, such as licensure, governmental audits and fraud and abuse investigations.
- For Judicial or Administrative Proceedings such as in response to a court order, search warrant or subpoena.
- For Law Enforcement Purposes. We may disclose your health information to a law enforcement official for purposes such as providing limited information to locate a missing person or report a crime.
- To Avoid a Serious Threat to Health or Safety to you, another person, or the public, by, for example, disclosing information to public health agencies or law enforcement authorities, or in the event of an emergency or natural disaster.
- For Workers’ Compensation as authorized by, or to the extent necessary to comply with, state workers’ compensation laws that govern job-related injuries or illness.
- To Business Associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us and pursuant to federal law, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract and as permitted by federal law.
- Additional Restrictions on Use and Disclosure. Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. “Highly confidential information” may include confidential information under Federal laws governing alcohol and drug abuse information and genetic information as well as state laws that often protect the following types of information: HIV/AIDS; mental health; genetic tests; alcohol and drug abuse; sexually transmitted diseases and reproductive health information; and child or adult abuse or neglect, including sexual assault.
If a use or disclosure of personal health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.
Except for uses and disclosures described and limited as set forth in this notice, we will use and disclose your health information only with a written authorization from you. We assume that if you provide information to use and seek to have it disclosed to a Participating Dentist that you consent to the Disclosure of such information to that Dentist. This includes, except for limited circumstances allowed by federal privacy law, not selling your health information to others, or using or disclosing your health information for certain promotional communications that are prohibited marketing communications under federal law, without your written authorization. Once you give us authorization to release your health information, we cannot guarantee that the recipient to whom the information is provided will not disclose the information. You may take back or “revoke” your written authorization at any time in writing by contacting us at the address shown below.
What Are Your Rights?
The following are your rights with respect to your health information:
- You have the right to ask to restrict uses or disclosures of your health information for treatment, payment, or health care operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in your health care or payment for your health care. Please note that while we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.
- You have the right to ask to receive confidential communications of information in a different manner or at a different place (for example, by sending information to a P.O. Box instead of your home address). We will accommodate reasonable requests where a disclosure of all or part of your health information otherwise could endanger you. In certain circumstances, we will accept your verbal request to receive confidential communications; however, we may also require you confirm your request in writing. In addition, any requests to modify or cancel a previous confidential communication request must be made in writing. Mail your request to the address listed below.
- You have the right to see and obtain a copy of health information we maintain about you. We may charge a reasonable fee for any copies. However, under federal law, you may not inspect or copy health information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. In some circumstances, a decision to deny access may be reviewable. Please contact us at the address below if you have questions about access to your health information.
- You have the right to ask to amend certain health information we maintain about you if you believe the health information about you is wrong or incomplete. Your request must be in writing and provide the reasons for the requested amendment. Mail your request to the address listed below. In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact us at the address below if you have questions about amending your health information.
- You have the right to receive an accounting of certain disclosures of your information made by us during the six years prior to your request. This accounting will not include disclosures of information made: (i) for treatment, payment, and health care operations purposes; (ii) to you or pursuant to your authorization; and (iii) to correctional institutions or law enforcement officials; and (iv) other disclosures for which federal law does not require us to provide an accounting. Please contact us at the address below if you would like to receive an accounting of disclosures or if you have questions about this right.
- You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You also may also print a copy of this notice on our Website.
- You have the right to be notified following a breach of unsecured health information. We will notify you in writing, at the address on file, if we discover an unauthorized acquisition, access, use, or disclosure of unsecured health information which compromises the security or privacy of such information.
Exercising Your Rights
- Contacting ASIRD. If you have any questions about this notice or want information about exercising your rights, please call (754) 307-6990.
- Submitting a Written Request. Mail to us your written requests to exercise any of your rights, including modifying or cancelling a confidential communication, requesting copies of your records, or requesting amendments to your record, at the following address:
1650-302 Margaret Street, #349
Jacksonville, FL 32204
- Filing a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us at the address above.
You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint.