Notice of Privacy 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.
Our Commitment to Your Privacy
Mercado Dental Studio is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices, and to follow the terms of the Notice currently in effect. We reserve the right to change this Notice and to make the revised Notice effective for information we already have as well as information we receive in the future.
How We May Use and Disclose Your Health Information
We may use and disclose your protected health information for the following purposes without your separate authorization:
- Treatment. To provide, coordinate, or manage your dental care, including sharing information with other providers, specialists, or dental laboratories involved in your care.
- Payment. To bill and collect payment for the treatment and services you receive, including verifying insurance coverage and submitting claims.
- Health care operations. For activities necessary to run the practice, such as quality assessment, staff training, and appointment scheduling and reminders.
- As required by law. When federal, state, or local law requires the use or disclosure, including public health, safety, and law enforcement situations.
Uses and Disclosures That Require Your Authorization
Most uses and disclosures of psychotherapy notes (where applicable), uses and disclosures for marketing purposes, and any sale of protected health information require your written authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, which you may revoke at any time in writing.
Your Rights Regarding Your Health Information
You have the right to:
- Inspect and obtain a copy of your dental and billing records.
- Request a correction or amendment to your health information.
- Request restrictions on certain uses and disclosures of your information.
- Request to receive confidential communications by alternative means or at an alternative location.
- Receive an accounting of certain disclosures of your health information.
- Obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.
- Be notified following a breach of your unsecured protected health information.
Our Responsibilities
We are required to maintain the privacy and security of your protected health information, notify you promptly if a breach occurs that may have compromised the privacy or security of your information, and follow the duties and privacy practices described in this Notice.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.
Contact
To exercise any of your rights, to request a full copy of this Notice, or to ask a question about our privacy practices, contact our office at (916) 448-5458 or visit us at 1029 56th Street, Sacramento, CA 95819.
A complete printed Notice of Privacy Practices is available at our office and will be provided to you at your first visit. This web summary is provided for your convenience and does not replace the full Notice.