HIPAA 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.
Dental Gallery
102 W. El Dorado Blvd., Suite C1
Friendswood, Texas 77546
281-990-8448
info@dentalgalleryfriendswood.com
This Notice of Privacy Practices describes how your protected health information may be used and disclosed and explains how you may access and exercise your rights regarding this information. You should review this Notice carefully.
For purposes of this Notice, the term “HIPAA” refers to the Health Insurance Portability and Accountability Act of 1996 and all implementing regulations including the HIPAA Privacy Rule, the HIPAA Security Rule, the Breach Notification Rule, and the Health Information Technology for Economic and Clinical Health Act. HIPAA establishes national standards governing the privacy and security of protected health information, requires healthcare providers to maintain appropriate safeguards, and grants individuals specific rights regarding access to their health information.
This Notice also complies with the Texas Medical Records Privacy Act contained in Texas Health and Safety Code Chapter 181, which in certain circumstances provides greater privacy protections than federal HIPAA, and the rules of the Texas State Board of Dental Examiners in 22 Texas Administrative Code §§108.1–108.8 regarding dental records, confidentiality, retention, and release requirements. When Texas law is more stringent than federal law, Dental Gallery follows Texas law.
Dental Gallery is required by law to maintain the privacy of your protected health information, to provide you with this Notice of our legal duties and privacy practices, and to abide by the terms of the Notice that is currently in effect.
Dental Gallery must notify you following a breach of your unsecured protected health information consistent with the federal Breach Notification Rule, including providing notice without unreasonable delay and no later than 60 days after discovery of a breach, as required under 45 C.F.R. §§164.400–414 and the Texas Breach Notification Law found in Texas Business & Commerce Code §521.053, including notification to the Texas Attorney General if the breach involves 250 or more Texas residents.
Protected health information refers to information about you, including demographic information, that identifies you or could reasonably identify you and relates to your past, present, or future physical or mental health or condition, the provision of healthcare to you, or payment for healthcare services. Protected health information may exist in written, oral, electronic, or any other form.
Electronic protected health information includes data contained in electronic health record systems, metadata, audit logs, images, diagnostic files, and all associated digital information to the extent such information constitutes protected health information under applicable law.
Uses and Disclosures of Protected Health Information
Under HIPAA and Texas law, Dental Gallery may use or disclose your protected health information for treatment, payment, and healthcare operations without obtaining your written authorization.
Treatment refers to the provision, coordination, or management of your dental or medical care, which may include communication with physicians, specialists, laboratories, pharmacies, imaging centers, or other providers involved in your care.
Payment refers to activities such as insurance verification, claims submission, billing, and obtaining payment for services, which may require the disclosure of relevant protected health information to your health plan.
Healthcare operations include quality assessment, credentialing, auditing, training, practice management, licensing activities, and other administrative functions.
Dental Gallery may electronically disclose your protected health information to another dentist, physician, healthcare provider, health plan, or healthcare entity for treatment, payment, or healthcare operations as permitted by Texas Health and Safety Code §181.154. Texas law generally requires authorization for electronic disclosure of protected health information unless an exception applies, including certain disclosures to covered entities for treatment, payment, or healthcare operations, or disclosures otherwise authorized or required by law. Dental Gallery provides a separate Texas Electronic Disclosure Notice for additional information.
Dental Gallery may use or disclose your protected health information when required by federal, state, or local law. Examples include public health reporting, reporting communicable diseases, reporting abuse or neglect, responding to subpoenas or court orders, complying with health oversight activities, cooperating with law enforcement, assisting coroners or funeral directors, responding to national security requests, facilitating organ donation, assisting with workers’ compensation programs, and other legally mandated disclosures.
If you are an inmate or in the custody of law enforcement, Dental Gallery may disclose your protected health information to the appropriate authorities when legally authorized.
Dental Gallery may contact you to remind you of appointments or inform you of treatment alternatives or health-related benefits and services that may be of interest to you.
Dental Gallery may conduct fundraising activities and may contact you for such purposes. You have the right to opt out of receiving fundraising communications at any time, and your decision will not affect your treatment, benefits, or access to care.
Dental Gallery will not use or disclose your protected health information for marketing purposes without your written HIPAA Marketing Authorization, including any marketing communication involving financial remuneration from a third party, as required under 45 C.F.R. §164.508(a)(3), except when the communication meets an exception under 45 C.F.R. §164.501, such as face-to-face communications or the provision of a promotional gift of nominal value.
Dental Gallery will not sell your protected health information without your explicit written authorization.
Dental Gallery will not use or disclose psychotherapy notes except as permitted by law.
Dental Gallery will not use or disclose genetic information for underwriting purposes as prohibited by the Genetic Information Nondiscrimination Act and 45 C.F.R. §164.502(a)(5).
Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time except to the extent that Dental Gallery has acted in reliance on the authorization.
Your Rights Regarding Your Protected Health Information
You have the right to inspect and obtain a copy of your protected health information in paper or electronic form. You may request that Dental Gallery transmit an electronic copy of your records to a third party of your choosing.
Federal and Texas law require that electronic health records maintained in an electronic system capable of fulfilling the request be provided within fifteen business days under Texas Health and Safety Code §181.102. All other dental records must be provided within thirty days under TSBDE Rule 22 TAC §108.8. Dental Gallery will not withhold records because of an unpaid balance. Reasonable copying fees permitted by Texas law may apply.
You also have the right to request that Dental Gallery transmit an electronic copy of your protected health information to any designated third party you identify, in any format you choose, as permitted under 45 C.F.R. §164.524(c)(3)(ii).
You have the right to request restrictions on how your protected health information is used or disclosed for treatment, payment, or healthcare operations. Dental Gallery is not required to agree to a requested restriction, except when you request that Dental Gallery not disclose information to your health plan regarding a service for which you have paid in full out of pocket as required by 45 C.F.R. §164.522(a)(1)(vi).
You have the right to request that Dental Gallery communicate with you by alternative means or at alternative locations. Dental Gallery will accommodate reasonable requests. You also have the right to request confidential communications, including by requesting reasonable alternative means or locations for communications.
You have the right to request an amendment to your protected health information if you believe it is inaccurate or incomplete. If Dental Gallery denies your request, you have the right to submit a written statement of disagreement, and Dental Gallery may respond with a rebuttal.
You have the right to receive an accounting of certain disclosures of your protected health information made by the Dental Gallery six years prior to your request, excluding disclosures made for treatment, payment, and healthcare operations, disclosures made pursuant to your authorization, and other exceptions permitted by law.
Record Retention
Dental Gallery maintains dental records in accordance with TSBDE Rule 22 TAC §108.8, which requires retention for at least five years after the last date of treatment for an adult patient and at least five years after a minor patient reaches the age of eighteen.
You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Dental Gallery posts the current Notice in the office and on its website and makes it available upon request at each visit.
Complaints
If you believe your privacy rights have been violated, you may submit a complaint to the Dental Gallery HIPAA Compliance Officer, to the Office for Civil Rights of the United States Department of Health and Human Services, or to the Texas State Board of Dental Examiners. You will not be retaliated against for filing a complaint.
This Notice is posted prominently in our office and on our website.
All questions regarding this Notice should be directed to the HIPAA Compliance Officer.
HIPAA Compliance Officer: Dr. Behnaz Saeedi
Phone: 281-990-8448
Email: admin@dentalgalleryfriendswood.com