Notice of Privacy Practices

Our commitment

Comfort Family Dental is required by law to maintain the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. PHI is information about you, including demographic information, that can reasonably be used to identify you and that relates to your dental or general health, care, or payment for care.

How we may use and disclose your information without your authorization

Treatment

We use your information to provide dental care and to coordinate it. If Dr. Rowe refers you to an oral surgeon, an orthodontist, or your physician, we share what that provider needs to treat you. If a dental laboratory fabricates a crown or an aligner for you, we send the laboratory what it needs to make it.

Payment

We use your information to bill and collect payment — submitting claims to your dental plan, verifying coverage and eligibility, obtaining pre-authorization for a proposed treatment, and, where necessary, pursuing an unpaid balance.

Health care operations

We use your information to run the practice: quality review, training our team and any students we host, licensing and accreditation, business planning, and audits.

Appointment reminders and health-related communication

We may contact you by phone, text message, email, or postcard to remind you of an appointment, to tell you results are ready, or to describe a treatment alternative or a service that may benefit you. Tell us if you prefer one channel over another, or none at all.

Other permitted uses

The law permits or requires disclosure in specific circumstances, including: as required by federal, state, or local law; public health activities and reporting of communicable disease; reporting suspected abuse, neglect, or domestic violence; health oversight activities such as licensure investigations; judicial and administrative proceedings under a subpoena or court order; law enforcement purposes as the law defines them; to coroners, medical examiners, and funeral directors; organ and tissue donation; approved research with privacy safeguards; to avert a serious and imminent threat to health or safety; specialized government functions including military and national security; and workers' compensation claims.

Uses that always require your written authorization

We will not use or disclose your information for marketing purposes, sell your information, or disclose psychotherapy notes without your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Your rights

• Inspect and copy. You may inspect and obtain a copy of your dental record. We will provide it in the form you request when we can readily do so, including electronically, generally within 30 days. A reasonable, cost-based fee may apply.
• Amend. If you believe something in your record is incorrect or incomplete, you may ask us in writing to amend it. We may deny the request if we did not create the record or if we determine it is accurate and complete, and we will explain the denial in writing.
• Accounting of disclosures. You may request a list of certain disclosures we made in the six years before your request, excluding those for treatment, payment, and operations and those you authorized.
• Request restrictions. You may ask us to restrict how we use or disclose your information. We are not required to agree, with one exception: if you pay in full out of pocket for a specific service, you may require us not to disclose that information to your health plan, and we must comply.
• Confidential communications. You may ask us to contact you at a specific number or address, or by a specific method. We will accommodate reasonable requests without asking why.
• Paper copy. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Breach notification. You will be notified if a breach occurs that compromises the privacy or security of your information.
• Choose someone to act for you. A personal representative with legal authority, or a parent or guardian of a minor patient, may exercise these rights on your behalf.

Our duties

We are required to maintain the privacy of your PHI, to provide this notice, and to abide by its terms. We reserve the right to change this notice and to make the revised notice effective for information we already hold as well as information we receive in the future. The current notice will always be posted in the office and on this page.

How to complain

If you believe your privacy rights have been violated, tell us. Ask for the Privacy Officer at the number below, or write to us at the address below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, by calling 1-877-696-6775, or at hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint.

Contact

Privacy Officer — Comfort Family Dental · 2036 W. 95th Street, Chicago, IL 60643 · 773-366-8718 · info@comfort-familydental.com