HIPAA Notice of Privacy Practices

Wellness Dental
Privacy Officer: privacy@mywellnessdental.com · 623-267-4097 · 2735 S Alma School Rd, Ste 1, Chandler, AZ 85286

Your rights

• Access and copies. Ask to inspect or receive an electronic or paper copy of your dental records and other information in our designated record set. We ordinarily respond within 30 days; if we need more time, we will tell you why in writing. Any fee will comply with applicable law. If we deny access, we will explain why and any review rights you have.
• Corrections. Ask us in writing to amend information you believe is inaccurate or incomplete, and explain why. We ordinarily respond within 60 days. If we deny your request, we will explain why and how you may submit a statement of disagreement.
• Confidential communication. Ask us to contact you by a particular method or at a different address. We accommodate reasonable requests.
• Restrictions. Ask us to limit uses or disclosures for treatment, payment or healthcare operations. We generally need not agree, except that we must honor a request not to disclose to a health plan, for payment or operations, information about a service you paid for in full out of pocket, unless disclosure is required by law.
• Accounting of disclosures. Request a list of certain disclosures we made during the six years before your request. This generally excludes treatment, payment, operations, authorized and other legally excluded disclosures. The first list in a 12-month period is free; we will tell you in advance of any charge for additional requests.
• Paper copy and representatives. Get a paper copy of this notice at any time, even if you accepted an electronic copy. A legally authorized personal representative may exercise these rights for you.

How we use and disclose your information

Treatment, payment and healthcare operations. We may use and disclose your information to treat you, obtain payment and run our practice. Examples include sharing relevant records with another treating dentist, submitting information to your insurer, and reviewing records to improve care. Business associates may help with billing, records, technology and administration under required safeguards and agreements.

People involved in your care. You may tell us whether we may share relevant information with family, friends or others involved in your care or payment, or for disaster relief. If you cannot express a preference, we may use professional judgment to act in your best interest.

Appointment reminders. We may contact you with appointment reminders by phone, text, email or mail, using the contact information you give us.

Other permitted or required disclosures. Subject to legal conditions, we may use or disclose information for public health and safety; product recalls or adverse-event reporting; reports of abuse, neglect or domestic violence; preventing a serious and imminent threat; health oversight; workers’ compensation; qualifying law-enforcement requests; special government functions, including military and national security; research that meets legal requirements; organ donation; and coroners, medical examiners or funeral directors. We may respond to court or administrative orders, subpoenas or other lawful process only when legal requirements are met. We disclose information when required by law, including to the U.S. Department of Health and Human Services.

Uses that require your written authorization

Uses and disclosures not described in this notice require your written authorization, including most marketing and any sale of your health information. You may revoke an authorization in writing at any time, except to the extent we have already relied on it. Agreeing to receive website cookies or text messages is not a HIPAA authorization.

Specially protected records

If we receive substance use disorder treatment records protected by federal law (42 CFR Part 2), we will not use or disclose them in civil, criminal, administrative or legislative proceedings against you without your written consent or a qualifying court order. Where state law gives your records more protection, we follow it.

Our responsibilities

We are required by law to protect the privacy of your health information, give you this notice, and follow the practices described in the notice currently in effect. We will notify you following a breach of unsecured protected health information as required by law. Information disclosed as permitted by this notice may be redisclosed by the recipient and may no longer be protected by HIPAA.

We do not maintain a patient directory or use your health information for fundraising.

Record retention

We keep dental records as Arizona law requires: generally at least six years after your last visit, and longer for patients treated as minors.

Changes to this notice

We may change this notice, and the change may apply to information we already hold. The current notice, with its effective date, will be available on our website, at each office and on request.

Questions, requests and complaints

To exercise your rights or ask questions, contact our Privacy Officer at privacy@mywellnessdental.com, 623-267-4097, or 2735 S Alma School Rd, Ste 1, Chandler, AZ 85286. Please ask for a secure method before sending records or sensitive documents.

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights: www.hhs.gov/hipaa/filing-a-complaint · 1-877-696-6775 · 200 Independence Avenue SW, Washington, DC 20201. We will not retaliate against you for filing a complaint.