Notice of Privacy Practices

Effective Date: 05/01/2020

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Grand Oaks Dentistry is committed to protecting the privacy and security of your health information. This Notice describes how we may use and disclose your Protected Health Information (“PHI”), your rights regarding that information, and our legal duties concerning your privacy.

Our Responsibilities

We are required by law to:

• • Maintain the privacy and security of your Protected Health Information.

• • Provide you with this Notice of our legal duties and privacy practices.

• • Follow the terms of the Notice currently in effect.

• • Notify you if a breach occurs that may compromise the privacy or security of your information.

How We May Use and Disclose Your Health Information

For Treatment

We may use and disclose your health information to provide, coordinate, and manage your dental treatment.

Examples include:

• • Reviewing dental records and x-rays.

• • Consulting with specialists.

• • Referring you to another healthcare provider.

• • Coordinating treatment with other healthcare professionals.

For Payment

We may use and disclose your health information to obtain payment for services provided.

Examples include:

• • Submitting claims to insurance companies.

• • Verifying insurance eligibility and benefits.

• • Collecting unpaid balances.

• • Obtaining pre-authorizations for treatment.

For Healthcare Operations

We may use and disclose your health information to support the operation of our practice.

Examples include:

• • Quality assessment and improvement activities.

• • Staff training and education.

• • Credentialing and licensing activities.

• • Appointment scheduling and management.

• • Internal audits and compliance reviews.

Appointment Reminders and Patient Communications

We may contact you regarding:

• • Appointment reminders

• • Treatment recommendations

• • Follow-up care

• • Insurance matters

• • Billing questions

Communications may be made by telephone, voicemail, text message, email, postal mail, or other reasonable methods.

Individuals Involved in Your Care

Unless you object, we may share relevant health information with family members, guardians, caregivers, or other individuals involved in your care or payment for your care.

As Required by Law

We may disclose your information when required by federal, state, or local law, including reporting requirements, court orders, subpoenas, and governmental investigations.

Public Health and Safety

We may disclose information when permitted or required for:

• • Public health reporting

• • Preventing or controlling disease

• • Reporting abuse, neglect, or domestic violence

• • Health oversight activities

• • Law enforcement purposes

• • Serious threats to health or safety

Audio and Video Monitoring

Grand Oaks Dentistry utilizes audio and/or video monitoring and recording systems in certain areas of the practice for purposes that may include patient safety, security, quality assurance, staff training, operational support, clinical documentation, and protection of patients, staff, and practice property.

Where permitted by applicable law, monitoring and recording may occur in treatment areas, common areas, administrative areas, and during certain communications with patients.

Any recordings that contain Protected Health Information will be maintained, secured, and disclosed in accordance with applicable federal and Texas privacy laws and practice policies.

Your Rights Regarding Your Health Information

You have the right to:

Access Your Records

Request to inspect or obtain a copy of your health information.

Request an Amendment

Request corrections to information you believe is incorrect or incomplete.

Request Confidential Communications

Request that we contact you in a specific manner or at a specific location.

Request Restrictions

Request limitations on certain uses or disclosures of your health information.

Receive an Accounting of Disclosures

Request a list of certain disclosures made by our office.

Receive a Copy of This Notice

Receive a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Privacy Officer
Grand Oaks Dentistry
8700 Menchaca Rd, Suite 102
Austin, Texas 78748
Phone: (512) 291-1666

You may also file a complaint with the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

Changes to This Notice

Grand Oaks Dentistry reserves the right to change this Notice at any time. Any revised Notice will apply to all health information maintained by our practice and will be available upon request and in our office.