THE
NOTICE
OF PRIVACY PRACTICES
Effective Date: April 14, 2003
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.
If you have any questions
about this notice, please contact the
Dental Faculty Practice
Privacy Office at 614-292-1810.
WHO IS
COVERED BY THIS NOTICE
This notice describes The Ohio State University
College of Dentistry and Dental Faculty Practice privacy practices and that of:
·
Any health care professional authorized to enter information into your
treatment record maintained by the
·
All sections of the
·
All faculty, staff, and students who participate in the
These entities, sites and locations may
share health information with each other for treatment, payment or health system
operations purposes described in this notice.
OUR PLEDGE
REGARDING HEALTH INFORMATION
We
are required by law to:
·
make sure that your health information is
kept private;
·
give you this notice of our legal duties and privacy practices; and
·
follow the terms of the notice currently in effect.
We understand that your health information is
personal. We create a record of the care and services you receive. We need this record to provide you with
quality care and to comply with certain legal requirements. We are committed to protecting this
information.
This
notice will tell you about:
·
the ways in which we may use and disclose your health information;
·
your rights; and
·
our obligations regarding the use and disclosure of
health information.
HOW WE MAY USE AND DISCLOSE
YOUR HEALTH INFORMATION
Ø
For
Treatment. It is
important that we be able to use or share your information to treat you. We may share your information with doctors,
nurses, assistants, dental hygienists, dental or dental hygiene students, or
other personnel who are involved in taking care of you. Different departments
also may share health information about you in order to coordinate the
different things you need, such as prescriptions or x-rays. We may share your information with health
care providers outside of The Ohio State University College of Dentistry or
Dental Faculty Practice for your treatment.
For example, a dentist
treating you may need to contact your medical doctor regarding your recent heart condition. Or
a health care provider may need to know about any drug allergies that you have
in order to provide you with appropriate medication.
Ø
For
Payment. We may use or share your health information so
that we are paid for the services provided.
We may share your information with another provider so that they may be
paid for services as well. We may bill, and share information with other
providers, an insurance company, you, or a third party. For example, we may need to give your health
plan information about your diagnosis and treatment so your health plan will
pay us or reimburse you for the care we provided. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
We may also share your health information in order to facilitate payment
to another provider who has participated in your care.
Ø
For
Health Care Operations.
We may use and share your health information for
Ø
Appointment
Reminders. We may
use and disclose health information to contact you as a reminder that you have
an appointment for treatment within the
If you do not wish to
receive appointment reminders, or wish to be contacted at a certain telephone
number, please contact the
Ø
Health-Related
Benefits and Services.
We may use and disclose health information to tell you about treatment
options, health-related benefits, or services that may be of interest to you.
Ø
Fund
Raising Activities.
We may use your health information to contact you in an effort to raise
money for the
If you do not want to
be contacted for fundraising efforts, you must notify, in writing, the
Director, Development and External Affairs,
Ø
Individuals Involved in Your
Care or Payment for Your Care.
We may release
information about you to a family member or other designated person who is
involved in your care. We may also give information to someone who helps pay
for your care. For example, we may need
to tell the person who comes with you to an appointment what he or she may need
to do to help you once you get home. In the event of an emergency, we may
need to use or share information about you in order to inform your family or
persons responsible for your care where you are and your condition.
SPECIAL
SITUATIONS: Additional uses and
disclosures for which authorization or opportunity to agree or object is not
required by federal privacy rules.
Ø
Research. Research is one of the missions of The Ohio
State University College of Dentistry and Dental Faculty Practice. You have the
opportunity to be a part of research at The Ohio State University College of
Dentistry or Dental Faculty Practice.
Under certain circumstances, we may use and disclose information about
you for research purposes, or we may contact you about research projects that
you may qualify for. All research projects are subject to a special approval
process before we use or disclose your information.
We also may disclose
information about you to people preparing to conduct a research project. They may be looking for patients with
specific needs or for certain information.
The information they review will be kept confidential.
Often, you will need
to give permission before we share your information with others for use in
research. If your information is used, the researcher must keep your
information safe and confidential.
Ø
As
Required By Law.
We may use or disclose your health information without your written
authorization if we are required to do so by federal, state or local law. Any disclosure will be strictly limited to
the requirements of the law.
Ø
To
Avert a Serious Threat to Health or Safety. We may use and disclose information about you
when necessary to prevent a serious threat to your health and safety or to the
health and safety of the public or another person.
Ø
Workers'
Compensation.
We may release medical information to Workers' Compensation, as required
by workers’ compensation laws. This program provides benefits for work-related
injuries or illness.
Ø
Public
Health Risks. As required by law, we may disclose
your health information to public health authorities for purposes related to:
preventing or controlling disease, injury, or disability; and/or reporting
disease or infection exposure.
Ø
Victims
of Abuse, Neglect, or Domestic Violence. We may
disclose certain health information to government agencies authorized by law to
receive reports of abuse, neglect, or domestic violence if we believe that you
have been a victim.
Ø
Health
Oversight Activities.
We may disclose health information to a health oversight agency for
activities authorized by law. These
oversight activities include, for example, audits, investigations, inspections,
and licensure.
Ø
Judicial
and Administrative Proceedings. We may disclose your health information in
the course of an administrative or judicial proceeding, such as in response to
a court order.
Ø
Law
Enforcement.
We may release health information to a law enforcement official if
required or permitted by law.
Ø
Deceased
Person Information.
We may release health information to a coroner or medical
examiner, or a funeral director as necessary to carry out their duties as
required or permitted by law.
Ø
Specialized
Government Functions. We may release health information about
you to authorized federal officials for national security and intelligence,
military, or veteran’s activities required by law.
Ø
Secretary
of the Department of Health and Human Services. We may be
required to disclose health information without your written authorization to
the Secretary of the Department of Health and Human Services when directed to
do so in order to review our compliance with federal privacy rules.
USES OF
HEALTH INFORMATION THAT REQUIRE AUTHORIZATION
In
all other situations (situations that are not treatment, payment, operations or
special situations), we may only share information with your specific written
authorization.
You
may revoke that authorization, in writing, at any time. If you revoke your permission, we will no
longer use or disclose health information about you for the reasons covered by
your written authorization, except to the extent that we already have used or
disclosed your information.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Although our business record consists of your health
information or designated record set, which includes information we used to
make decisions about your care, and is the property of The Ohio State
University College of Dentistry or Dental Faculty Practice, the information
contained in those records is your information, and you have certain rights
regarding that information.
You
have the following rights regarding health information we maintain about
you. If you wish to exercise any of
these rights, please send a written request to the
Ø
Right
to Review and Obtain a Copy. You have the right to inspect and obtain a
copy of health information that may be used to make decisions about your care.
Usually, this
information includes treatment and billing records, but does not include
psychotherapy notes, information compiled for use in or created in anticipation
of a civil, criminal or administrative action or proceeding, or certain lab
test results subject to the Clinical Laboratories Improvement Act of 1988.
You must submit a
request for your health information in writing to the
Ø Right To Appeal a Denial of Access to Health Information.
You
have the right to access your health information. There are some limitations on that
right. If for clear treatment reasons
your health provider has determined that access to your health information is
likely to have an adverse effect on you, the health care provider shall provide
the record to a practitioner designated by you to help you with your review of
the information.
Your access is limited to your designated record
set. Your designated record set is
information we used to make decisions about your care. It does not include:
·
information compiled for use in
or created in anticipation of a civil, criminal or administrative action or
proceeding, or
·
certain lab test results subject to the Clinical Laboratories
Improvement Act of 1988, or
·
other types of information that we did not use to make
decisions about your health care.
Ø
Right
to Amend.
If you feel that health information we have about you
is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment
for as long as the information is maintained. We may deny your request if you
ask us to amend information that:
·
is not part of the information which you would be permitted to inspect
and copy; or
·
we believe is accurate and complete.
Submit
your request to the
Ø Right to an Accounting
of Disclosures.
You have the right to request an "accounting of
disclosures." An accounting of
disclosures is a list of the disclosures we made to others of health
information about you that are not related to treatment, payment, health care
operations, certain disclosures required by law to be kept confidential or
disclosures you specifically authorized.
You must submit your request in writing to the
·
tell
us the calendar dates you want to see. The time period cannot include more than
six years of information, and cannot begin prior to
·
indicate in what form you want the list (paper copy or
electronic).
Charges: There will be no charge for the first list
you request within a 12-month period. We
may charge you for the costs of providing any additional lists within the
following twelve-month period. We will
notify you of the cost involved. You may
choose to withdraw or modify your request at that time before any costs are
incurred.
Ø
Right
to Request Restrictions.
You have the right to request a restriction or limitation on the health
information we use or disclose about you for treatment, payment or health care
operations. We are not required to
agree with your request. If we
do agree, we will comply with your request unless the information is needed to
provide you emergency treatment.
You must make your
request for any restrictions in writing to the
Ø
Right
to Request Confidential Communications. You have the right to request that we
communicate with you about health matters in a certain way or at a certain
location. For example, you can ask that
we only contact you at work or by mail.
You must make your
request for confidential communications in writing to the
Ø
Right to a Paper Copy of
This Notice. You have the right to a paper
copy of this notice. You may ask us to
give you a copy
of this notice at any time. Contact a
member of the office staff for a copy.
You may also print a copy of this notice at http://www.dent.ohio-state.edu under
“Patients”. If you have any questions
about how to access this information, please contact the
CHANGES TO THIS NOTICE
We
reserve the right to change this notice.
We reserve the right to make the revised or changed notice effective for
health information we already have about you as well as any information we
receive in the future. Current copies of
this notice will be available at our office sites. The current notice will also be posted at the
website listed above. The effective date
of the notice will be posted on the top of the first page.
If
you believe your privacy rights have been violated, you may file a complaint
with the