Leland W. Nebeker DMD
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. PLEASE REVIEW IT CAREFULLY.
EFFECTIVE AS OF MARCH 23, 2013.
If you have any questions about this notice, please contact the designated privacy officer of our office.
To write: 2233 Willamette St., Bldg. E, Eugene, Oregon 97401
To call: 541-505-5118
We take our responsibility to safeguard your protected health information very seriously. We value your trust as an important part of our ability to provide you with the best possible medical care. We are dedicated to defending your right to a confidential relationship with your physician.
This notice is intended to inform you of how we protect, use and disclose your information, as well as to explain your right to control these disclosures.
Your Health Information
We may use and disclose health information about you without your permission for the following purposes:
- We may disclose your information for treatment purposes and to coordinate your medical care.
- We may disclose your information to ensure that you receive insurance benefits.
- We may disclose your information internally to enhance the operation of our practice. This includes our commitment to reviewing the quality of care we provide.
- We may disclose your information to comply with a limited number of legal requirements, as outlined in this notice.
Additional information regarding each of these disclosures is provided in this notice. In any case, we will only disclose the minimum amount of information necessary for the purpose it was requested.
We are required by law to keep your information private. We must also provide you with this Notice and abide by its terms. We may need to revise our privacy practices from time to time. We expressly reserve the right to change the terms of our Notice of Privacy Practices and to make the new terms effective for all information covered by our Notice. If such changes occur, we will let you know about the new terms by providing a copy of the changes.
Your Privacy Rights
Please note that you are entitled to very specific rights regarding the use and disclosure of your information. We have listed your rights below:
Right to Inspect and Copy
We may deny your request to inspect and/or copy information in certain limited circumstances. If you are denied access to your health information, you can ask that the denial be reviewed. If the law requires such a review, we will select a licensed health care professional to review your request and our denial. The person conducting the review will not be the person who denied your request and we will comply with the outcome of the review.
Right to Amend
We may deny your request for an amendment if we did not create the information, unless the person or entity that created the information is no longer available to make the amendment.
Right to Request Restrictions
Right to Request Confidential Communications
To request confidential communications, you may complete and submit the form request for restriction on use/disclosure of medical information to our designated Privacy Office/Contact. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of the Notice
Right to an Accounting of Disclosures
To obtain this list, you must submit your request in writing to our designated Privacy Officer/Contact. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what format you want the list (for example, on paper or electronically).
The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Complaints and Investigations
We have developed procedures for investigating any complaints or concerns you may have regarding our use and disclosure of your information or any other complaint you may have regarding our services. The law allows you to contact the Secretary of the Department of Health and Human Services with complaints about our use and disclosure of information.
You may also contact our on-site Privacy Officer/Contact, who is dedicated to investigating complaints regarding the use and disclosure of information in our care. We will not, and legally cannot, retaliate against you for any complaint.
Types of Use and Disclosure of Your Protected Health Information
We may disclose your information for the following purposes without your consent:
For treatment Purposes
For example, we may need to give your health plan information about a service you received here so your health plan will pay us or reimburse you for the service. 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. You have the right to restrict disclosures of your PHI to a health plan if you have paid out-of-pocket in full for the treatment.
For Health Care Operations
- Quality assessment and improvement activities.
- Reviewing the competence or qualifications of healthcare professionals or evaluating practitioner and provider performance.
- Conducting training programs, accreditation, certification, licensing or credentialing activities.
- Arranging for or conducting medical review, legal services or auditing functions, including fraud and abuse detection and compliance programs.
- Managing and operating our practice, including activities such as customer service and complaint resolution.
Marketing Health-Related Services
- To avert a serious threat to health or safety. We may use or disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- Required by law. We will disclose health information about you when required to do so by federal, state or local law.
- Research. We may use or disclose health information about you for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the office.
- Organ and tissue donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donor bank, as necessary to facilitate such donation and transplantation.
- Military, Veterans, National Security and Intelligence. If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate forgiegn military authority.
- Workers” Compensation. We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Public Health risks. We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.
- Health Oversight Activities. We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs and compliance with civil rights laws.
- Lawsuits and disputes. If you are involved in a law suit or dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.
- Law Enforcement. We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.
- Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death.
- Information Not personally Identifiable. We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
- Family and Friends. We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgement, that you would not object.
- Deceased Person’s PHI may be disclosed by our practice to family or others involved in the person’s care or payment for care, unless our practice knows the deceased preferred that certain people did not receive the PHI. Disclosures are limited to the DHI directly relevant to the person’s involvement.
For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed.
In situations where you are not capable of giving consent (because you are not present or due to to your incapacity or medical emergency), we may, using our professional judgement, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care.
Other Uses and Disclosures of Health Information
If you give us Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time.
If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization. However, we cannot take back any uses or disclosures already made with your permission.
You have a right to be notified following a breach of your PHI by our practice.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact:
Leland W. Nebeker DMD
2233 Willamette St., Bldg. E
Eugene, OR 97401
You will not be penalized for filing a complaint.