SMILE GENERATION
JOINT NOTICE OF PRIVACY PRACTICES AND NOTICE OF ORGANIZED HEALTH CARE ARRANGEMENT
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 OUR “PRIVACY OFFICER” AT 714-845-8605.
We are legally obligated to keep your protected health information confidential and to provide you with this Notice detailing our legal responsibilities and privacy practices concerning your protected health information. “Protected health information” includes information about you, such as demographic details, that could identify you and relates to your past, present, or future physical or mental health condition and the related health care services or payments.
This Notice became effective on April 1, 2020. We must comply with the terms of this Notice while it is in effect. We might update the Notice at any time, with changes applying to all protected health information we hold at that time. You may request a copy of any updated Notice by visiting our website, calling our Privacy Contact, requesting it by mail, or asking for one during your next visit.
Organized Health Care Arrangement: Pacific Dental Services, LLC (“PDS”) offers business support services to various entities practicing dentistry (“Dental Entities”). All Dental Entities are listed on the Smile Generation website managed by PDS, with their office locations available at http://www.smilegeneration.com/SiteMap.aspx, which is periodically updated. PDS, its subsidiaries, and the Dental Entities participate in an Organized Health Care Arrangement under federal privacy regulations and may share your information among themselves for treatment, payment, and operational purposes as described in this Notice. The terms “we,” “our,” and “us” refer collectively to PDS, its subsidiaries, and the Dental Entities. This Notice applies to every Dental Entity providing health care to you.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
To Contact You: We may use your protected health information to remind you of appointments, notify you about treatment options, or inform you about other health-related services and benefits.
Treatment: We may use and disclose your protected health information for the provision, coordination, or management of your health care and related services. This includes coordinating care with third parties, consulting with other health care providers, or providing referrals. For instance, your dentist might need information about other health conditions that could affect your treatment and may request records from other providers who’ve treated you. Additionally, your health information might be shared with providers outside the Organized Health Care Arrangement through secure health information exchanges like Care Everywhere to enhance care coordination.
Payment: We may use and disclose your protected health information to obtain or provide payment for dental services. This involves sharing information with parties responsible for payment, including your insurer. Insurers might use your information to verify coverage, eligibility, or to review services rendered. For example, we may inform your insurance company about dental procedures so claims can be processed.
Operations: Your information may be used for healthcare operations supporting our business functions and quality assurance, including performance evaluations, employee and peer reviews, training, licensing, accreditation, data aggregation, audits, and business planning. We may disclose information to other providers, health plans, or clearinghouses with whom you have a relationship for similar operational purposes.
Business Associates: We may share your protected health information with third-party service providers such as billing or legal services, bound by contractual obligations to safeguard your privacy.
Treatment Alternatives and Health-Related Products and Services: We may use or disclose your information to inform you about certain products or services, including participation in dentist or health plan networks, products or services included in benefit plans, and alternative treatment options, therapists, dentists, or care settings.
Family and Friends: Your protected health information may be shared with family members or friends involved in your care or payment if you consent or do not object when aware of such disclosures. Should you be unavailable or unable to express preferences, we may disclose information if professionally assessed as being in your best interest with no objection implied. For example, if your spouse accompanies you during visits or picks up prescriptions, we might share information with them.
If you are a minor, you may have the right to restrict parental access to your health information under certain laws. Contact your dental provider or our Privacy Officer using the contact information provided.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION
We may use or disclose your protected health information without authorization in specific situations required by law or for public health and safety reasons, adhering to pertinent legal constraints.
As Required by Law: We may disclose protected health information in compliance with federal, state, or local laws.
Public Health Activities: Information may be disclosed to public health authorities for preventing or controlling disease, injury, or disability; reporting suspected abuse, neglect, or certain physical injuries; monitoring medication reactions or product safety concerns; and complying with recalls.
Health Oversight Activities: Disclosures may be made to oversight agencies involved in audits, investigations, inspections, licensing, or enforcing civil rights laws.
Lawsuits and Disputes: We may disclose information pursuant to court or administrative orders, subpoenas, discovery requests, or other legal processes.
Law Enforcement: Protected health information may be used or disclosed to law enforcement for legal process compliance, suspect identification or location, victim information, reporting on-premises crimes, or responding to medical emergencies involving crimes.
Coroners, Medical Examiners and Funeral Directors: Information may be released to coroners or medical examiners for identification or cause of death determinations and to funeral directors as necessary for their duties.
Organ and Tissue Donation: If you are an organ or tissue donor, your information may be shared with organizations that handle procurement or transplant activities.
Research: We may use or disclose protected health information for research purposes approved by institutional or privacy review boards.
Serious Threat to Health or Safety; Disaster Relief: Disclosure may be made to prevent serious threats to health or safety of individuals or public and to notify or locate family in disasters.
Military and Veterans: Disclosures may be made as required by military command or government authorities if you are a service member.
National Security; Intelligence Activities; Protective Service: Information may be disclosed to federal officials for national security, intelligence, or protective service activities, including those related to the President or foreign dignitaries.
Workers’ Compensation: Disclosures may be made for workers’ compensation or related injury programs, subject to legal permissions.
Inmates: We may disclose information to correctional institutions or law enforcement officials if you are incarcerated or in custody, as necessary for providing healthcare, protecting safety, or prison security.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITH YOUR AUTHORIZATION
Any use or disclosure not detailed in this Notice requires your written authorization. For instance, we will not sell your protected health information without your consent. Applicable federal and state laws may provide further protections or impose additional restrictions on how your information is used or shared. We comply fully with such laws and will request authorization when necessary. Information with heightened protection includes psychotherapy notes, genetic data, mental health records, HIV/AIDS status, reproductive health information, communicable diseases, and substance abuse disorder records.
You may revoke your authorization at any time, in writing, directed to our Privacy Contact. Revocation ceases future uses or disclosures except for those already made based on your prior authorization.
YOUR RIGHTS WITH RESPECT TO PROTECTED HEALTH INFORMATION
You have several rights regarding your protected health information, exercisable by submitting written requests to our Privacy Contact. Please reach out with any questions about these rights.
Right to Inspect and Copy: You can inspect and obtain copies of your protected health information maintained in your dental records, including clinical, billing, and other records we utilize in care decisions. Fees may apply to cover copying, mailing, and supply costs. We may deny access to certain records, such as those compiled for legal proceedings; in such cases, you may request a review of the denial.
Right to Request Restrictions: You may ask us to restrict uses or disclosures of your protected health information for specific treatments, payments, or health care operations, or to restrict sharing with particular family or friends involved in your care. We are not required to honor such requests unless you ask to limit disclosure to a health plan for payment/operations concerning a service you fully paid out of pocket. Agreed restrictions can be overridden in emergencies.
Right to Request Confidential Communications: Requests can be made to receive communications via alternate means or at different locations, e.g., using your work telephone instead of your home phone. We will accommodate reasonable requests without requiring explanations but may ask for additional information to ensure contact and billing accuracy.
Right to Amend: You may request corrections or amendments to your protected health information. We may deny such requests under certain conditions, but you may submit a statement opposing our denial. We may respond with a rebuttal, providing you a copy if done.
Right to an Accounting of Disclosures: You may request a report detailing certain disclosures of your protected health information made within six years before your request. This excludes disclosures made to you, authorized disclosures, for treatment, payment, health care operations, to family/friends for care or notification, and other specified exceptions. There are legal limits to this right.
Right to Breach Notification: If your protected health information is improperly used or disclosed in a manner compromising its privacy or security (a “breach”), we will notify you as legally required.
Right to Paper Copy of This Notice: You may receive a paper version of this Notice at any time upon request, even if you agreed to electronic delivery.
QUESTIONS OR COMPLAINTS
We are committed to safeguarding your privacy. For questions about this Notice, please contact our Privacy Contact. If you believe your privacy rights have been violated, you may file a complaint either with us via the Privacy Contact number listed at the top of this Notice or with the Secretary of the U.S. Department of Health and Human Services. Filing a complaint will not result in any penalty or loss of services.
