Notice of Privacy Practices
Our office policy regarding your rights to privacy regarding your protected health information, under the Health Insurance Portability & Accountability Act of 1996 (HIPAA). This information can and will be used to:
Provide and coordinate your treatment among a number of health care providers who may be involved in that treatment directly and indirectly.
- Obtain payment from third-party payers for your health care services.
- Conduct normal health care operations such as quality assessment and improvement activities.
- Information may be shared with family members unless excluded in writing.
Our office does not disclose, nor sell private health information (PHI) for marketing purposes, and disclosures that constitute a sale of PHI require an individual’s written authorization. You have the right to restrict certain disclosures of your PHI to a health plan if you pay out of pocket in full for a health care item or service. You will be notified if there is a breach of unsecured PHI which affects your information.
I have been informed of my dental provider’s Notice of Privacy Practices containing a more complete description of the uses and disclosures of my protected health information. I have been given the right to review and receive a copy of such Notice of Privacy Practices. I understand that my dental provider has the right to change the Notice of Privacy Practices and that I may contact this office at the address above to obtain a current copy of the Notice of Privacy Practices.
I understand that I may requests in writing that you restrict how my private information is used or disclosed to carry out treatment, payment of health care operations and I understand that you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.
The offices of Drs. Michael W Huey D.M.D., F.I.C.D. and Sevak Adamian D.D.S., M.S., P.S. complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.