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This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
Bella Vita Dental is required by law to maintain the privacy and security of your protected health information ("PHI"), provide you with this notice of our legal duties and privacy practices, and follow the terms of this notice currently in effect.
Bella Vita Dental
3900 Fifth Ave #270
San Diego, CA 92103
(619) 810-1864
You have the right to:
You may request to inspect or obtain a copy of your dental and health records. We will provide a copy or summary of your records within the time required by law. A reasonable fee may apply for copies.
If you believe information in your records is incorrect or incomplete, you may request that we amend the information. We may deny your request under certain circumstances but will provide an explanation in writing.
You may request that we contact you in a specific way (for example, at a different phone number, email address, or mailing address). We will accommodate reasonable requests.
You may ask us not to use or share certain health information for treatment, payment, or healthcare operations. While we are not always required to agree, we will comply when required by law.
You may request a list of certain disclosures of your health information made during the previous six years.
You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices regarding your health information.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
We typically use or share your health information in the following ways:
We may use and disclose your health information to provide, coordinate, and manage your dental care.
Example: A dentist, hygienist, specialist, or laboratory may review your records to assist with your treatment.
We may use and disclose your health information to bill and receive payment from insurance companies, benefit plans, or other responsible parties.
Example: We may provide information to your dental insurance carrier to obtain payment for services rendered.
We may use and disclose your information to operate and improve our practice.
Examples include:
We may disclose your information when:
We will share information if federal, state, or local laws require us to do so.
We may disclose information to prevent or reduce a serious threat to health or safety or to report certain diseases, injuries, or adverse events when required.
We may share information with agencies responsible for licensing, audits, investigations, inspections, and regulatory oversight.
We may disclose information in response to court orders, subpoenas, or other lawful legal processes.
We may disclose information as authorized by workers' compensation laws and similar programs.
We may provide information to law enforcement officials when required or permitted by law.
We may disclose information as necessary to assist with their lawful duties.
We will obtain your written authorization before:
You may revoke an authorization at any time in writing, except to the extent we have already acted on it.
Bella Vita Dental is required by law to:
We reserve the right to change our privacy practices and update this Notice. Any revised Notice will apply to all information we maintain and will be made available upon request and on our website.
If you have questions about this Notice or wish to exercise your privacy rights, please contact:
Bella Vita Dental
3900 Fifth Ave #270
San Diego, CA 92103
Phone: (619) 810-1864
You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights
https://www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be penalized or retaliated against for filing a complaint.
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