NOTICE OF PRIVACY PRACTICES

Greenwood Smile Dental

Effective Date: Jan 2009

THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. OUR LEGAL DUTY

Greenwood Smile Dental is committed to maintaining the privacy and security of your Protected Health Information (“PHI”). We are required by applicable federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA), to:

● Protect the privacy of your PHI

● Provide you with this Notice of our legal duties and privacy practices

● Abide by the terms of this Notice currently in effect

● Notify you in the event of a breach involving your unsecured PHI

II. PERMITTED USES AND DISCLOSURES OF PHI

We may use and disclose your PHI for the purposes described below without your written authorization:

1. Treatment

To provide, coordinate, or manage your dental care and related services. This includes consultation with other healthcare professionals regarding your treatment.

2. Payment

To obtain reimbursement for services provided, including billing, claims management, and collection activities. This may involve disclosure to insurance carriers or third-party payors.

3. Healthcare Operations

To support the administrative and operational functions of the practice, including quality assessment, staff training, licensing, accreditation, and compliance activities.

III. OTHER PERMITTED AND REQUIRED DISCLOSURES

We may disclose your PHI without your authorization when required or permitted by law, including but not limited to:

● Public health reporting and disease control

● Health oversight activities (e.g., audits, inspections, licensure)

● Judicial and administrative proceedings

● Law enforcement purposes

● To prevent or lessen a serious and imminent threat to health or safety

● Compliance with workers’ compensation laws

IV. USES AND DISCLOSURES REQUIRING AUTHORIZATION

Uses and disclosures not otherwise described in this Notice will be made only with your written authorization. You may revoke such authorization at any time in writing, except to the extent that action has already been taken in reliance on it.

V. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights with respect to your PHI:

● Right of Access: To inspect and obtain a copy of your records, subject to limited exceptions

● Right to Amend: To request corrections to your PHI if you believe it is inaccurate or incomplete

● Right to an Accounting of Disclosures: To receive a record of certain disclosures made by the practice

● Right to Request Restrictions: To request limitations on certain uses and disclosures (note: we are not required to agree to all requests)

● Right to Confidential Communications: To request that communications be made through alternative means or locations

● Right to a Paper Copy: To obtain a paper copy of this Notice upon request

VI. OUR RESPONSIBILITIES

We are required to:

● Maintain the confidentiality, integrity, and availability of your PHI

● Implement appropriate administrative, technical, and physical safeguards

● Provide notice of our privacy practices and legal duties

● Comply with applicable federal and state privacy regulations

VII. CHANGES TO THIS NOTICE

We reserve the right to amend this Notice at any time. Any revised Notice will apply to all PHI we maintain and will be made available in our office and upon request.

VIII. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services. You will not be subject to retaliation for filing a complaint.

IX. CONTACT INFORMATION

Privacy Officer
Greenwood Smile Dental
8308 Greenwood Ave N
Seattle, WA 98103
(206) 783-7305
Greenwoodsmiledental@gmail.com

This document is provided for general informational purposes and is intended to support HIPAA compliance. It is recommended that dental practices obtain legal review to ensure full compliance with applicable federal and state laws.