Notice Effective Date: May 1, 2019
NOTICE OF PRIVACY PRACTICES FOR ALL DENTAL PRACTICES AFFILIATED OR CONTRACTED WITH CLARITY REGARDING THE PROVISION OF CLARITY ALIGNER THERAPY
c / o Clearfy, 1930 S Dixie Hwy STE C6, West Palm Beach, FL 33401
THIS NOTICE COMMUNICATES HOW YOUR PERSONAL AND HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
We respect our legal obligation to keep health information that identifies you private. We are required by law to notify you of our privacy practices. This Notice describes how we protect your health information and what rights you have with respect to your health information. If you have any questions about this Notice, please contact the contact person listed above.
For certain purposes, we may disclose your health information without your authorization, including the following:
Treatment, Payment, and Health Care Operations:
The most common reason we use or disclose your health information is for treatment, payment, or health care operations.
Treatment: To treat you, we may use or disclose your information. Treatment may include, but is not limited to, developing a draft treatment plan or communicating with a dental laboratory regarding dental appliances being developed or modified for you, scheduling an appointment for you, conducting a dental exam, or perform diagnostic tests, prescribe medications, and fax or electronically submit for completion, refer you to another healthcare provider for additional or specialized services, or obtain copies of your medical information from another healthcare provider that you have seen before.
Payment: To obtain payment for the services we provide to you, we may use or disclose your information. Such instances include, but are not limited to, the use of your information to ask you or your insurance company about your dental insurance coverage or other sources of payment, to prepare and submit invoices or claims, or to collect unpaid amounts (either ourselves or through a contracted third party).
Healthcare Operations: For certain clerical and administrative activities that are necessary for us to run our business, we may use or disclose your information. Such instances include, but are not limited to, disclosing your information to train or evaluate our staff, conduct financial or billing audits for internal quality control, participate in managed care plans, advocate for legal matters, conduct business planning, or contract the storage of our records.
You Can Object to Disclosures: We We may disclose your health information to a friend, family member, or other person who is involved in your medical and dental care, except with your explicit instruction not to do so.
To remind you of scheduled appointments or the need for a routine appointment, including for dental monitoring, we may need to call, write, email or message you, that is, "get in touch." We may also contact you to notify you of other available treatments or services that may help you.
In addition, we may communicate to follow up, perform quality evaluations, request reviews, comments, satisfaction evaluations, complaints or similar activities.
We will not use your information for marketing purposes without your authorization. You understand that if we contact you to request a marketing authorization, and if you refuse to provide such consent, this will not affect your treatment and we will not repeatedly bother you about such authorization.
We may also use or disclose your information without your permission, in some limited situations and if certain conditions are met. These are some of the disclosures that may occur, but are not guaranteed to occur, and some disclosures will not be made by us, but under the jurisdiction of state or federal law:
Unless you sign a written "authorization form," we will not make any other use or disclosure of your information. Federal law determines the content of this "authorization form." We can start the authorization process if the use or disclosure is our idea, but you can start the process if it is your idea that we send your information to someone else.
In situations like the above, you will give us a properly completed authorization form or you can use one of ours.
You do not have to sign the authorization form if we start the process and ask you to sign it. If you choose not to sign the authorization, we cannot make the use or disclosure.
You can revoke the authorization form at any time unless we have already acted relying on it. Your withdrawal of authorization must be in writing and sent to the contact address named at the beginning of this Notice.
Before releasing any information related to mental health, substance abuse, HIV or AIDS treatment, we will request your authorization. We will also request your written authorization for most uses and disclosures of any psychotherapy note, your health information for marketing purposes, and for sale if your health information.
You many rights regarding your health information as governed by the law. To request any of the following, send a written request to the contact address named at the beginning of this Notice:
We must abide by the terms of this Notice of Privacy Practices and we reserve the right to change this Notice at any time as required by law. If we change this Notice, the new privacy practices will apply to all health information that we maintain and to all information that we may generate in the future. If we change our Notice of Privacy Practices, it will be available and posted in our office and on our website.
You may file a complaint with us or with the US Department of Health and Human Services, Office for Civil Rights if you believe that we have not adequately respected the privacy of your health information and we will not retaliate against you if you file a complaint. If you wish to complain to us, please send a written complaint to the contact address or email shown at the beginning of this Notice. Or, if you prefer, you can discuss your complaint in person at the store or over the phone.
If you would like more information about our privacy practices, please call us, visit the contact address, or email us at the respective contact information listed at the beginning of this Notice.
This notice is effective May 1, 2019.