Privacy Policy

Your personal (demographic) and health information may be used and disclosed by your dental provider to carry out treatment, payment, or other health care operations. Health information means all information that identifies me as an individual (or can resonably be used to identify me as an individual) and relates to my past, present or future physical or mental health, health care services provided to mek, examinations and treatment plans, and/or payment for the provision of health care services proposed or provided to me. My dental provider is autorized to disclose my personal and health information to another health care provider, a health care service plan or an insurance company for purposes of treatment, evaluating or investigating any claim for benefits or as otherwise needed to administer any health care coverage I may have.

My personal and medical information may be accessed and used by business associates contracted with my dental provider to provide administrative services adn/or system support; provided, however, that such business associates must agree to use this information only as necessary to fulfill their respective obligations and to not further disclose my personally identifiable information for any other purpose. I have the right to request that my dental provider restrict how my health information is used or disclosed to carry out treatment, payment and/or health care operations. My dental provider is not required to agree to such requested restriction shall be binding on my dental provider and his/her contracted business associates.

I have the right to ask my dental provider for a more complete description of his/her privacy practices and may review this information prior to providing any consent. I also understand that I have the right to revoke any consent in writing at any time, except to the extent that my dental provider or his/her contracted business associates has already acted in reliance on my consent. I understand that my dental provider may refuse to provide or continue treatment without the provision of a valid consent.