Our Legal Duty
Rothenberg DDS / TLC Dental Group (“we,” “our,” “us”), like all other medical and dental practices, is required by applicable federal and state laws to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice went into effect January 22,2015 and will remain in effect until modified or replaced. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us according to the means outlined in this notice.
Uses and Disclosures of Health Information
We use and disclose health information about you for treatment, payment, and healthcare purposes. For example:
We may use or disclose your health information to a physician/dentist, dental auxiliaries, and other healthcare providers providing treatment to you.
We may use and disclose your health information to obtain payment for services we provide to you.
We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performances, conducting training programs, accreditation, certification, licensing or credentialing activities.
In addition to our use of your health information for treatment, payment or healthcare purposes, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
To Your Family and Friends
We must disclose your health information to you, as described in the Patient Rights section of this notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only with your authorization.
Persons Involved in Care
We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up prescriptions, dental supplies, X-rays, or other similar forms of health information.
Marketing Health-Related Services
We may use Patient Information internally to improve services to you and fellow patients. We may use Patient Information to contact you about your personal treatment experience with us and to ask how we might better serve you. We may also create and use aggregate Patient Information that is not personally identifiable to understand more about the common dental interests and needs of our Patients.
We may utilize one or more third-party service providers to send email or other communications to you on our behalf, including Patient satisfaction surveys. These service providers are prohibited from using your email address or other contact information for any purpose other than to send communications on our behalf.
It is our intention to only send email communications that would be useful to you and that you want to receive. When you provide us with your email address as part of the registration or appointment setting process, we will place you on our list of patients to receive personal general dental care emails to maintain and improve your dental health and appearance. Upon request we would promptly discontinue sending you these personal general dental care notices.
Our cookies are twofold: “session” cookies and “persistent” cookies. Session cookies are automatically deleted once you leave our website. Persistent cookies remain until you delete them. Our cookies do not corrupt or damage your computer, programs or computer files. You have ultimate control over our cookies. You may either enjoy the facilitating benefits of their use or you may, in addition to deleting them, set your browser to block them.
We will not use your health information for fundraising activities without your written consent.
We may use or disclose your health information when we are required to do so by law.
Abuse or Neglect
We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence, or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety, or the health or safety of others.
Under certain circumstances, we may disclose to military authorities the health information of Armed Forces personnel. We may disclose, to authorized federal officials, health information required for lawful intelligence, counterintelligence, and other national security activities. Under certain circumstances we may disclose the protected health information of an inmate or patient to law enforcement officials vested with their legal custody.
We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).
Patient Rights Access
You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we deem it impractical We may charge a fee for producing dental records and X-rays as allowed by law.
You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations and certain other activities for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). When you pay in full for services outside of your insurance plan, you may request that we restrict this information and not disclose it to your healthcare plan or insurer.
We will provide you with notification of a breach of unsecured PHI as required by law.
You have the right to request the mode and destinations of our health related communications to you. This request must be in writing. Your communication request must specify the desired mode and destinations, and provide a satisfactory explanation of how payments will be handled pursuant to you request.
You have the right to request that we amend your health information. This request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
If you received this notice on our web site or by electronic mail (e-mail), you are also entitled to receive this notice in written form.
Questions and Concerns
If you would like additional information about our privacy practices or have questions, please phone our HIPAA Compliance Manager, Marsha Rothenberg at 315-637-7684.
If you are concerned that we may have violated your privacy rights, or if you disagree with a decision we made about access to your health information or our handling of your response to a request you made to amend or restrict the use or disclosure of your health information, or to have us communicate with you by alternative means or at alternative locations, you may send your concerns to Marsha Rothenberg at Rothenberg DDS / TLC Dental Group, 7197 Highbridge Road, Fayetteville, NY 13066. We support your right to maintain the privacy of your health information.