Notice of Privacy Practices
Revised 01-19-2010


THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

This notice describes our practice's policies, which extend to:

  • All areas of the practice (physicians, credentialed providers, assistants, RN's, front desk, administration, billing and collection, etc.)
  • All employees, staff and other personnel working for or with our practice (janitors, computer support personnel, etc.)
  • Our business associates (labs, referring offices, dental supply companies, etc.)

Centre Oral & Facial Surgery provides this notice to privacy practices to comply with the privacy regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

OUR THOUGHTS ABOUT YOUR PROTECTED HEALTH INFORMATION

We understand that your medical information is personal to you and we are committed to protecting your information. We create paper and electronic medical records about your health; care for you; provide services and/or items for you. We need this record to provide for your care and to comply with certain legal requirements. We are required by law to:

  • Make sure that the protected health information about you is kept private.
  • Provide you access to the notice of privacy practices and your legal rights regarding your protected health information.
  • Follow the conditions of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe ways that we use and disclose protected health information. Each category includes a description, including examples, of their uses. Not every use or disclosure in a category is listed or actually in place. The explanation is provided for you general information only.

  • Medical Treatment

We use your medical information to provide current or prospective medical treatment or services and may disclose your medical information to doctors, nurses, technicians, medical students, or hospital personnel involved in your care. For example, a doctor to whom we refer you for further care may need your medical records, prescriptions, requests for lab work and/or x-rays. We may discuss your medical information with you to recommend possible treatment options or alternatives that may be of interest to you. We may disclose your medical information to others involved in your medical care after you leave the practice. This may include your family members, personal representatives authorized by you or by a legal mandate (a guardian or person named to handle your medical decisions, should you become incompetent).

  • Payment

We may disclose your medical information for services and procedures so they may by billed and collected from you, to an insurance company or any other third party payer. For example, we may need to give your health care information, about treatment you received, to obtain payment or reimbursement for the care provided to you by us. We may also tell your health plan and/or referring physician about a treatment you are going to receive to obtain prior approval, to determine whether your plan will cover the treatment, to facilitate payment of a referring physician or the like.

  • Health Care Operations

We may use and disclose medical information about you so that we can run our practice more efficiently and ensure our patients receive quality care. These uses may include reviewing our treatment and services to evaluate the performances of our staff, determining what additional services are needed and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other personnel for review and education. We may also combine the medical information we have with medical information from other practices to ascertain how we are doing and discover where we can make improvements in the care and services we offer. We may remove personal information so others may use it to study health care and health care delivery without learning your identity.

  • Use of Electronic Mail and Other Electronic Forms of Communication

Centre Oral & Facial Surgery may use standard electronic mail communication and the Internet to more efficiently and effectively communicate health care information about you, and to coordinate care with other health providers. The practice cannot guarantee that information sent in such manner will not be intercepted during transmission or otherwise. Our staff will, however, make reasonable efforts to use secure pathways and send and receive information from known entities. The practice will keep personally identifying information contained within these forms of communication at a minimal level. We define "minimal level" as information adequate for the intended receiving entity to properly identify the subject, while an unintended receiving or intercepting entity would find it difficult, if not impossible, to identify the subject.

We may use or disclose information about you for internal or external utilization review and/or quality assurance; to business associates for helping us comply with our legal requirements, to auditors to verify records, to billing companies to aid us in this process, etc. We shall, at all times when business associates are used, advise them of their continued obligation to maintain the privacy of your medical records.

  • Appointment/Patient Recall Reminders and Patient Follow-up Calls

We may ask that you sign at the receptionist's desk, on a log sheet and may also ask you to update your demographics, including insurance coverage, on the day of your appointment. In addition, on the day of your appointment, we may call your name in the reception area to bring you to the treatment area. We may use and disclose medical information to contact you as a reminder that you have an appointment or that you are due to receive periodic care. In addition, medical information may be disclosed if the doctor contacts you following surgery. This contact may be by phone, in writing, e-mail or otherwise and may involve the leaving of an e-mail, a message on any answering machines or otherwise which could (potentially) be received or intercepted by others.

  • Emergency Situations

In addition, we may disclose medical information about you to an organization assisting in a disaster relief effort or in an emergency situation so that your family can be notified about your condition, status and location.

  • Research

Under certain circumstances, we may use and disclose medical information about you for research purposes regarding medications, efficiency of treatment protocols and the like. All research projects are subject to an approval process, which evaluates a proposed project and its use of medical information. Before we use or disclose medical information for research, the project must pass through the research approval process. We will obtain an authorization from you before using or disclosing your individually identifiable health information unless the authorization requirement has been waived. If possible, we will render the information unidentifiable to a specific patient. If the information has been sufficiently de-identified, an authorization for the use or disclosure is not required.

  • Required By Law

We will disclose medical information about you when required to do so by federal, state or local law.

  • To Avert a Serious Threat to Health or Safety

We may use and disclose medical information about you when necessary to prevent a serious threat either to your specific health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

  • Organ and Tissue Donation

If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

  • Workers' Compensation

We may release your medical information for workers' compensation or similar programs that provide benefits for work-related injuries or illness.

  • Public Health Risks

Law or public policy may require us to disclose medical information about you for public health activities. These activities generally include the following:

  • Preventing or controlling disease, injury or disability;
  • Reporting births and deaths;
  • Reporting child abuse or neglect;
  • Reporting reactions to medications or problems with products;
  • Notifying persons of recalls of products they may be using;
  • Notifying persons who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • Notifying  the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if the patient agrees or when required or authorized by law.
  • Investigation and Government Activities

We may disclose medical information to a local, state or federal agency for activities authorized by law. These oversight activities include, but are not limited to, audits, investigations, inspections and licensure. These activities are necessary for the payor, the government and other regulatory agencies to monitor the health care system, government programs and compliance with civil rights laws.

  • Lawsuits and Disputes

If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. This is particularly true if you make your health an issue. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute. We shall attempt in these cases to tell you about the request so that you may obtain an order protecting the information requested if you so desire. We may use such information to defend ourselves, or any member of our practice in any actual or threatened action.

  • Law Enforcement

We may release medical information if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain circumstances, we are unable to obtain the person's agreement;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at the Practice; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
  • Coroners, Medical Examiners and Funeral Directors

We may release medical information to a coroner or medical examiner. This may be necessary to identify a deceased person to determine the cause of death. We may also release medical information about patients of the practice to funeral directors as necessary to carry out their duties.

  • Inmates

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care; to protect your health and safety or the health and safety of others or for the safety and security of the correctional institution.

CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve the right to make the revised notice effective for all of the medical information we already have about you as well as any of the information that we may obtain from you in the future. We will post a copy of the current notice in the practice. The notice will contain the date of the last revision and the effective date (top left corner of 1st page). In addition, you may request a copy of the current notice each time you visit the practice for treatment.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the practice or with the secretary of the Department of Health and Human Services. To file a complaint with the Practice, contact our office manager, who will direct you on how to file an office complaint. All complaints must be submitted in writing, and each complaint will be investigated, without retaliation to you for filing the complaint.

CONTACT
For further information concerning this notice to privacy, please contact the compliance officer at 814-235-7700.

OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission, unless those uses can be reasonably inferred from the intended uses above. If you have provided us with your permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your permission. We are required to retain our records of the care that we provided to you.

Patient Rights

THIS SECTION DESCRIBES YOUR RIGHTS AND OUR OBLIGATIONS REGARDING THE USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION.

You have the following rights regarding medical information we maintain about you:

  • Right to Inspect and Copy

You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes your own medical and billing records, but does not include psychotherapy notes. Upon proof of an appropriate legal relationship, records of others related to you or under your care (guardian or custodial) may also be disclosed.

To inspect and copy your medical record, you must submit your request in writing to our compliance officer. Ask the front desk receptionist for the name of the compliance officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies (tapes, disks, etc.) associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that our compliance committee review the denial. Another licensed health care professional chosen by the practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome and recommendations from that review.

  • Right to Amend

If you feel that the medical information we have about you in your record is incorrect or incomplete, then you may ask us to amend the information, following the procedure below. You have the right to request an amendment for as long as the practice maintains your medical record.

To request an amendment, your request must be submitted in writing, along with your intended amendment and a reason that supports your request to amend. The amendment must be dated and signed by you and notarized.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
    • Is not part of the medical information kept by or for the Practice;
    • Is not part of the information which you would be permitted to inspect and copy; or
    • Is inaccurate and incomplete.
  • Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you, to others.

To request this list, you must submit your request in writing. Your request must state a time period not longer than six (6) years back and may not include dates before April 14, 2003 (or the actual implementation of the HIPAA Privacy Regulations). Your request should indicate in what form you want the list (i.e. paper, electronic). We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

  • Right to Request Restrictions

You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care (a family member or friend). For example, you could ask that we not use or disclose information about a particular treatment you received.

We are not required to agree to your request, and we may not be able to comply with it. If we do agree, we will comply with your request. We shall not comply (even with a written request) if the information is required to be disclosed by law.

To request restrictions, you must make your request in writing. In your request, you must indicate:

    • What information you want to limit;
    • Whether you want to limit our use, disclosure or both; and
    • To whom you want the limits to apply (i.e. disclosures to children, spouse, etc.)
  • Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail, that we not leave voice mail or e-mail, or the like.

To request confidential communications, you must make your request in writing. We will not ask the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish us to contact you.

  • Right to a Paper Copy of this Notice

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you still are entitled to a paper copy of this notice.

Dr. Greg Kewitt and the staff of Centre Oral & Facial Surgery specialize in
oral & maxillofacial surgery procedures including dental implants, bone grafting, wisdom tooth
removal, and cosmetic surgery. Our practice is located at 474 Windmere Drive, Ste. 202,
State College, PA 16801

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