Notice of privacy practices


Dr. Carlo A Ciaramitaro, P.C.
Auburn Village Family Dental Center

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

Your Choices

You have some choices in the way that we use and share information as we:

Our Uses and Disclosures

We may use and share your information as we:

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

Ask us to correct your medical record

Request confidential communications

Ask us to limit what we use or share

Get a list of those with whom we've shared information

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

File a complaint if you feel your rights are violated

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

In the case of fundraising:

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways:

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: We may send your films to an Endodontist to have a root canal performed.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/inde.html

Help with public health and safety issues

We can share health information about you for certain situations such as:

Do research

We can use or share your information for health research. Research is conducted under strict Federal Drug Administration (FDA) and Institutional Review Board (IRB) guidelines designed to protect the subjects of research. For example, our researchers may look for patients with specific medical characteristics or treatment to prepare a research protocol. For actual research studies, we would contact you to obtain your authorization to be a part of study.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena. For clarification, please note that we do not create or manage a hospital directory of patient names nor do we create or maintain psychotherapy notes.

The HIPAA privacy regulations establish a minimum acceptable threshold for the use and disclosure of a patient's health information. State and other federal laws may require greater limits. The State of Michigan sets forth greater protections governing the use and disclosure of certain types of records, reports and data including substance abuse treatment HIV/AIDS, communicable diseases, and mental illness.

Our Responsibilities

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Other Instructions for This Notice

If you have questions, would like additional information, or you believe your privacy rights have been violated; you may contact our Privacy Offcial:
Carlo Ciaramitaro, 3308 Auburn Road, Auburn Hills, MI 48326

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