This Notice of Privacy Practices describes how this office may use and disclose your information and the rights that you have regarding
your health information.
How We Will Use or Disclose Your Health Information
Treatment: We will use your health information for treatment. For example, information obtained by the orthodontist or other members of
your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your
orthodontist will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare
team will then record the actions they took and their observations, so the physician will know how you are responding to treatment. We
will also provide your physician, or a subsequent healthcare provider, with copies of various reports that should assist him or her in
Payment:We will use your health information for payment. For example, a bill may be sent to you or your health plan. The information
on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
Health Care Operations:: We will use your health information for our regular health care operations. For example, we may use information
in your health record to assess the care and outcome in your case and others like it. This information will then be used in a continued
effort to improve the quality and effectiveness of the services we provide.
Business Associates:We may enter into contracts with persons or entities known as business associates that provide services to or
perform functions on our behalf. Examples include our accountants, consultants, and attorneys. We may disclose your health information
to our business associates so they can perform the job we have asked them to do, once they have agreed in writing to safeguard your
Notification: We may use or disclose information to assist in notifying a family member, personal representative, or another person
responsible for your care, of your location, and general condition. If we are unable to reach your family member or personal
representative, then we may leave a message for them at the phone number that they have provided to us, e.g., on an answering machine.
Communication with Family:We may disclose to a family member, other relative, close personal friend or any other person you identify,
health information relevant to that person’s involvement in your care or payment related to your care.
Appointment Reminders / Health Benefits:We may contact you to provide appointment reminders or information about treatment
alternatives or other health benefits that may be of interest to you.
Funeral Directors and Coroners: We may disclose your health information to funeral directors, and to coroners or medical examiners, to
carry out their duties consistent with applicable law.
Organ Procurement Organizations:: Consistent with applicable law, we may disclose your health information to organ procurement
organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and
Research:We may disclose your health information to researchers when their research has been approved by an institutional review board
that has reviewed the research proposal and established protocols to ensure the privacy of your health information. We may also disclose
your health information to people preparing to conduct a research project, so long as the health information is not removed from us. We
may also use and disclose your health information to contact you about the possibility of enrolling in a research study.
Fundraising: We may contact you as part of our fundraising efforts; however, you may opt-out of receiving such communications.
Food and Drug Administration (FDA):We may disclose to the FDA health information relative to adverse events with respect to food,
supplements, product, and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers’ Compensation:We may disclose health information to the extent authorized by and to the extent necessary, to comply with laws
relating to workers’ compensation or other similar programs established by law.
Public Health Activities:As required by law, we may disclose your health information to public health, or legal authorities, charged with
preventing or controlling disease, injury, or disability.
Health Oversight Activities:We may disclose your health information to health oversight agencies for purposes of legally authorized
health oversight activities, such as audits and investigations necessary for oversight of the health care system and government benefit
Correctional Institution:Should you be an inmate of a correctional institution, we may disclose to the institution, or agents thereof, health
information necessary for your health and the health and safety of other individuals.