HIPAA Notice of Privacy Practices

Below is a summary of your rights under HIPAA regarding your PHI. Our team is available to answer any questions you may have.

We are required to provide you with a copy of this Notice of Privacy Practices.
We may update this notice at any time, and you may request a revised copy by calling our office or asking for one at your next appointment. The most current version will always be available in our office and on our website.

Any use or disclosure of PHI not covered in this notice requires your written authorization.
Examples requiring authorization include:

• Use of PHI for marketing purposes
• Sale of PHI
• Most disclosures of psychotherapy notes

You may revoke an authorization at any time, in writing, unless we have already relied on it.

You may request to be contacted using alternative methods or at alternative locations—such as a different phone number or email address.
Requests must be made in writing, and we will honor any reasonable request.

You may request to inspect or obtain copies of your dental records.
If your records are stored electronically, you may request an electronic copy.
A reasonable fee may apply as permitted by state and federal law.

You may request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations.
In some cases, we may deny these requests.
However, we may not deny your request to restrict disclosures to your health plan when the treatment has been fully paid out-of-pocket.

You may request an amendment to your PHI if you believe it is incorrect or incomplete.
We may deny your request in certain circumstances.

You may request a list of certain disclosures of your PHI made by our practice.

We will notify you in writing if a breach occurs that compromises the privacy or security of your PHI.

If you have questions about your rights, please contact our Privacy Manager.

We may disclose PHI to coordinate or manage your dental care.
Example: providing prescription details to a pharmacy or consulting with a specialist involved in your treatment.

We may contact you regarding:

• Appointment reminders
• Test results
• Treatment recommendations
• Information about services or benefits offered by our office

You may opt out of such communications at any time.

Your PHI may be used to obtain payment for services, including insurance authorizations, eligibility verification, and claims processing.

We may use PHI for administrative and operational purposes such as:

• Quality improvement
• Staff training
• Auditing and compliance
• Business planning

We may participate in a secure electronic health information exchange to improve care coordination.

Unless you object, we may share PHI with family members or caregivers involved in your care.
In emergencies, we may use professional judgment to determine whether sharing information is in your best interest.

We may disclose PHI without your authorization for:

• Public health activities
• Health oversight
• Abuse or neglect reporting
• FDA requirements
• Legal proceedings
• Law enforcement
• Coroners or funeral directors
• Organ donation
• Workers’ compensation
• National security
• Military activity
• Compliance investigations by the Department of Health and Human Services

If you believe your privacy rights have been violated, you may file a complaint with our practice or directly with the U.S. Department of Health and Human Services.

You may contact our Privacy Manager at:

Brandon Goldwater DMD

• (267) 763 – 1500
• Jenkintown, PA

We will not retaliate against you for filing a complaint.