This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This Notice applies to Makhzan Orthodontics and its workforce members who provide or support care through the Practice.
At a Glance
Your Rights
- Access or copy records
- Request corrections
- Request confidential communications
- Ask us to limit sharing
- Receive an accounting of certain disclosures
- Get a copy of this Notice
- Choose a personal representative
- File a complaint
Your Choices
- Tell us preferences about sharing with family/friends or in disaster relief
- Give or withhold permission for certain marketing, sale of PHI, or other uses requiring authorization
Our Uses and Disclosures
- Treat you
- Run our practice
- Bill for services
- Public health and safety
- Research where permitted
- Comply with law
- Government and law-enforcement requests
- Legal proceedings and other permitted uses
Your Rights
When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities.
Get an Electronic or Paper Copy of Your Medical or Dental Record
- You can ask to see or get an electronic or paper copy of your medical or dental record and other health information we maintain about you. Ask us how to do this.
- We will provide access or a copy within the time required by law, generally within 30 days after receiving a valid request, subject to permitted extensions.
- We may charge a reasonable, cost-based fee permitted by law. Fees for a HIPAA access request will not include impermissible search, retrieval, or other administrative costs.
Ask Us to Correct Your Record
- You can ask us to amend health information about you that you believe is incorrect or incomplete. Ask us how to do this.
- We may deny the request in circumstances permitted by law, but if we do, we will explain the denial in writing within the time required by law.
Request Confidential Communications
- You can ask us to contact you in a specific way, such as at a particular phone number, or to send mail to a different address.
- We will accommodate reasonable requests as required by law.
Ask Us to Limit What We Use or Share
- You can ask us not to use or share certain health information for treatment, payment, or health care operations. We generally are not required to agree, except as described below or otherwise required by law.
- If you pay for a health care item or service out of pocket in full, you can ask us not to disclose information about that item or service to your health plan for payment or health care operations. We will agree unless a law requires the disclosure.
Get a List of Certain Disclosures
- You can ask for an accounting of certain disclosures of your health information made during the six years before the date of your request.
- The accounting does not include every disclosure. For example, disclosures for treatment, payment, and health care operations and certain other disclosures are generally excluded.
- We will provide one accounting in a 12-month period without charge. We may charge a reasonable, cost-based fee for additional accountings if permitted by law, after notifying you in advance.
Get a Copy of This Notice
You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. We will provide a paper copy promptly.
Choose Someone to Act for You
- If a person has legal authority to act as your personal representative, that person may exercise your rights and make choices about your health information as provided by law.
- We may verify the person’s authority before taking action.
File a Complaint if You Believe Your Rights Were Violated
- You may complain to us by contacting our Privacy Officer at 770-901-2222 or info@makhzanortho.com.
- You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting https://www.hhs.gov/hipaa/filing-a-complaint/, calling 1-877-696-6775, or writing to 200 Independence Avenue, S.W., Washington, D.C. 20201.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference in the situations below, tell us what you want us to do, and we will follow your instructions as required by law.
Family, Friends, and Others Involved in Your Care
- We may share health information relevant to your care or payment with a family member, close friend, or another person you identify as involved in your care or payment when you agree, when you have an opportunity to object and do not object, or when the circumstances otherwise permit the disclosure under applicable law.
- If you are not able to tell us your preference, such as when you are incapacitated or unavailable, we may share relevant information if, in our professional judgment, doing so is in your best interest or is otherwise permitted by law.
- We may also share information as permitted by law for disaster relief or to lessen a serious and imminent threat to health or safety.
Uses That Generally Require Written Authorization
Except where applicable law allows otherwise, we will obtain your written authorization before using or disclosing PHI for purposes that require authorization, including:
- most uses and disclosures of psychotherapy notes, if we maintain them;
- marketing uses or disclosures when HIPAA requires authorization; and
- a sale of PHI as defined by HIPAA.
If you give us a written authorization, you may revoke it in writing at any time. Revocation does not affect actions already taken in reliance on the authorization.
Fundraising
We do not currently use your PHI for fundraising communications. If we do so in the future as permitted by law, you will have the right to tell us not to contact you again. If we have substance use disorder patient records subject to 42 CFR Part 2, we will provide any additional notice and choice required by law before using Part 2 information for fundraising.
Our Uses and Disclosures
How We Typically Use or Share Health Information
Treat you. We may use your health information and share it with other health care professionals who are treating you. Example: we may share orthodontic records or radiographs with your dentist, oral surgeon, or another treating provider when appropriate for your care.
Run our organization. We may use and share health information to operate the Practice, improve care, train staff, conduct quality activities, coordinate services, and contact you when necessary.
Bill for your services. We may use and share health information to bill and obtain payment from you, health plans, or other entities responsible for payment.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose health information in other situations permitted or required by law, subject to applicable conditions and safeguards. These may include:
- public health and safety activities, such as preventing disease, reporting adverse events, reporting suspected abuse or neglect, or preventing or reducing a serious threat to health or safety;
- health oversight activities authorized by law;
- research when the applicable legal requirements are satisfied;
- organ and tissue donation requests, where applicable;
- disclosures to a coroner, medical examiner, or funeral director as permitted by law;
- workers’ compensation claims and other programs authorized by law;
- law-enforcement and other government requests as permitted or required by law;
- special government functions such as military, national-security, or protective-service activities when legally authorized;
- court or administrative orders, subpoenas, and other legal proceedings when the legal requirements for disclosure are satisfied; and
- other uses or disclosures required by federal, state, or local law.
Substance Use Disorder Records Protected by 42 CFR Part 2
To the extent we create, receive, or maintain substance use disorder patient records that are subject to 42 CFR Part 2, those records receive additional federal protections. We will not use or disclose Part 2 records in civil, criminal, administrative, or legislative investigations or proceedings against you unless permitted by Part 2, including when supported by your written consent or by a court order and subpoena that satisfy applicable requirements.
Specially Protected Information and More Protective Laws
Some categories of information may receive additional protection under federal or Georgia law. When another applicable law provides greater privacy protection or greater access rights than HIPAA, we will follow the more protective requirement.
Our Responsibilities
- We are required by law to maintain the privacy and security of your PHI.
- We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in the Notice that is currently in effect.
- We will not use or disclose your information other than as described in this Notice unless you authorize us in writing or applicable law otherwise permits or requires the use or disclosure.
- We do not sell your PHI.
Changes to This Notice
We may change the terms of this Notice, and the changes may apply to all health information we maintain, including information created or received before the change. If we make a material change, we will make the revised Notice available as required by law, including on our Website and in our office.
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