ORALCARE
  ASSOCIATES

SUMMARY OF PRIVACY PRACTICES

    This summary of our privacy practices is a condensed version of our Notice of Privacy Practices. Our full-length Notice follows this summary.

Date of Last Revision: 11-07-02
Effective Date: Immediately

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.

    We understand that your medical information is personal to you, and we are committed to protecting the information about you. As our patient, we create medical records about your health, our care for you, and the services and/or items we provide to you as our patient. By law, we are required to make sure that your protected health information is kept private.

    How will we use or disclose your information? Here are a few examples (for more detail please refer to the Notice of Privacy Practices that follows this summary):

For medical treatment
To obtain payment for our services
In emergency situations
For appointment and patient recall reminders
To run our Practice more efficiently and ensure all our patients receive quality care
For research
To avert a serious threat to health or safety
For organ and tissue donation
For workers' compensation programs
In response to certain requests arising out of lawsuits or other disputes


    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. All complaints must be submitted in writing. You will not be penalized for filing a Complaint.

 

    I have read and understand the above summary of Privacy Practices. I understand a full copy is available for my review and that I may request a copy of the full length notice.




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patient or guardian signature date