Notice of Privacy Practices

1. 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 a copy of your dental records. You can ask to see or get a paper or electronic copy of your records and other health information we have about you. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost based fee.
• Ask us to correct your records. You can ask us to correct health information that you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way, for example by home or office phone, or to send mail to a different address. We will say yes to all reasonable requests.
• 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 our operations. We are not required to agree if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will say yes unless the law requires us to share it.
• Get a list of those with whom we have shared information. You can ask for a list of the times we have shared your health information for six years before the date you ask, who we shared it with, and why. It will include all disclosures except those about treatment, payment and health care operations, and certain others, such as ones you asked us to make. We provide one list a year for free and may charge a reasonable, cost based fee if you ask for another within 12 months.
• Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we act.
• File a complaint if you feel your rights are violated. See the last section of this notice.

2. Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference, talk to us and we will follow your instructions.

You have both the right and the choice to tell us to share information with your family, close friends or others involved in your care, and to share information in a disaster relief situation. If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest, and when needed to lessen a serious and imminent threat to health or safety.

We never share your information for marketing purposes or sell your information unless you give us written permission.

3. Our uses and disclosures

We typically use or share your health information in the following ways.

• To treat you. We can use your health information and share it with other professionals who are treating you, for example a specialist or your physician.
• To run our practice. We can use and share your health information to run our practice, improve your care and contact you when necessary, for example appointment reminders.
• To bill for your services. We can use and share your health information to bill and get payment from health plans or other entities.

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:

• Helping with public health and safety issues, such as preventing disease, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety
• Doing research
• Complying with the law, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law
• Responding to organ and tissue donation requests
• Working with a medical examiner or funeral director
• Addressing workers’ compensation, law enforcement and other government requests, and special government functions such as military and national security
• Responding to lawsuits and legal actions, such as a court or administrative order or a subpoena

Any other use or disclosure requires your written permission, which you may revoke in writing at any time.

4. Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly 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 this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

5. Changes to 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 on request, in our office and on this website.

6. Questions and complaints

To ask a question, use any of the rights above, or file a complaint with us, contact:

Privacy Officer, Express Dental Emergency Services
1111 Park Avenue, Suite L-109, Baltimore, MD 21201
443-708-3232

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue SW, Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint.

For how this website handles information you enter online, see our website Privacy Notice.