HIPAA Notice of Privacy PracticesOur Commitment to Your PrivacyOur dental practice is committed to protecting the privacy and confidentiality of your protected health information (PHI). We are required by law to maintain the privacy of your PHI, to provide you with this Notice of Privacy Practices, and to follow the terms of this Notice currently in effect. This Notice explains how we may use and disclose your PHI, your rights regarding your PHI, our legal duties, and whom to contact for additional information or to file a complaint. What Is Protected Health Information (PHI)Protected Health Information (PHI) is individually identifiable health information that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or payment for that care. PHI may be created, received, maintained, or transmitted in any form, including electronic, paper, or oral communications. Examples of PHI include, but are not limited to:
How We May Use and Disclose Your PHI Without Your Authorization
Other Permitted or Required Uses and DisclosuresWe may also use or disclose your PHI without your authorization in the following circumstances, as permitted or required by law: To comply with federal, state, or local laws:
Special Protections for Certain Records (Including Substance Use Disorder Records) Some health information may be subject to additional protections under federal or state law, including records related to substance use disorder (SUD) treatment governed by 42 CFR Part 2. Uses and Disclosures Requiring Your Written Authorization We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice. Your Rights Regarding Your PHI:
Our Legal DutiesWe are required by law to:
ComplaintsIf you believe your privacy rights have been violated, you may file a complaint with our practice, using the contact information listed above, or The U.S. Department of Health and Human Services, Office for Civil Rights We will not retaliate against you for filing a complaint. Changes to This Notice We reserve the right to change the terms of this Notice at any time. Any changes will apply to all PHI we maintain. Updated Notices will be available upon request and posted in our office and on our website, if applicable. Who we can share information with: The individual(s) listed below are who you may share information with regarding my health/financial records: Not provided * If you have given someone medical power of attorney or if 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 and can act for you before we take any action. You may at any time, also request information to be confidential. |
 Contact UsAppletree Cove Dental 26114 Illinois Ave. Northeast, Kingston, WA 98346-7674 PO Box 149, Kingston, WA 98346 360-297-4331 Office HoursMonday Tuesday Wednesday Thursday Friday 8am - 5pm 8am - 5pm 8am - 5pm 8am - 2pm Closed |
