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Privacy Notice


HOW MEDICAL OR DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS.

PLEASE REVIEW IT CAREFULLY.

I. Dental Practice Covered by this Notice

This Notice describes the privacy practices of Grewal Dental Care. “We” and “our” means the Dental Practice. “You” and “your” means our patient. “PHI” means Protected Health Information.

II. How to Contact Us/Our Privacy Official

If you have any questions or would like further information about this Notice, you can contact Grewal Dental Care at:

26597 N. Dixie Hwy; Ste 169, Perrysburg, OH 43551

III. Our Promise to You and Our Legal Obligations

The privacy of your health information is important to us. We understand that your health information is personal, and we are committed to protecting it. We are also committed to protecting your contact information from third parties/affiliates for marketing or promotional purposes.  All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties. This Notice describes how we may use and disclose your PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We are required by law to:

  • Maintain the privacy of your PHI;
  • Give you this Notice of our legal duties and privacy practices with respect to that information; and
  • Abide by the terms of our Notice that is currently in effect.

IV. Last Revision Date This Notice was last revised on January 27, 2025.

V. How We May Use or Disclose Your Health Information The following examples describe different ways we may use or disclose your health information. These examples are not meant to be exhaustive. We are permitted by law to use and disclose your health information for the following purposes:

 

A. Common Uses and Disclosures

1. Treatment. We may use your health information to provide you with dental treatment or services, such as cleaning or examining your teeth or performing dental procedures. We may disclose health information about you to dental specialists, physicians, or other health care professionals involved in your care.

2. Payment. We may use and disclose your PHI to obtain payment from health plans and insurers for the care that we provide to you.

3. Health Care Operations. We may use and disclose health information about you in connection with the health care operations necessary to run our practice, including review of our treatment and services, training, evaluating the performance of our staff and health care professionals, quality assurance, financial or billing audits, legal matters, and business planning and development.

4. Appointment Reminders. We may use or disclose your health information when contacting you to remind you of a dental appointment. We may contact you by using a postcard, letter, phone call, voice message, text or email.

5. Treatment Alternatives and Health-Related Benefits and Services. We may use and disclose your health information to tell you about treatment options or alternatives or health-related benefits and services that may be of interest to you.

6. Disclosure to Family Members and Friends. We may disclose your PHI to a family member or friend who is involved with your care or payment for your care if you do not object or, if you are not present, we believe it is in your best interest to do so.

7. Disclosure to Business Associates. We may disclose your PHI to third-party service providers (“business associates”) that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use a business associate to assist us in maintaining our software. All our business associates are obligated, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

 

B. Less Common Uses and Disclosures

1. Disclosures Required by Law. We may use or disclose patient health information to the extent we are required by law to do so. For example, we are required to disclose patient health information to the U.S. Department of Health and Human Services so that it can investigate complaints or determine our compliance with HIPAA.

2. Public Health Activities. We may disclose patient health information for public health activities and purposes, which include: preventing or controlling disease, injury or disability; reporting births or deaths; reporting child abuse or neglect; reporting adverse reactions to medications or foods; reporting product defects; enabling product recalls; and notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition

3. Victims of Abuse, Neglect or Domestic Violence. We may disclose health information to the appropriate government authority about a patient whom we believe is a victim of abuse, neglect or domestic violence.

4. Health Oversight Activities. We may disclose patient health information to a health oversight agency for activities necessary for the government to provide appropriate oversight of the health care system, certain government benefit programs, and compliance with certain civil rights laws.

5. Lawsuits and Legal Actions. We may disclose patient health information in response to (i) a court or administrative order or (ii) a subpoena, discovery request, or other lawful process that is not ordered by a court if efforts have been made to notify the patient or to obtain an order protecting the information requested.

6. Law Enforcement Purposes. We may disclose your health information to a law enforcement official for a law enforcement purposes, such as to identify or locate a suspect, material witness or missing person or to alert law enforcement of a crime.

7. Coroners, Medical Examiners and Funeral Directors. We may disclose your health information to a coroner, medical examiner or funeral director to allow them to carry out their duties.

8. Organ, Eye and Tissue Donation. We may use or disclose your health information to organ procurement organizations or others that obtain, bank or transplant cadaveric organs, eyes or tissue for donation and transplant.

9. Research Purposes. We may use or disclose your information for research purposes pursuant to patient authorization waiver approval by an Institutional Review Board or Privacy Board.

10. Serious Threat to Health or Safety. We may use or disclose your health information if we believe it is necessary to do so to prevent or lessen a serious threat to anyone’s health or safety.

11. Specialized Government Functions. We may disclose your health information to the military (domestic or foreign) about its members or veterans, for national security and protective services for the President or other heads of state, to the government for security clearance reviews, and to a jail or prison about its inmates.

12. Workers’ Compensation. We may disclose your health information to comply with workers’ compensation laws or similar programs that provide benefits for work-related injuries or illness.

 

Your Rights Regarding Your Protected Health Information

You have the following rights, subject to certain limitations, regarding your PHI:

Right to Inspect and Copy. You have the right to inspect and copy your PHI. We have up to 30 days to make your PHI available to you and we may charge you a reasonable fee. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed dental professional not directly involved in the denial of your request.

Right to a Summary or Explanation. We can also provide you with a summary of your PHI, rather than the entire record, so long as you agree to this alternative form and pay the associated fees.

Right to an Electronic Copy of Electronic Dental Records. If your PHI is maintained in an electronic format, you have the right to request an electronic copy. We will make every effort to provide access to your PHI in the format you request. If the PHI is not readily producible in that format your record will be provided in either our standard electronic format or a readable hard copy form. We may charge you a reasonable, cost-based fee for the electronic medical record.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured PHI.

Right to Request Amendments. If you feel that the PHI we have is incorrect or incomplete, you may ask us to amend the information. A request for an amendment must be made in writing and it must tell us the reason for your request. In certain cases, we may deny your request. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and provide you with a copy of any such rebuttal.

Right to an Accounting of Disclosures. You have the right to ask for an "accounting of disclosures," which is a list of the disclosures we made of your PHI. This right applies to disclosures for purposes other than treatment, payment or dental/healthcare operations as described in this Notice. It excludes disclosures we may have made to you, for a resident directory, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations.

Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or dental/health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. To request a restriction, you must submit a written request. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to ·agree to your request. If we do agree to the requested restriction, we may not use or disclose your PHI unless it is needed to provide emergency treatment.

Out-of-Pocket Payments. If you paid out-of-pocket in full for a specific item or service, you have the right to ask that your PHI with respect to that item or service not be disclosed to a dental plan for purposes of payment or dental operations.

Right to Request Confidential Communications. You have the right to request that we communicate with you only in certain ways to preserve your privacy. For example, you may request that we contact you by mail at a specific address or call you only at your work number. You must make such a request in writing, and you must specify how or where we are to contact you. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time.

 

How to Exercise Your Rights

To exercise your rights described in this Notice, send your request, in writing, to the address listed at the beginning of this Notice. We may ask you to fill out a form that we will supply.

Changes To This Notice

We reserve the right to change this Notice. We reserve the right to make the changed Notice effective for PHI we already have as well as for any PHI we create or receive in the future.

Complaints

You may file a complaint with us or with the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated. To file a complaint with us, contact us at the address listed at the beginning of this Notice. All complaints must be made in writing and should be submitted within 180 days of when you knew or should have known of the suspected violation. To file a complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave, S.W., Washington, D.C. 20201. Call toll free (877) 696-6775. There will be no retaliation against you for filing a complaint.


26597 N. Dixie Highway|Perrysburg, OH 43551|Map & Directions

Call: (419) 872 3000