Protecting Your Health While Respecting Your Right to Privacy
We respects each individual’s right to privacy. We have appropriate safeguards to protect the privacy of personal health information. A copy of our privacy policy is available for your review. Our office adheres to HIPAA Regulations for patient information.
Our office understands the importance of protecting your personal information. An unspoken part of providing our patients with safe and effective care has always been protecting the privacy of their personal information. This office will collect, use and disclose information about you, with your signed consent for the following purposes to:
- Deliver safe, effective and high quality health care treatment
- Communicate on an ongoing basis with your related health care providers
- Allow us to efficiently conduct the business of specialized dentistry/medicine
- Complete and submit dental claims and related information for third party adjudication and payment
- Comply with legal and regulatory requirements
- Permit potential practice consultants, advisors or purchasers to evaluate the practice
- Deliver your charts and records to the insurance carriers
- Process electronic claims and payments
- Take those steps necessary to secure collection of accounts
You may withdraw your consent for use or disclosure of your personal information but in some instances this may render us unable to provide or continue providing our services. By signing the consent form, you agree to have given your informed consent to the collection, use and/or disclosure of your personal information for the purposes that are listed and explained.