At Butler Family Dental, we understand the importance of keeping your health information private. We are committed to protecting the confidentiality of your patient records and ensuring you understand your rights regarding this information. This notice explains our privacy practices, legal duties, and your rights concerning your health information. Please review it carefully.
Your Privacy Matters to Us
We are located at:
819 Main Street
Tell City, Indiana 47586
You can reach us at (812) 548-4444
Matthew A. Butler and Meghan E. Butler are dedicated to maintaining the privacy of your health information.
Our Legal Responsibility
Federal and state laws require us to protect the privacy of your health information. We are also obligated to provide you with this Notice of Privacy Practices, which outlines our legal duties and your rights concerning your health information. We are committed to following the practices described in this Notice, which is currently in effect and will remain so until we update or replace it. This Notice is effective from 04/14/03.
We may change our privacy practices and the terms of this Notice at any time, provided these changes are legal and compliant with applicable laws. Any changes will apply to all health information we maintain, including information created or received before the changes were made. If we make significant changes to our privacy practices, we will update this Notice and make the new version available to you upon request.
You are entitled to request a copy of our Notice at any time. For further information about our privacy practices or to obtain additional copies of this Notice, please contact us using the details provided at the end of this document.
How We Use and Disclose Your Health Information
We use and disclose your health information for purposes related to treatment, payment, and healthcare operations. Here are some examples:
Treatment
We may use or share your health information with dentists or other healthcare providers involved in your dental care. For instance, if you are referred to a specialist, we will share relevant information to ensure you receive the best possible care.
Payment
To receive payment for the services we provide, we may use and disclose your health information to insurance companies or other payers. This could include information needed for billing and claims processing.
Healthcare Operations
Butler Family Dental may use your health information for healthcare operations. This includes activities that support the quality of care we provide, such as:
- Evaluating the quality of our services and working to improve them.
- Reviewing the skills and qualifications of our dental professionals.
- Assessing the performance of our providers and staff.
- Organizing training programs.
- Managing accreditation, certification, and licensing processes.
Your Authorization
For any uses or disclosures of your health information beyond treatment, payment, and healthcare operations, we will require your written authorization. You have the right to revoke this authorization at any time by writing to us. However, this revocation will not affect any actions taken while the authorization was in effect. Unless you provide us with written authorization, we will only use and disclose your health information as described in this Notice.
Sharing Information with Family and Friends
We understand that you may want to involve family members or friends in your healthcare journey. We may disclose your health information to a family member, friend, or another person who is helping with your care or with payment for your care, but only if you agree to this disclosure.
Persons Involved In Your Care
To assist in notifying family or those responsible for your care, we may use or disclose health information to locate and inform a family member, your personal representative, or another person responsible for your care about your location, general condition, or in case of death. When possible, we will discuss this with you and obtain your agreement before disclosing such information. In emergency situations or if you are unable to make decisions, we will disclose health information based on our professional judgment, sharing only information directly relevant to that person’s involvement in your healthcare. We will also use our professional judgment and common practices to reasonably infer that it is in your best interest to allow someone to pick up prescriptions, medical supplies, x-rays, or similar health information on your behalf.
Marketing Health-Related Services
We will not use your health information for marketing communications without obtaining your explicit written authorization. Your privacy is respected, and we ensure your information is not used for marketing purposes without your consent.
Legal Requirements
Butler Family Dental may disclose your health information if required by law. This could be in response to a court order, subpoena, or other legal processes.
Abuse or Neglect
To protect your well-being, we may disclose your health information to appropriate authorities if we reasonably believe you are a victim of abuse, neglect, domestic violence, or other crimes. We may also disclose information to prevent a serious threat to your health and safety or that of others.
National Security
In certain circumstances, we may be required to disclose health information to military authorities for Armed Forces personnel, to authorized federal officials for national security activities, or to correctional institutions or law enforcement officials regarding inmates or patients in lawful custody.
Appointment Reminders
As a service to our patients, we may use your health information to provide you with appointment reminders. These reminders may be in the form of voicemail messages, postcards, or letters to help you keep track of your appointments at Butler Family Dental.
Questions and Complaints
If you have any questions, concerns, or require more information about our privacy practices, please do not hesitate to contact us.
If you believe your privacy rights have been violated, or if you disagree with a decision we made regarding access to your health information, or in response to a request to amend or restrict the use or disclosure of your health information, or to communicate with you through alternative means or locations, you have the right to file a complaint with us. Please use the contact information provided at the end of this Notice to submit your complaint.
You also have the right to submit a written complaint to the U.S. Department of Health and Human Services. We can provide you with the address for filing such complaints upon request. We fully support your right to the privacy of your health information.
We assure you that there will be no retaliation of any kind if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Contact Officer:
Butler Family Dentistry
Tel. (812) 548-4444
819 Main Street
Tell City, Indiana 47586
This notice is based on the framework provided by the American Dental Association and is intended for educational purposes only. It is not legal advice and pertains to federal law, not state law (August 14, 2002).
