HIPAA Privacy Practices for Precision Oyster Bay Dental & Specialty

Effective Date: 5/8/2023

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Commitment to Your Privacy

We take our obligation to protect your privacy seriously. This notice explains our policies and practices regarding your medical information. We are required by law to maintain the privacy of your medical information, and we will comply with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).

How We Use and Disclose Your Medical Information

We use your medical information to provide you with quality dental care. We may also use your medical information for payment and health care operations, as described below:

1. Payment: We may use and disclose your medical information to obtain payment for the dental services we provide to you.
2. Health Care Operations: We may use and disclose your medical information for our health care operations, which include activities such as quality assessment, training, and other administrative purposes.

We may also use and disclose your medical information for other purposes permitted or required by law, such as public health or law enforcement activities.

Your Rights Regarding Your Medical Information

You have the right to:

1. Access your medical information: You have the right to access and obtain a copy of your medical information.
2. Request restrictions: You have the right to request restrictions on the use and disclosure of your medical information.
3. Request confidential communications: You have the right to request that we communicate with you about your medical information in a certain way or at a certain location.
4. Request amendments: You have the right to request that we amend your medical information if you believe it is incorrect or incomplete.
5. File a complaint: You have the right to file a complaint if you believe your privacy rights have been violated.

Contact Information

If you have any questions about this notice or our privacy practices, please contact us at [Insert Contact Information]. We reserve the right to change our privacy practices and this notice. Any changes will apply to medical information we already have about you, as well as any information we receive in the future.

Acknowledgment of Receipt of Notice of Privacy Practices

I acknowledge that I have received a copy of Precision Oyster Bay Dental and Specialty's Notice of Privacy Practices.

Name: ___________________________

Signature: ___________________________

Date: ___________________________