HIPPA

Notice of Privacy Practices Summary (HIPPA)

This describes how health data about you may be used and shared and how you can get access to this data.

1. How we may use health data about you:

a. Treatment – We may use or share your health data to give you medical treatment or other typesof health services.

b. Payment – We may use or share your health data to bill you or a third party for payment for services provided to you.

c. Health Care Operations – We may use and share health data about you for our own operations such as quality control, compliance monitoring, outcome evaluation, audit, etc.

2. Disclosures where we do not have to give you a chance to agree or object:

a. To you

b. As required by federal, state, or local law

c. If child abuse or neglect is suspected

d. Public Health risks for public health activities to prevent and control of disease.

e. Lawsuits and disputes in response to a court or administrative order.

f. Law enforcement to help law enforcement officials respond to criminal activities.

g. Coroners, medical examiners, and funeral directors

h. Organ or tissue donation facilities if you are an organ donor

i. To avert a threat to individual or public health or safety

3. Disclosures where we have to give you a chance to agree or object:

a. Patient directories – You can decide what health data, if any, you want to be listed in patient directories.

b. Persons involved in your care or payment for your care – We may share your health data with a family member, a close friend or other person that you named as being involved with your health care.

4. Other uses of health data: Other uses not covered by this notice or the laws that apply to us will be made only with your written consent.

5. You have these rights for the health data we keep about you

a. Right to inspect your health record and to receive a copy of your health record upon request.

b. Right to amend information in your health record you believe is inaccurate or incomplete.

c. Right to know to whom we have disclosed your health information.

d. Right to ask for limits on the health information data we give out about you.

e. Right to receive communication from us about your health information in alternate ways.

f. Right to a paper copy of the complete Notice of Privacy Practices.

Should you have any questions regarding your privacy and information, contact us at:

Tamal Vista Family Dentistry
1447 4TH STREET
San Rafael, California 94901
(415) 453-4720