Notice of Privacy Practices and SMS Privacy Policy
Tamal Vista Family Dentistry
Effective Date: [Insert Effective Date]
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At Tamal Vista Family Dentistry, we respect your privacy and are committed to protecting your personal and health information. This Notice explains how we may use and disclose your protected health information, describes your rights, and explains how we protect information provided through our website and text messaging program.
Protected health information, or PHI, generally includes information that identifies you and relates to your health, dental care, or payment for your care.
Our Responsibilities
We are required by law to:
- Maintain the privacy of your protected health information.
- Provide you with this Notice describing our legal duties and privacy practices.
- Follow the terms of the Notice currently in effect.
- Notify you if a breach of your unsecured protected health information occurs, as required by law.
We reserve the right to change our privacy practices and this Notice as permitted by law. Any revised Notice may apply to health information we already maintain, as well as information we receive in the future. We will post the updated Notice on our website and make copies available at our office upon request.
How We May Use and Disclose Your Health Information
We may use and disclose your health information for the following purposes, as permitted or required by law.
Treatment
We may use and share your health information to provide, coordinate, or manage your dental care. For example, we may share information with a dental specialist to whom we refer you.
Payment
We may use and share your health information to obtain payment for services provided to you. For example, we may submit a claim to your dental insurance company or communicate with your health plan about your benefits and coverage.
Healthcare Operations
We may use and share your health information to support the operation of our practice. These activities may include quality assessment, staff training, licensing, practice management, and improving the services we provide.
Appointment Reminders and Other Communications
We may contact you about appointments, treatment, follow-up care, billing, or other matters related to your care. We may communicate by telephone, voicemail, email, mail, or text message, consistent with your communication preferences and applicable law.
Individuals Involved in Your Care
Unless you object or applicable law requires otherwise, we may share relevant information with a family member, friend, caregiver, or other person you identify who is involved in your care or payment for your care.
We may also share information with your legally authorized personal representative as required or permitted by law.
Business Associates and Service Providers
We may share information with service providers that perform functions on our behalf, such as billing, information technology, practice management, or patient communications. When required by law, these providers must agree to appropriately safeguard your health information.
Required by Law
We may use or disclose your health information when required to do so by federal, state, or local law.
Public Health and Safety
We may disclose information for public health activities, such as preventing or controlling disease, reporting suspected abuse or neglect, reporting problems with medications or medical devices, or responding to a product recall.
We may also disclose information when permitted by law to help prevent or lessen a serious and imminent threat to health or safety.
Health Oversight Activities
We may disclose information to a government agency responsible for oversight activities, such as audits, investigations, inspections, licensing, or enforcement.
Legal Proceedings
We may disclose information in response to a court or administrative order, subpoena, discovery request, or other lawful process when the applicable legal requirements are met.
Law Enforcement
We may disclose information to law enforcement officials when required or permitted by law, including in response to certain court orders, warrants, or subpoenas.
Workers’ Compensation
We may disclose information as authorized and necessary to comply with workers’ compensation or similar laws.
Research
We may use or disclose health information for research when permitted by law and when applicable privacy protections and approval requirements have been satisfied.
Coroners, Medical Examiners, and Funeral Directors
We may disclose information to coroners, medical examiners, or funeral directors as permitted by law to allow them to carry out their responsibilities.
National Security, Military, and Correctional Institutions
We may disclose information to authorized federal officials for lawful national security or intelligence activities, to military authorities under certain circumstances, or to correctional institutions or law enforcement officials with lawful custody of an individual, as permitted by law.
Disaster Relief
We may share information with organizations assisting in disaster relief efforts as permitted by law.
U.S. Department of Health and Human Services
We may disclose information to the U.S. Department of Health and Human Services when required to investigate or determine our compliance with applicable privacy laws.
Fundraising
We may contact you about fundraising activities as permitted by law. If we do, you may opt out of receiving future fundraising communications.
Information Subject to Special Protections
Certain types of information, including information relating to mental health, HIV, genetic information, and substance use disorder treatment, may be subject to additional protections under federal or California law. We will comply with applicable requirements when using or disclosing this information.
Substance Use Disorder Records
If we receive or maintain substance use disorder treatment records protected by 42 CFR Part 2, we will use and disclose those records only as permitted by applicable law and any required consent.
Subject to applicable requirements, a patient’s Part 2 records, or testimony describing information in those records, may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the patient without the patient’s written consent or an appropriate court order and subpoena, as applicable.
Uses and Disclosures Requiring Your Authorization
We will obtain your written authorization before using or disclosing your health information for purposes not otherwise permitted or required by law.
Your authorization is generally required for:
- Most uses and disclosures of psychotherapy notes.
- Uses and disclosures of protected health information for marketing purposes.
- Disclosures that constitute a sale of protected health information.
If you provide an authorization, you may revoke it in writing at any time. Your revocation will not affect actions we have already taken in reliance on your authorization.
Your Health Information Rights
You have the following rights concerning your protected health information, subject to applicable legal requirements and exceptions.
Access to Your Records
You have the right to request access to or a copy of your health information. If your information is maintained electronically, you may request an electronic copy in a form and format that is readily producible.
We may charge a reasonable, cost-based fee as permitted by law. If we deny your request, we will explain the reason and any applicable right to have the denial reviewed.
Request a Correction
You have the right to request that we amend information you believe is incorrect or incomplete. We may ask you to submit your request in writing and explain the reason for the requested change.
If we deny your request, we will provide a written explanation and information about your rights.
Request Restrictions
You have the right to request restrictions on how we use or disclose your health information. We are not required to agree to every request.
However, we generally must agree to your request not to disclose information to your health plan for payment or healthcare operations when the information relates solely to an item or service for which you or another person on your behalf has paid us in full, unless the disclosure is otherwise required by law.
Request Confidential Communications
You have the right to request that we communicate with you in a particular way or at a particular location. For example, you may ask us to contact you at a different telephone number or mailing address. We will accommodate reasonable requests.
Receive an Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your health information, subject to legal exceptions. We may charge a reasonable, cost-based fee for additional requests made within a 12-month period, as permitted by law.
Receive Notice of a Breach
You have the right to be notified following a breach of your unsecured protected health information when notification is required by law.
Obtain a Copy of This Notice
You have the right to request a paper copy of this Notice, even if you previously agreed to receive it electronically.
File a Complaint
You have the right to file a complaint if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
Website Privacy
Information We Collect
When you visit our website or communicate with us through an online form, we may collect information you choose to provide, such as your:
- Name.
- Telephone number.
- Email address.
- Preferred appointment information.
- Information included in your message or request.
Our website may also automatically collect certain technical information, such as your IP address, browser type, device information, pages visited, and general website usage information.
How We Use Information
We may use the information we collect to:
- Respond to inquiries and appointment requests.
- Communicate with you about our services.
- Provide and coordinate patient care.
- Improve our website and patient experience.
- Maintain website security and prevent misuse.
- Comply with applicable legal obligations.
Please do not submit sensitive medical, financial, or other confidential information through a general website contact form unless the form specifically states that it is intended for that purpose and is secure.
Website Analytics and Cookies
Our website may use cookies or similar technologies to help it function and to understand how visitors use the site. You may be able to adjust your browser settings to limit or disable cookies; however, some website features may not function properly.
Third-Party Links
Our website may contain links to third-party websites or services. We are not responsible for the privacy practices or content of those websites. We encourage you to review their privacy policies before providing information.
SMS/Text Messaging Privacy Policy
Types of Messages
If you opt in to receive text messages from Tamal Vista Family Dentistry, we may send messages related to:
- Appointment confirmations and reminders.
- Scheduling or rescheduling requests.
- Patient follow-up and care coordination.
- Billing or payment reminders.
- Responses to questions or other practice-related communications.
Messages may be sent using an automated messaging system, as applicable. Message frequency varies. Message and data rates may apply.
Consent to Receive Text Messages
You may opt in to receive text messages by completing an online form, a paper form, or another method offered by our practice. By providing your mobile number and affirmatively consenting, you agree to receive the types of messages described at the point where you opt in.
Consent to receive text messages is not a condition of receiving dental care or purchasing services. You may contact our office by telephone if you prefer not to communicate by text.
We will obtain any additional consent or authorization required for promotional messages or other communications under applicable law.
How to Opt Out
You may opt out of text messages at any time by replying STOP to a message from us. You may receive a confirmation message acknowledging your opt-out.
You may also contact our office at (415) 453-4720 to update your communication preferences.
After you opt out, we may contact you through another appropriate method regarding your care, appointments, account, or other necessary matters.
Help
For help with our text messaging program, reply HELP to a message from us or call (415) 453-4720.
Sharing of Mobile Information and Consent
We do not sell, rent, or share your mobile number or SMS opt-in information with third parties or affiliates for their marketing or promotional purposes.
Text messaging consent and opt-in information will not be shared with third parties for their independent marketing or promotional purposes. We may use service providers to deliver messages and support our communications, subject to appropriate privacy and security requirements. Such providers may use the information only to perform services for us or as required by law.
Text Message Security
Standard text messages may not be encrypted and may be viewed by others who have access to your mobile device or account. Please avoid sending sensitive health, financial, or other confidential information by text message.
Text messaging should not be used for dental or medical emergencies. If you are experiencing a medical emergency, call 911.
Information Security
We use reasonable administrative, technical, and physical safeguards designed to protect personal and health information. However, no method of electronic transmission or storage can be guaranteed to be completely secure.
Questions, Requests, and Complaints
If you have questions about this Notice, want to exercise your privacy rights, or wish to file a complaint with our practice, please contact:
Privacy Official
Tamal Vista Family Dentistry
1447 4th Street
San Rafael, CA 94901
Phone: (415) 453-4720