Carothers Parkway General Dentistry
Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities
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.
Your Rights:
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your
medicalrecord and other health information we have about you.
Ask us how to do this. - We will provide a copy or a summary of your health information,
usually within 30 days of your request. We may charge a
reasonable, cost-based fee.
Ask us to correct your medical record - You can ask usto correct health information about you that you think
is incorrect or incomplete. Ask us how to do this. - We may say “no” to your request, but we will tell you why in writing
within 60 days.
Request confidential communications - You can ask us to contact you in a specific way (for example,
home or office phone) or send mail to a different address. - We will say “yes” to all reasonable requests.
Get a copy of this privacy notice - You can ask for a paper copy of this notice at any time, even if you
have agreed to receive this notice electronically. We will provide you
with a paper copy promptly.
Ask us to limit what we use or share - You can ask us NOT to use or share certain health information
for treatment, payment, or our operations. - We are not required to agree to your request, and we may say
“no” if it would affect your care. - If you pay for a service or health care item out-of-pocket in full,
you can ask us not to share that information for the purpose of
payment or our operations with your health insurer. - We will say “yes” unless a law requires us to share that
information.
Get a list of those with whom we’ve shared information - You can ask for a list (accounting) of the times we’ve shared your
health information for six years prior to the date you ask, who we
shared it with, and why. - We will include all the disclosures except for those about treatment,
payment, and health care operations, and certain other disclosures
(such as any you asked us to make). We’ll provide one accounting a
year for free but will charge a reasonable, cost-based fee if you ask
for another one within 12 months.
Choose someone to act for you - If you have given someone medical power of attorney or if
someone is your legal guardian, that person can exercise your
rights and make choices about your health information. - We will make sure the person has this authority and can act for
you before we take any action.
File a complaint if you feel your rights are violated - You can complain if you feel we have violated your rights by
contacting us at Carothers Parkway General Dentistry, 904 Carothers
Parkway A 203, Franklin, TN 37067,615-771-7123 - You can file a complaint with the U.S. Department of Health and
Human Services Office for Civil Rights by sending a letter to 200
Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-
696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. - We will not retaliate against you for filing a complaint.
Your choices:
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information
in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the
right and choice to tell us to: - Share information in a disaster relief situation • Share information with your family, close friends, or
others involved in your care including stepparents - Include your information in a hospital directory if applicable • Contact you for fundraising efforts
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we
believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or
safety.
In these cases, we never share your information unless you give us
written permission: - Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising: • We may contact you for fundraising efforts, but you can tell us
not to contact you again.
Our Uses and Disclosures:
How do we typically use or share your health information? We typically use or share your health information in the following ways:
Treat You • We can use your health information and share it
with other professionals who are treating you
Example: A doctor treating you for an injury asks
another doctor about your overall health condition.
Run our organization (Health
Care Operations) - We can use and share your health information to
run our practice, improve your care, and contact
you when necessary
Example: We use health information about you to
manage your treatment and services.
Bill for your services (Payment) • We can use and share your health information to
bill and get payment from health plans or other
entities
Example: We give information about you to your
health insurance plan so it will pay for yourservices.
How else can we use or share your health information? We are allowed or required to share your information in other ways-usually in ways
that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your
information for these purposes. For more information see: www.hhs.gov/ocr/priacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues
We can share health information about you for certain situationssuch
as: - Preventing Disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health
or safety
Address workers’ compensation, law enforcement and other
government requests
We can use or share health information about you - For workers’ compensation claims
- For law enforcement purposes or with a law enforcement
official - With health oversight agencies for activities authorized by law
- For special government functions such as military, national
security, and presidential protective services
Do Research - We can use or share your information for health research
Comply with the law - We will share information about you if state or federal laws
require it, including with the Department of Health and Human
Services if it wants to see that we’re complying with federal
privacy law.
Respond to organ and tissue donation requests - We can share health information about you with organ
procurement organizations.
Work with a medical examiner or funeral director - We can share health information with a coroner, medical
examiner, or funeral director when an individual dies.
Respond to lawsuits and legal actions • We can share health information about you in response to a
court or administrative order, or in response to a subpoena.
Other Permitted and Required Uses And Disclosures:
Students: - We may share PHI with students working in our Practice
to fulfill their educational requirements. - If you do not wish a student to observe or participate in
your care, please notify your provider
Appointment Reminders: - We may contact you as a reminder of your appointment.
- Only limited information is provided on an answering machine
or another individual that may have answered the call other
than you. - We may use an auto text reminder server, automated patient
reminder servicer, or other patient reminder platforms. - We may issue a post card or letter notifying you that it istime
to make an appointment. - You may provide a preferred means of contact such as mobile
number or email address. - Appointment reminders are considered part of treatment of an
individual and, therefore, can be made without an
authorization. - Reasonable requests will be accommodated.
Kendra Lawyer
Carothers Parkway General Dentistry
9040 Carothers Parkway A 203 ,Franklin, TN 37067
klawyer@lawyerdds.com
615-771-7123
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may
change your mind at any time. Let us know in writing if you change your mind.
For more information visit www.hhs.gov/ocr/priacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The amended notice will be available upon
request, in our office, and on our website at http://lawyerdds.com/
This notice takes effect 01/26/2023 and remains in effect until we replace it.