THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
Your privacy is important to us, and we will make every reasonable effort to ensure the safety and integrity of any information we collect. DPID, LLC (“DPid”) is committed to responsibly handling all information collected in connection with DPid’s Dental Prosthetic Identification Services. DPid is also fully committed to compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). You have a right to be informed of DPid’s privacy practices and of your privacy rights with respect to your personal health information.
DPid is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide you with this notice. PHI is sensitive, personal information about our dental patient clients and includes individually identifiable health care and demographic data. You may always request a copy of DPid’s most current HIPAA Privacy Notice from our Privacy Officer, whose contact information is provided below. Please carefully review this notice.
Understanding Your Health Information
Each time you correspond with DPid or visit our website, a record of your visit is made. Typically, this record contains your prescription and additional descriptive details of your dental prosthetic. This information is still part of your individual health or medical record, qualifying as PHI and may be used by DPid, your dentist, and your dental laboratory for
- Planning your care and treatment
- Verifying to you or a third-party payer that services billed were actually provided
- Sources of data for educating health professionals, medical research, and public health officials who oversee the delivery of health care in the United States
- A source of data for planning and marketing
- A tool with which we can assess and continually work to improve the services DPid renders and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who may access your health information and for what
reasons and at what times, and make more informed decisions when authorizing disclosure to others.
DPid must provide you access to your own PHI. We may also contact you to let you know about treatment options or other dental health-related benefits or services. We may also send you reminders about routine dental checkups, cleanings, and tests.
How We May Use and Disclose Health Information About You to Other People
Treatment and Prosthetic Manufacture or Restoration. DPid may share your personal health information with your dentist’s and dental laboratory’s PHI so that they may treat you and manufacture or restore your dental prosthetics. DPID DOES NOT PROVIDE TREATMENT AND DOES NOT MANUFACTURE OR RESTORE YOUR DENTAL PROSTHETIC. These are the roles of your dentist and the dental laboratory, respectively. DPid may share your PHI with such providers so that they may treat you and manufacture or restore your dental prosthetic.
Payment. DPid may use and disclose health information about you so that we can bill and receive payment for the services you receive from DPid and so that other providers can bill and be paid for the treatment services they provide.
Health Care Operations. DPid may use your PHI in the support functions of our service related to treatment and prosthetic manufacture or restoration. Health care operations may include quality assurance, case management, receiving and responding to patient complaints, dental professional reviews, compliance programs, audits, business planning, development, management, and administrative activities. We may remove information that identifies you from your PHI so that DPid and others can use this de-identified information to study the effectiveness and delivery of our services, dental care, and dental prosthetic manufacture and restoration without learning who you are.
In addition, DPid will only disclose your health information for certain health care operations of other entities only under the following conditions: (a) the other entity must have, or have had in the past, a relationship with you; (b) the health information used or disclosed must relate to that other entity’s relationship with you; and (c) the disclosure must only be for one of the following purposes: (i) quality assessment and improvement activities; (ii) population-based activities relating to improving health or reducing health care costs; (iii) case management and care coordination; (iv) conducting training programs; (v) accreditation, licensing, or credentialing activities; or (vi) health care fraud and abuse detection or compliance.
Business Associates. Some of our services may be provided through contracts or agreements with other public and private entities, and some of these contracts or agreements require that health information be disclosed to the contractor. These contractors are known as “business associates.” Examples include accountants, consultants, laboratories, dentists and attorneys. We may disclose your health information to these people so that they can
perform the job we have asked them to do. Business associates are required to appropriately safeguard your information.
As Required by Law. DPid will disclose health information about you when we are required to do so by a federal, state, or local law or regulation. We may also disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensing, court orders or in response to a subpoena that meets the requirements of Pennsylvania law.
Public Health. As authorized by law, DPid will disclose your health information to public health authorities charged with preventing or controlling disease, injury, or disability.
Marketing. DPid may contact you regarding your treatment, to coordinate your care, or to direct or recommend alternative treatments, therapies, health care providers, or settings. In addition, we may contact you to describe a health-related product or service that may be of interest to you, and the payment for such product or service.
Workers’ Compensation. DPid may release health information about you for workers’ compensation or similar programs that provide benefits for work-related injuries or illness, as authorized by the law and to the extent we are required to do so to comply with the law.
Food and Drug Administration (FDA). DPid may disclose information about you to the FDA as necessary for product recalls, withdrawals, and other problems with a product; to track products; or to report adverse events, product defects, or other problems with products.
National Security, Intelligence Activities and Protective Services for the President. We may disclose health information to a public official for national security activities and the protective services of the President and others when we are required to comply with a valid subpoena or other legal processes, or if such disclosure is required by state or federal law.
Correctional Institutions and Other Law Enforcement Custodial Situations. We may disclose health information to a correctional institution if it is necessary for your care or if the disclosure is required by state or federal law.
Research. We may disclose aggregate health information to researchers, when this information does not identify you or any other person or when research has been approved by an institutional review board that has established procedures to ensure the privacy of your health information.
Victims of Abuse and Neglect. If we reasonably believe that you are a victim of abuse or neglect, we will disclose health information about you to a government agency authorized by law to receive such information, to the extent that we are required to do so by law.
Other uses and disclosures will be made only with your written authorization (permission). You may revoke your authorization in writing at any time, except to the extent that we have acted in reliance on the authorization.
Other Authorized Recipients. You may give us permission in writing to share your PHI with someone else for any reason. You will be given that opportunity when you provide the Tier 2 information. For example, we may disclose your PHI to your family or friends or to any other individual you identified when such persons are involved in your care or the payment for your care. We will disclose only the PHI that is directly relevant to such persons’ involvement in your care or payment for your care. In an emergency situation, and if you are not available, we may use or share your PHI to notify, or assist in the notification of, a family member, personal representative, or another person responsible for your care of your location, general condition, or death. We will do so only if we determine that such a disclosure is in your best interest and we will disclose only the PHI that is directly relevant to such persons’ involvement in your care. If you are available in such a situation, we will give you an opportunity to object to such disclosures, and we will not make such disclosures if you object.
Your Rights Regarding Your Protected Health Information
You have the Right to Request Restrictions. You have the right to request restrictions on DPid’s use and sharing of your PHI for treatment, payment, and health care operations. However, we are not required to agree to your request. To request a restriction, you must make your request, in writing, to the Privacy Officer whose contact information is provided below.
You have the Right to Request Your PHI. You have the right to request that we send your PHI using reasonable alternative communication methods. You may also request that we send communications of PHI to you at alternative locations. You must submit such a request, either verbally or in writing, to the Privacy Officer whose contact information is provided below. Your request must specify how or where you wish to be contacted.
You have the Right to Inspect and Copy Your PHI. You have the right to inspect and copy certain sections of your PHI contained in our records under certain circumstances. You must submit such a request, in writing, to our Privacy Officer whose contact information is provided below. We may charge you for the reasonable costs of copying and mailing your records, as well as for any other reasonable costs associated with your request.
You have the Right to Amend Your Records. You have the right to request an amendment to your PHI if you believe the PHI is incorrect or that PHI is missing. We may deny your request for amendment if we determine that the relevant PHI was not created by us (unless you provide a reasonable basis to believe that the originator of the PHI is no longer available to act on the requested amendment), is not part of your records, is not available for inspection, or is accurate and complete. If some other party provided DPid with the PHI, such as your dental professional, we will let you know so that you may ask that party to correct it.
If DPid agrees to your request for amendment, we will include an agreed upon amendment as an addition to your already existing records rather than a replacement of any record.
You must submit any request for amendment, in writing, to DPid’s Privacy Officer whose contact information is provided below.
You have the Right to an Accounting of Disclosures. You have the right to receive an accounting of, or a list of, certain disclosures of PHI made by DPid to individuals or entities other than you. You must send a request for such accounting, in writing, to our Privacy Officer whose contact information is provided below.
You have the Right to a Copy of This Notice. You have a right to request and receive a paper copy of this Notice. Send such request, either verbally or in writing, to the Privacy Officer whose contact information is provided below.
DPid is required to abide by all of the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice and to make the new notice provisions effective for all protected health information we maintain. If our notice changes, a revised notice shall be displayed at a prominent location in your living area and you may get a copy if you request one.
For More Information or to Report a Problem
If you have any questions, would like further information about this notice, or if you would like to make a written or verbal request pursuant to this notice, please contact the Privacy Officer:
711 Pine Street
Jeannette, Pennsylvania 15644-2666
If you believe your privacy rights have been violated, you may submit a complaint, in writing, to our Privacy Officer with us. These complaints must be filed, in writing, on a form provided by our facility. You may also file a complaint with the secretary of the Federal Department of Health and Human Services.
There will be no retaliation for filing a complaint.
This notice is effective as of January 1, 2013.
To learn more about how DPid can benefit you, please explore our web site or contact us.
Thank you for considering DPid (Dental Prosthetics Identification).