Notice of Privacy Practices

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. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

Our Legal Duty

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to provide you with this Notice which describes our privacy practices and legal duties, as well as your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect. This Notice takes effect September 23, 2013, and will remain in effect until we replace it.

We may change our privacy practices, and/or this Notice, from time to time. If we make any material revisions to this Notice, we will provide you with a copy of the revised Notice. The revised Notice will apply to all of your health information from and after the revised date.

Uses and Disclosures of Health Information Without Written Authorization

A. Uses and Disclosures for Treatment, Payment, and Health Care Operations

• Treatment: We may use or disclose your health information to provide treatment and coordinate your care.
• Payment: We may use or disclose your health information to obtain payment for the services we provide.
• Health Care Operations: We may use or disclose your health information for quality assessment, credentialing, training, and other operational purposes.
• Disclosures to Family or Friends: We may share information with those involved in your care unless you object.
• Business Associates: We may share your information with service providers who perform functions for us under privacy agreements.
• Appointment Reminders and Health Services: We may use your information to remind you of appointments or inform you of services.
• Patient-Related Communications: Communications like intraoral photography or prescription coordination may involve your information.

B. Uses and Disclosures for the Public Need

• Required by Law
• Public Health Activities
• Health Oversight Activities
• Abuse or Neglect
• Product Monitoring, Repair and Recall
• Lawsuits and Disputes
• Law Enforcement
• To Avert a Serious Threat
• Workers’ Compensation
• National Security and Inmates
• Coroners, Medical Examiners, and Funeral Directors

C. Completely De-Identified and Partially De-Identified Information

We may use or disclose de-identified health information for research or operations. Partially de-identified data will not directly identify you.

Requirement for Written Authorization

We require your written authorization for any use or disclosure not described in this Notice, including marketing or selling your information. You may revoke authorization at any time in writing.

Your Rights to Access and Control Your Health Information

• Access: You may request to inspect or receive copies of your records. If in electronic format, you may request it that way.
• Disclosure Accounting: You may request a list of disclosures made in the last 6 years, excluding treatment, payment, or operations.
• Restrictions: You may request additional limitations on disclosures. We are not required to agree except under specific conditions.
• Alternative Communication: You may request contact via alternate methods or locations.
• Amendments: You may request corrections to your records with justification.
• Breach Notification: You will be notified if we experience a breach of your unencrypted health information.
• Paper Copy: You may request a paper version of this Notice at any time.

Other Specific State Law Requirements

Nevada law and others may provide additional rights. We will comply with such laws when applicable.

Contact Information

Tomalty Tomalty
8794 W. Boynton Beach Blvd, Ste 100
Boynton Beach, FL 33473

Complaints

If you believe your rights have been violated, you may contact us or file a complaint with the U.S. Department of Health and Human Services. No retaliation will occur for filing a complaint.

Office Information

Tomalty Dental Care
8794 W. Boynton Beach Blvd, Ste 110
Boynton Beach, FL 33473
561-777-8980

Office Hours

• Monday: 8:00 AM - 7:00 PM
• Tuesday: 8:00 AM - 5:00 PM
• Wednesday: 8:00 AM - 5:00 PM
• Thursday: 8:00 AM - 5:00 PM
• Friday: 8:00 AM - 12:00 PM

Additional Notices

We accommodate patients with disabilities. Please call 561-777-8980 to request assistance.
IT IS OUR OFFICE POLICY THAT THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS THE RIGHT TO REFUSE TO PAY, CANCEL PAYMENT OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION OR TREATMENT WHICH IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED-FEE OR REDUCED-FEE SERVICE, EXAMINATION OR TREATMENT.