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.
How we use and share your health information
Without your written authorization, we may use and share your health information to:
- Treat you — for example, sending your records to a specialist we refer you to, or discussing your care with the nursing staff at your facility.
- Get paid — for example, sending treatment details to your dental or Medicare Advantage plan to verify benefits and obtain payment.
- Run our practice — for example, reviewing records for quality of care, scheduling, and staff training.
We may also use or share your information without your authorization where the law permits or requires it: to remind you of appointments and tell you about treatment alternatives or health-related services; with a family member, caregiver, or personal representative involved in your care; with public health authorities; for health oversight, licensing, and audits; in response to a subpoena or court order; to report suspected abuse, neglect, or domestic violence; with law enforcement or a coroner as permitted by law; for workers’ compensation; to prevent a serious threat to health or safety; and for specialized government functions such as military or national security.
Any other use or sharing requires your written authorization — including marketing and any sale of your information. You may revoke an authorization in writing at any time, except where we have already acted on it.
Your rights
- Get a copy of your record. Inspect and obtain a copy of your dental record, usually within 30 days. A reasonable, cost-based fee may apply.
- Ask us to correct it. Request an amendment if you believe something is wrong or incomplete. We may deny the request, and you may file a statement of disagreement.
- Ask for confidential communication. Request that we contact you at a different phone number or address, or by a specific method. We will accommodate reasonable requests.
- Ask us to limit what we share. We are not required to agree — with one exception: if you pay for a service in full and out of pocket, you may require that we not tell your health plan about it, and we must honor that.
- Get a list of disclosures. Request an accounting of certain disclosures we made in the six years before your request.
- Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Be notified of a breach of your unsecured health information.
- Choose someone to act for you. A personal representative with legal authority may exercise these rights on your behalf.
Our responsibilities
We are required by law to protect the privacy of your health information, provide you with this notice, follow the terms of the notice currently in effect, and notify you if a breach affects your information. We reserve the right to change this notice and to apply the changes to information we already hold; the current version is always posted at www.lasvegasmobiledentist.com/notice-of-privacy-practices and available on request.
Questions or complaints
Contact our Privacy Officer, Milad Gheisari, DDS, at (702) 602-7058 or info@lvmobiledental.com.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights — 200 Independence Avenue SW, Washington, DC 20201; 1-800-368-1019 (TDD 1-800-537-7697); www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.