Effective Date: [DATE PUBLISHED]
Shari Carroll DMD, PC
Dr. Shari Carroll Pediatric Dentistry
1611 S. Catalina Avenue, Suite 100
Redondo Beach, CA 90277
Phone: 310-357-4414
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical and dental information about you or your child may be used and disclosed and how you can obtain access to this information. Please review it carefully. For a minor patient, references to ‘you’ generally include a parent, legal guardian, or other personal representative to the extent permitted by law.
Your Rights
You have the right to inspect or obtain an electronic or paper copy of the medical and dental information we maintain about you or your child. We will provide access or a copy within the time required by law and may charge a reasonable, cost-based fee when permitted.
You may ask us to correct health information that you believe is incorrect or incomplete. We may deny a request in certain circumstances, but if we do, we will explain the reason in writing as required by law.
You may ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests.
You may ask us to limit how we use or disclose certain health information for treatment, payment, or health-care operations. We are not always required to agree. If you pay in full out of pocket for a service, you may ask us not to disclose information about that service to your health plan for payment or health-care operations, and we will honor that request unless disclosure is required by law.
You may request an accounting of certain disclosures of your health information made during the period allowed by law. The accounting will not include every disclosure, such as many disclosures for treatment, payment, or health-care operations.
You may ask for a paper copy of this Notice of Privacy Practices at any time, even if you received it electronically.
If another person has legal authority to act for you or your child, we will recognize that person as a personal representative to the extent required or permitted by law.
You may complain to us if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or through HHS’s HIPAA complaint process. We will not retaliate against you for filing a complaint.
Your Choices
In certain situations, you may tell us whether and how to share information with family members, friends, caregivers, or other people involved in care or payment for care. If you are not able to state a preference, we may share information when permitted by law and when we believe it is in the patient’s best interests.
We will not use protected health information for marketing purposes or sell protected health information without written authorization except where the law expressly permits the use or disclosure without authorization. We do not use protected health information for fundraising.
Our Typical Uses and Disclosures
Treatment. We may use and share health information with dentists, physicians, specialists, laboratories, pharmacies, hospitals, anesthesiologists, therapists, or other professionals involved in the patient’s care.
Payment. We may use and disclose health information to bill for services, submit insurance claims, obtain payment, determine eligibility or benefits, and coordinate payment with health plans and other payers.
Health-Care Operations. We may use and disclose health information to operate our practice, coordinate care, improve quality, train staff, conduct audits and compliance activities, manage records, and perform other lawful health-care operations.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose health information when permitted or required for public-health activities, reporting suspected abuse or neglect, health oversight, workers’ compensation, certain law-enforcement purposes, judicial or administrative proceedings, organ and tissue donation, coroners or medical examiners, disaster relief, prevention of a serious threat to health or safety, research when legally authorized, and other uses or disclosures required by law.
California and other applicable laws may provide additional privacy protections for certain medical information. When a state or other applicable law is more protective of patient information than HIPAA, we will follow the more protective law.
To the extent we receive patient records that are protected by the federal confidentiality rules for substance use disorder records under 42 CFR Part 2, we will use and disclose those records only as permitted by applicable law. Such records generally may not be used against a patient in a civil, criminal, administrative, or legislative proceeding without the patient’s written consent or the process required by federal law.
Our Responsibilities
We are required by law to maintain the privacy and security of protected health information. We will notify affected individuals as required by law if a breach occurs that may have compromised the privacy or security of protected health information.
We must follow the privacy practices described in the notice that is currently in effect. We will not use or disclose protected health information other than as described in this notice unless you authorize us in writing or another law permits or requires the use or disclosure. You may revoke a written authorization at any time in writing, except to the extent we have already acted in reliance on it.
Changes to This Notice
We may change the terms of this Notice of Privacy Practices. A revised notice may apply to all protected health information we maintain, including information created or received before the revision. The current notice will be available in our office, on our website, and upon request.
Privacy Contact
If you have questions about this notice, want to exercise a privacy right, or wish to make a privacy complaint, contact:
Privacy Officer
Dr. Shari Carroll Pediatric Dentistry
1611 S. Catalina Avenue, Suite 100
Redondo Beach, CA 90277
Phone: 310-357-4414
