Notice of Privacy Practices

Effective Date: 01/01/2024

This Notice describes how your medical and dental information may be used and disclosed and how you can access this information. Please review it carefully.

Our Commitment to Your Privacy

At MidCoast Dental Health, LLC, we are committed to protecting the privacy of your personal health information. We are required by law to maintain the confidentiality of your health records and to provide you with this notice of our legal duties and privacy practices with respect to your protected health information (PHI).

Uses and Disclosures of Your Health Information

We may use and disclose your PHI for the following purposes without your specific authorization:

1. Treatment

We may use your health information to provide and coordinate your dental hygiene care. This includes communication with dentists, specialists, or other healthcare professionals as needed to ensure you receive appropriate treatment.

2. Payment

We may use and disclose your information to bill and receive payment from insurance companies or third-party payers for services provided.

3. Healthcare Operations

We may use your information for administrative purposes, such as internal quality assurance, audits, licensing, and staff training.

Other Uses and Disclosures

In certain situations, we may be required or permitted to disclose your PHI without your authorization, including:

As required by federal, state, or local law
For public health purposes (e.g., reporting communicable diseases)
To report abuse or neglect
For health oversight activities (e.g., audits, inspections)
In connection with lawsuits or legal proceedings (with proper authorization)
To coroners or medical examiners, as required
To avert a serious threat to health or safety

Disclosures Requiring Your Authorization

For uses and disclosures not described in this notice, we will obtain your written authorization before using or disclosing your PHI. This includes:

Marketing communications
Sale of health information
Most disclosures of psychotherapy notes (if applicable)

You may revoke your authorization in writing at any time, except to the extent that we have already taken action based on it.

Your Rights Regarding Your Health Information

You have the right to:

Request Restrictions: Ask us not to use or disclose certain health information. (We are not required to agree.)
Request Confidential Communications: Request that we contact you in a specific way or location (e.g., home or work phone).
Inspect and Copy Your Health Record: Obtain a copy of your health records. (Fees may apply.)
Amend Your Health Record: Request changes to your health record if you believe there is an error or incomplete information.
Receive an Accounting of Disclosures: Request a list of disclosures of your PHI made for purposes other than treatment, payment, or operations.
Receive a Paper Copy of This Notice: You may request a printed copy of this notice at any time.

Our Responsibilities

We are required by law to:

Maintain the privacy and security of your protected health information
Provide you with this notice of our legal duties and privacy practices
Abide by the terms of this notice
Notify you if a breach of your unsecured PHI occurs

We reserve the right to change our privacy practices and to apply the revised practices to all PHI we maintain. Updated notices will be available at our office and on our website (if applicable).

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/

You will not be retaliated against for filing a complaint.

Contact Information

If you have questions about this Notice or need more information, please contact:

Privacy Officer: Tiffany Tyler-Bisson, RDH, IPDH

Phone: 207-504-4220