Patient Privacy

Understanding Your Health Information

Each time you visit Center for Oral Maxillofacial Surgery and Dental Implants for care, a record of your visit is made. This record usually contains identification and financial information as well as symptoms, diagnoses, test results, a description of an oral examination and a treatment plan. This record is often referred to as your “medical record,” or “health information,” and includes information contained in paper as well as electronic records.

Our Duty to Protect Your Health Information

Under the Health Insurance Portability and Accountability Act of 1996 (a Federal law also known as “HIPAA”) Center for Oral Maxillofacial Surgery and Dental Implants providers are required to keep your health information confidential, and to provide you with this notice of our legal duties and privacy practices. This notice describes how Center for Oral Maxillofacial Surgery and Dental Implants providers use and disclose your health information.

Center for Oral Maxillofacial Surgery and Dental Implants may change the terms of this notice if their privacy practices change or as federal or state requirements change. Each notice will have an effective date listed on the page. Center for Oral Maxillofacial Surgery and Dental Implants providers reserve the right to make the amended notice effective for any health information Center for Oral Maxillofacial Surgery and Dental Implants providers have at the time the change is made, as well as for future health information.

How Center for Oral Maxillofacial Surgery and Dental Implants Providers May Use and Disclose Your Health Information

Center for Oral Maxillofacial Surgery and Dental Implants providers use and disclose your health information for many different reasons, most of which are necessary to provide you with quality health care services. Federal and state laws do not require Center for Oral Maxillofacial Surgery and Dental Implants providers to get your permission to perform many routine functions, especially those activities necessary to treat you, create and deliver bills for your treatment and other routine activities necessary to perform efficiently. Federal and state law also permits Center for Oral Maxillofacial Surgery and Dental Implants to share this information with third parties that assist us in the performance of these routine functions. For some activities, however, federal and/or state law requires Center for Oral Maxillofacial Surgery and Dental Implants providers to obtain written authorization.

Uses and disclosures of your health information for the purpose of providing you with medical care

Providing you with treatment, collecting payment, and conducting health operations are necessary activities for delivering health care. State and federal law permits Center for Oral Maxillofacial Surgery and Dental Implants providers to use and disclose your health information for these purposes. The following are some examples of what constitutes treatment, payment, and health care operations:

A provider treating you for a jaw injury may need to know your medical condition and speak to your primary care physician. Lab work and x-rays may be sent out for viewing and reading.
Center for Oral Maxillofacial Surgery and Dental Implants providers may disclose your health information by phone, letter, fax, or online to people not affiliated with Center for Oral and Maxillofacial
Surgery who are involved in your medical care, such as your primary care physician, dentist or home health agency.
Center for Oral Maxillofacial Surgery and Dental Implants may need to give your health insurance plan information about your surgery to receive payment.
Center for Oral Maxillofacial Surgery and Dental Implants may also tell your health insurance plan about treatment to obtain approval or to determine whether your plan will pay for the treatment.
Center for Oral Maxillofacial Surgery and Dental Implants may bill the person in your family who is responsible for payment or who pays for your health insurance.
Your health information may be used to review the performance and competence of the oral surgeon, dentist, surgical staff member and others involved in your care.
Center for Oral Maxillofacial Surgery and Dental Implants providers may use your health information for administrative activities, or for accreditation, certification or licensing purposes.
Other uses and disclosures of your information that do not require your authorization

There are some instances, usually those in the “interest of the public,” when Center for Oral Maxillofacial Surgery and Dental Implants providers are permitted or required by law to use and disclose your information without your authorization.

Disclosure required by law
Center for Oral Maxillofacial Surgery and Dental Implants providers will disclose medical information about you when required to do so by federal or state laws.
Public health activities
Center for Oral Maxillofacial Surgery and Dental Implants providers may disclose medical information about you for public health purposes. For example: Reporting certain conditions such as cancer and communicable diseases for purposes of monitoring, preventing and controlling disease, or reporting reactions to medications or problems with health products and notifying people of health product recalls.
Health oversight activities
Center for Oral Maxillofacial Surgery and Dental Implants providers may disclose health information to agencies that monitor our compliance with state and federal laws.
Judicial and administrative proceedings
If you are involved in a lawsuit or a dispute, Center for Oral Maxillofacial Surgery and Dental Implants may disclose medical information about you in response to court orders.
Law enforcement
Center for Oral Maxillofacial Surgery and Dental Implants may disclose health information about you to law enforcement officials in response to a court order or other similar process allowed by law.
Appointment reminders and additional communications
Center for Oral Maxillofacial Surgery and Dental Implants may use your information to call you or send you a letter reminding you of an upcoming appointment. Center for Oral Maxillofacial Surgery and Dental Implants providers may use your health information to send you the results of tests or to give you other health communications.
Serious threat to health or safety
Center for Oral Maxillofacial Surgery and Dental Implants may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of others.
Specific government functions
If you are a member of the Armed Forces, Center for Oral Maxillofacial Surgery and Dental Implants providers may disclose your health information, under certain circumstances, to military authorities to assist with the military missions.
Workers' compensation
Center for Oral Maxillofacial Surgery and Dental Implants providers may release your health information to workers' compensation or similar programs that provide benefits for your work-related injuries or illness.

Uses and disclosures of your health information that you may refuse

Center for Oral Maxillofacial Surgery and Dental Implants may use or disclose your health information without your authorization unless you refuse or object.

Information disclosed to family members, close friends, or others
To coordinate your care and explain your condition and treatment plan, Center for Oral Maxillofacial Surgery and Dental Implants may disclose health information about you to your family or close personal friends. You have the right to object to these kinds of disclosures. In an emergency, Center for Oral Maxillofacial Surgery and Dental Implants providers will exercise their professional judgment to determine if family or friends should receive information about you.
Notification
Unless you object, Center for Oral Maxillofacial Surgery and Dental Implants providers may use your health information to notify, or assist in notifying members of your family, close personal friends or any other people responsible for your care about your condition.

Uses and disclosures of your health information requiring your authorization

If Center for Oral Maxillofacial Surgery and Dental Implants providers need to use or disclose your health information for any purpose not listed above, they must first obtain your written authorization. Even if you authorize Center for Oral Maxillofacial Surgery and Dental Implants providers to use or disclose your information for a particular purpose, you may revoke your authorization.

Your rights as a patient of Center for Oral Maxillofacial Surgery and Dental Implants

As a patient of Center for Oral Maxillofacial Surgery and Dental Implants, you have the following rights with regard to your health information:

Right to inspect and copy your medical and billing records
Right to add information to correct your medical and billing records
Right to an accounting of disclosures
Right to a paper copy of this notice
Right to request restrictions on uses and disclosures of your health information

Contact and Compliant Information

If you have any questions, concerns, comments or complaints regarding the information in this notice, please contact:

Center for Oral Maxillofacial Surgery and Dental Implants, SC
Attn: Human Resources Manager
7007 Old Sauk Road, Madison, WI 53717
608-819-8761