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.
Our commitment
Mint Leaf Dentistry is required by law to maintain the privacy of your protected health information (PHI), to provide you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
How we may use and disclose your health information
- Treatment: to provide, coordinate, and manage your dental care, including sharing with other providers involved in your care.
- Payment: to bill and obtain payment for the services we provide, including with your insurance.
- Health care operations: for activities necessary to run the practice, such as quality assessment and administrative functions.
- Appointment reminders and follow-up: to contact you about appointments, treatment, or services.
- As required by law and for public health, safety, and similar purposes permitted by HIPAA.
Other uses and disclosures not described in this notice will be made only with your written authorization, which you may revoke.
Your rights
- Request to inspect and copy your health information.
- Request corrections to your health information.
- Request restrictions on certain uses and disclosures.
- Request confidential communications.
- Receive an accounting of certain disclosures.
- Receive a paper copy of this notice.
Our responsibilities
We are required to maintain the privacy of your PHI, notify you following a breach as required by law, and abide by the terms of this notice. We reserve the right to change this notice and to make the revised notice effective for information we already have as well as information we receive in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized for filing a complaint.
Contact
Privacy Officer, Mint Leaf Dentistry
110 Lattner Court, Suite 106, Morrisville, NC 27560
919-330-1710
[HIPAA privacy officer email]