PRIVACY POLICY NOTICE

FULLER & SPENCER-FULLER, PC

This notice is required by federal law and describes how medical information may be used and disclosed and how you can get access to this information. Our office has ALWAYS held your personal, medical, and dental information as confidential, however the law requires that we have a written policy and document our procedures and training. Please review and if you would like a copy to take home, please notify the front desk staff. This will remain posted at the office at all times. (Also, Virginia law requires that we update your medical history with every recall/check-up appointment unless under continuous restorative care. Many patients have seen this as an invasion of privacy. Please remember we are following federal and state law and many dental agents can interact with prescription and non-prescription medications.)

USES AND DISCLOSURES: This policy encompasses use and disclosure of your information for purposes of treatment, payment, insurance billing, collections, and general health-care operations. (All uses and disclosures that are already permitted by law without authorization by the patient, although we have some of this listed at the bottom of your personal, medical, and dental history form you filled out at your first appointment.)

Treatment: Our office will use and disclose your protected health information (PHI) for purposes of treatment, meaning the provision, coordination and management of your health care and related services. An example would be to disclose your health information to coordinate benefits with a third-party payer or consultation with a specialist for your care.

Payment: Our office will use and disclose the minimum necessary amount of your PHI to obtain payment for services rendered. For example, our office may share your treatment plan with your insurer to pre-estimate insurance coverage. (You should have received a privacy policy statement from your insurance company.)

Collections: Our office will use and disclose the minimum necessary amount of your PHI for purposes of collections. Our office will have a binding privacy contract with the collection agency. Minimum personal information will be released. An example would be in case of non-payment by you, the agency would possibly disclose what services were done for the outstanding balance on your account.

Health-care Operations: Our office will use and disclose the minimum necessary amount of your PHI for health-care operations, such as business planning and development that relates to business management. For example, if our office was to hire a consultant to improve patient flow and reduced wait time. (This consultant would also be required to sign a privacy contract involving anything consultant was exposed to at our office.)

This section of our policy also describes other purposes for which our office is permitted or REQUIRED to use or disclose your PHI without your written authorization.

Required by law: Our office may use and disclose your PHI only to the extent that such use is required by law.

Public health activities: Our office may use and disclose the minimum necessary amount of your PHI to appropriate public health authorities for reasons such as, but not limited to, preventing and controlling disease, or child abuse and neglect, domestic violence or abuse.

Judicial and administrative proceedings: Our office may use and disclose the minimum amount of your PHI in the course of any judicial or administrative proceedings if required by law to do so.

Law enforcement agencies: Our office may use and disclose the minimum amount of your PHI to a law enforcement agency if required by law to do so.

Deceased patients: Our office may use and disclose the minimum necessary amount of your PHI to a medical examiner/coroner for the purpose of identifying a deceased person, determining a cause of death or another matter authorized by law, or to funeral directors.

Specialized government functions: Our office will use and disclose the minimum necessary amount of your PHI for military and veterans activities. Our office also will use and disclose the minimum necessary amount of your PHI for national security and intelligence activities. If an inmate, our office will use and disclose the minimum PHI to a correctional institution or law enforcement agency.

Safety: Our office may use and disclose the minimum necessary amount of your PHI if we believe doing so is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Workers' compensation proceedings: Our office may use or disclose the minimum necessary amount of your PHI as authorized by and to the extent necessary to comply with laws related to workers compensation.

Family, friend and personal representatives: Our office will use and disclose the minimum necessary amount of your PHI that is directly relevant to the involvement of a family member, relative, or close friend identified by you. Such uses and disclosures will be made only with your permission if you are present, unless you are incapacitated or there is an emergency where our office must exercise professional judgment.

Federal investigation: Our office may use and disclose the minimum amount of your PHI for an investigation by the US Department of Health and Human Services Secretary to determine if our office is in compliance with the HIPAA privacy regulation.

Business associates: Our office may disclose the minimum necessary amount of your PHI to a business associate if the business associate had agreed in writing to appropriately safeguard the information.

Marketing: Our office will obtain written authorization from you if we would like to use your PHI (example, bleaching results) for marketing purposes, except face to face communications.

General authorization statement: For any other purposes not stated in this notice, our office will not use or disclose your PHI without prior written authorizaiton.

PATIENT RIGHTS

The patient: You have the right to inspect or obtain a copy of your PHI from our office. Our office requires you submit such request in writing to our front desk staff. Our office must act on your request within 30 days unless your information is in storage. Federal law only requires that we maintain this information for 6 years. After 6 years we can get rid of this information by shredding the written information or deleting from the computer this information. In the latter case, our office must respond to your request iwthin 60 days. If for some unforseen circumstance, our office will need more time, we will inform you as soon as possible. If you agree to receive a summary of your PHI, our office will supply you with access to the summary. Our office will charge you a cost-based fee for the copies provided you.

Denial of access appeals: If our office denies your request for access to your PHI in whole or in part, we must provide you with access to any other PHI for which access is not denied. For the information that is denied, our office must inform you in writing of this denial within 30 days or the original request. Reasons for denial may include for example the doctor has determined, using his professional judgment, that granting the request, is likely to cause substantial harm to this person or to another person. If access to your PHI is denied for these reasons, you have the right to have the denial reviewd by Joy H. Spencer-Fuller, who has agreed to serve in this capacity for our office. Joy Spencer-Fuller, DDS will not be involved in the original decision to deny access to your PHI. Our office will inform you in writing as to the decision of Joy Spencer-Fuller, DDS within 30 days.

Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI, though our office is not required to grant such requests.

Accounting of disclosures: You have the right to receive an accounting of disclosures of your PHI made by our office for the six years prior to the date on which the accounting requested. This becomes active with the start of the law April 14, 2003.

Right to amend: You have the right to request to amend your PHI. Our office may deny such a request if we determine that the PHI was not created by our office, is not part of the designated record set, the information is not available for access to you, or the current information is accurate and complete. Amendment requests must be made in writing to our privacy director, Robert D. Fuller, DDS. Our office must act on such requests within 60 days of such requests. If we deny your request, we will inform you in writing within 60 days indicating the reason for denial. If you do not submit a statement of disagreement, you may request that our office provide your request for amendment and denial with any future disclosures of your PHI that is the subject of the amendment. If you submit a statement of disagreement (limited to 500 words), our office may prepare a written rebuttal to your statement. You will be provided a copy of this rebuttal.

Complaints: Patients may file a complaint with our office if they believe their privacy rights have been violated. A complaint form is available here at our office. We will try earnestly to address your complaint. If you still feel that your privacy rights are in violation, you may contact the US Department of Health and Human Services Secretary. Complaints must be filed within 180 days of when you knew or thought a violation occurred. Patients who file complaints will not be retaliated against for doing so. Also, if you have a suggestion for improving our policy please make that suggestion known. Our office reserves the right to change the terms of this notice with notification.

Contact: Privacy Director: Robert D. Fuller, DDS, 703-771-8500