Notice of Privacy Practices
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.
Privacy Promise
American Sleep Dentistry ("ASD") understands that your medical and health information is personal. Protecting your health information is important. We follow strict federal and state laws that require us to maintain the confidentiality of your health information.
How We Use Your Health Information
When you receive care from American Sleep Dentistry, we may use your health information for treating you, billing for services, and conducting our normal business known as healthcare operations. Examples of how we use your information include:
- Treatment - We keep records of the care and services provided to you. Healthcare providers use these records to deliver quality care to meet your needs.
- Payment - We keep billing records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment from you, your insurance company, or other third party. We may also contact your insurance company to verify coverage for your care or to notify them of upcoming services that may need prior notice or approval. For example, we may disclose information about the services provided to you to claim and obtain payment from your insurance company or Medicare.
- Healthcare Operations - We use health information to improve the quality of care, train staff and students, provide customer service, manage costs, conduct required business duties, and make plans to better serve our communities. For example, we may use your health information to evaluate the quality of treatment and services provided by our physicians, nurses, and other healthcare workers.
Other Services We Provide
We may also use your health information to:
- Recommend treatment alternatives;
- Tell you about health services and products that may benefit you;
- Share information with third parties who assist us with treatment, payment, and healthcare operations. Our business associates must protect your information by following our privacy practices;
- And Remind you of an appointment (if you do not wish to be reminded, notify the scheduler)
More Information
For more information about the practices and rights described in this notice:
- Visit our website at www.AmericanSleepDentistry.com
- Contact us at 800.555.1518
Sharing Your Health Information
There are limited situations when we are permitted or required to disclose health information without your signed authorization. These situations are:
- For public health purposes such as reporting communicable diseases, work-related illnesses, or other diseases and injuries permitted by law; reporting births and deaths; and reporting reactions to drugs and problems with medical devices;
- To protect victims of abuse, neglect, or domestic violence;
- For health oversight activities such as investigations, audits, and inspections;
- For lawsuits and similar proceedings;
- When otherwise required by law;
- When requested by law enforcement as required by law or court order;
- To coroners, medical examiners, and funeral directors;
- For organ and tissue donation;
- For research approved by our review process under strict federal guidelines;
- To reduce or prevent a serious threat to public health and safety;
- For workers' compensation or other similar programs if you are injured at work; and
- For specialized government functions such as intelligence and national security.
All other uses and disclosures, not described in this notice, require your signed authorization. You may revoke your authorization at any time with a written statement. However, American Sleep Dentistry may not be able to reverse the use or disclosure of your health information while your authorization was in effect.
Our Privacy Responsibilities
American Sleep Dentistry is required by law to:
- Maintain the privacy of your health information;
- Provide this notice that describes the ways we may use and share your health information; and
- Follow the terms of the notice currently in effect.
We reserve the right to make changes to this notice at any time and make new privacy practices effective for all information we maintain. Current notices will be posted in American Sleep Dentistry facilities and on our website, www.AmericanSleepDentistry.com. You may also request a copy of any notice from the American Sleep Dentistry Privacy Office.
Your Individual Rights
You have the right to:
- Request restrictions on how we use and share your health information. We will consider all requests for restrictions carefully but are not required to agree to any restriction;
- Request that we use a specific telephone number or address to communicate with you;
- *Request to inspect and copy your health information, including medical and billing records. Fees may apply. Under limited circumstances, we may deny you access to a portion of your health information and you may request a review of the denial;
- *Request corrections or additions to your health information;
- *Request an accounting of certain disclosures of your health information made by us. The accounting does not include disclosures made for treatment, payment, and healthcare operations and some disclosures required by law. Your request must state the period of time desired for the accounting, which must be within the six years prior to your request and exclude dates prior to April 14, 2003. The first accounting is free but a fee will apply if more than one request is made in a 12-month period;
- Request a paper copy of this notice even if you agree to receive it electronically.
Requests marked with a star (*) must be made in writing. Contact the American Sleep Dentistry Privacy Office for the appropriate form for your request.
Our Organization
This notice describes the privacy practices of American Sleep Dentistry, LLC (referred to as "American Sleep Dentistry" in this Notice) including healthcare facilities and services, as well as the American Sleep Dentistry employees and volunteers at those facilities. This notice also describes the privacy practices of affiliated providers while they are performing services in an American Sleep Dentistry facility, unless they provide you with a notice of their specific privacy practices. Affiliated providers are not employed by American Sleep Dentistry but are either authorized to provide services to patients in an American Sleep Dentistry facility or are approved participants on the panel of Select Health's providers.
Contact Us
If you would like further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to your health information, contact:
American Sleep Dentistry
1289 S Interstate Drive,
Cedar City, Utah 84720
800.555.1518
Email: sales@AmericanSleepDentistry.com
We will investigate all complaints and will not retaliate against you for filing a complaint. You may also file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services.