NOTICE OF PRIVACY PRACTICES
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPPA). The privacy component of this law, also known as the Privacy Rule, took effect on April 14, 2003. State and Federal laws require our office to maintain the privacy of your health information and to inform you about our privacy practices by providing you with this Notice. It is our right to change our privacy practices provided the law permits the change. Before any significant changes, this Notice will be amended to reflect the changes and we will make the new Notice available to our patients upon request. We reserve the right to make any changes in our privacy practices and the new terms of our notice effective for all health information maintained, created and/or received by us before the date changes were made. You may request a copy of our Privacy Notice by contacting the Privacy Officer. Information on contacting us can be found at the end of this Notice.

TYPICAL USES & DISCLOSURES OF HEALTH INFORMATION
We will keep your health information confidential, using it only for the following purposes:
Treatment: We may use your health information to provide you with our professional services. We have established “minimum necessary” or “need to know” standards that limit various staff members’ access to your health information according to their primary job functions. Everyone on our staff is required to sign a confidentiality statement.

Disclosure: We may disclose and/or share your healthcare information with other healthcare professionals who provide treatment to you. These professionals will have a privacy policy like this one. Health information about you may be disclosed to your family, friends, and/or persons you choose to involve in your healthcare, only if you agree that we may do so.

Payment: We may use and disclose your health information to seek payment for services we provide to you. This disclosure involves our business staff and may include insurance organizations or other businesses that may become involved in the process of mailing statements and/or collecting unpaid balances.

Emergencies: We may use or disclose your health information to notify, or assist in the notification of a family member or anyone responsible for your care, in case of emergency involving your care, your location, your general condition or death. If at all possible we will provide you with an opportunity to object to this use or disclosure. Under emergency conditions or if you are incapacitated we will use our professional judgment to disclose only that information relevant to your care. We will also use our professional judgment to make reasonable inferences of your best interest by allowing someone to pick up filled prescriptions, X-rays, or other similar forms of health information and/or supplies unless you have advised us otherwise.

Healthcare Operations: We will use and disclose your healthcare information to keep this practice operable. Examples pf personnel who may need access to this information include, but are not limited to, our dental records staff, outside health or management reviewers and individuals performing similar activities.

Required by Law: We may use or disclose your healthcare information when we are required by law to do so (court or administrative orders, subpoena, discovery request or other lawful process). We will use and disclose your information when requested by national security, intelligence, and other State and Federal officials and/or if you are an inmate or otherwise under the custody of law enforcement.
Abuse or neglect: We may disclose your healthcare information to the proper authorities if we reasonably believe that you are a victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety of others.

Public Health Responsibilities: We will disclose your healthcare information to report problems with products, reactions to medications, public recalls, disease/infection exposure and to prevent and control disease, injury and/or disability.
Marketing Health Related Services: We will not use your information for marketing purposes unless we have your written authorization to do so.
National Security: The health information of Armed Forces personnel may be disclosed to military authorities under certain circumstances. If the information is required for lawful intelligence, counterintelligence or other national security activities, we may disclose it to authorized federal officials.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders, including but not limited to, voicemail messages, postcards or letters.

QUESTIONS AND COMPLAINTS
You have the right to file a complaint with us if you feel we have not complied with our Privacy Policies. Your complaint should be directed to our Privacy Officer. If you feel we may have violated your privacy rights, or if you disagree with a decision we made regarding your access to your health information, you can complain to us, in writing. We support your right to the privacy of your information and will not retaliate in any way if you choose to file a complaint with us. If you wish to receive a copy of this Notice or want to sign a form acknowledging receipt of this Notice, please call the office for assistance.

HOW TO CONTACT US
Practice Name: Alan S. Kellner, D.M.D., PA
Privacy Officer: Miriam Llossas
Office Phone: 561.965.8888
Fax: 561.965.8897