Ross I.Heisman, D.D.S., P.C.

NOTICE OF PRIVACY PRACTICES
 

     We are required by law to maintain the privacy and security of your health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. You may request a copy of this notice at any time.

     We use and disclose health information about you for treatment, payment and healthcare operations ONLY.

Treatment: We may use or disclose your health information to a physician, specialist or other healthcare provider providing treatment to you.

Payment: We may use and disclose your health information to obtain payment for services we provide to you.

Healthcare Operations: We may use your health information in quality assurance, training, certification, licensing and credentialing activities.

We must disclose your health information to you. We may disclose your health
information to a family member or friend to the extent necessary to help with
your healthcare or with payment for your healthcare only if you agree that we
may do so. In the event of an emergency we will disclose health information
based upon our professional judgment only as directly relevant to your
healthcare.

   We do NOT use your health information for any marketing purposes.

   We may use or disclose your health information as required to do so by law, such as in cases where we believe that you are a possible victim of abuse, neglect or domestic violence.

     We may use or disclose your health information to provide you with written appointment reminders.

Access: You have the right to view or obtain copies of your health information by written request. Reasonable costs will be charged for photocopying, staff time and postage.

Restriction: You have the right to restrict the use or disclosure of your health information.

Designate someone to act for you: Someone with medical power of attorney or your legal guardian may exercise your rights or make choices about your health
information.

     If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health care information you may complain to contact person Dr. Ross Heisman, or in writing to the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, DC 20201, calling 877.696.6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/