Mont Dental Aesthetics - 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.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at our office for use in your care and treatment. This notice applies to all the records of your care generated by our practice, whether made by practice personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
- For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to dentists, doctors, nurses, technicians, or other office personnel who are involved in taking care of you.
- For Payment: We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company, or a third party.
- For Health Care Operations: We may use and disclose medical information about you for office operations. These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care.
- Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at our office.
- Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- As Required By Law: We will disclose medical information about you when required to do so by federal, state, or local law.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
- Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care.
- Right to Amend: If you feel that medical information, we have about you is incorrect or incomplete, you may ask us to amend the information.
- Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures we have made of your medical information.
- Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations.
- Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
CONTACT INFORMATION
For more information about our privacy practices, or to file a complaint, please contact:
Dr. Alireza Khoshvaghti
220 Montgomery ST., Suite 483,
San Francisco, CA 94104
Owner contact email: info@montgomerystdental.com
This Notice of Privacy Practices is in effect as of the effective date and will remain in effect until it is replaced or amended by us.
We are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. Prior to making significant changes to our privacy practices, we will change this notice and make the new notice available upon request.