Notice of Privacy Practices
This Notice describes how health information about you may be used and disclosed by Uplift Family Dentistry (1700 E Summit Street, Red Oak, Iowa 51566); how you can get access to this information; as well as to inform you of your patient rights regarding your protected health information. Uplift Family Dentistry may also be referred to as: “dental practice”, “UFD”, “us”, or “we”; the patient may be referred to as “you”.
We may disclose your protected health information to conduct treatment, payment, and health care operations. You may request a copy of this form at any time under the Health Insurance Portability and Accountability Act of 1996.
- Disclosure of Protected Health Information
We may disclose protected health information to the following:
- other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations.
- other healthcare professionals outside our practice for the purpose of collaboration on treatment and health conditions.
- insurance providers for the purpose of payment or health care operations.
- appropriate entities, as necessary, to comply with State Workers’ Compensation Laws.
- appropriate persons responsible for patient care about patient medical conditions to notify or assist in notifying a family member in the event of an emergency or urgent care.
- public health authorities, as required by law, for purposes related to preventing or controlling disease; injury or disability; reporting child or elder abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
- court-appointed officials, as required by law, for any administrative or judicial proceedings.
- law enforcement officials for purposes such as identifying or locating a suspect, fugitive, material witness or missing person; complying with a court order or subpoena; or other law enforcement purposes.
- coroners or medical examiners.
- organizations involved in procuring, banking, or transplanting organs and tissues.
- researchers conducting board-approved research.
- appropriate persons, to prevent or lessen a serious and imminent threat to the health or safety of a particular person or public.
- appropriate persons for military, national security, prisoner and government benefits and purposes.
- Rights to Your Protected Health Information
You have a right to the following:
- request restrictions on certain uses and disclosures of your protected health information.
- request alternative methods of communication that includes your protected health information.
- view and request an electronic or paper copy of your protected health information for a nominal administration fee. Your request must be in writing.
- request an amendment to your protected health information.
- receive an accounting of disclosures of your protected health information.
Uplift Family Dentistry reserves the right to amend this Notice of Privacy Practices at any time in the future and will make the new provisions effective for all information that it maintains. In the event of a company merger or transfer of ownership, patient health information and records will become the property of the new owner.
For questions or more information about patient privacy rights, please schedule a telephone conference with the UFD Privacy Officer at (712) 623-5404. Formal complaints may be made in writing to: DHHS Office of Civil Rights, 200 Independence Avenue, S.W., Room 509F HHH Building, Washington, DC 20201.
This notice was last revised March 1, 2022.