HIPAA Policy Statement

Effective Date: April 1st, 2024

Welcome to Bay Star Dental. Our commitment to providing quality dental care extends to safeguarding the privacy and confidentiality of your protected health information (PHI). This Statement of Privacy Practices outlines our policies regarding the collection, use, and disclosure of your PHI in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other relevant privacy regulations.

Protected Health Information (PHI):
Protected health information (PHI) refers to any information, whether oral or recorded in any form or medium, that pertains to an individual's past, present, or future physical or mental health or condition, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual. This includes but is not limited to:

• Patient's name, address, and contact information Date of birth
• Medical and dental history
• Treatment records
• Insurance information

Uses and Disclosures Allowed by HIPAA:
HIPAA permits certain uses and disclosures of PHI without the patient's authorization for purposes of treatment, payment, and health care operations (TPO). These activities are essential for providing you with quality dental care and ensuring efficient administrative processes.

1. Treatment: We may use and disclose your PHI to provide, coordinate, or manage your dental treatment. This includes sharing information with other health care providers involved in your care, such as specialists or laboratories.
2. Payment: Your PHI may be used and disclosed for billing purposes, claims management, and reimbursement from your insurance company or other third-party payers. This ensures that you receive appropriate coverage for the dental services you receive.
3. Health Care Operations: We may use and disclose your PHI for activities necessary to support the operation of our dental practice. This includes quality improvement initiatives, staff training, and administrative functions.

As part of our TPO activities, we may use and disclose your PHI without obtaining your written authorization. However, for any other uses or disclosures not covered by this Statement of Privacy Practices or required by law, we will obtain your written acknowledgment. This acknowledgment ensures that you are informed of how your PHI will be used and disclosed and gives you the opportunity to express any preferences or concerns.

Your Rights:
As a patient, you have certain rights concerning your PHI under HIPAA. These rights include:

1. Access: You have the right to request access to your PHI and obtain copies of your health records, subject to certain limitations. We will provide you with access to your records within a reasonable timeframe and may charge a reasonable fee for copying and postage expenses.
2. Amendment: If you believe that your PHI is inaccurate or incomplete, you have the right to request that we amend it. We will review your request and make the necessary amendments if appropriate. If we deny your request, you have the right to submit a statement of disagreement that will be included in your records.
3. Restrictions: You may request restrictions on how we use and disclose your PHI for treatment, payment, and operations. While we will consider your request, we are not required to agree to it, except in certain circumstances.
4. Confidential Communication: You have the right to request confidential communication of your PHI, such as contacting you only at a specific phone number or address.
5. Accounting of Disclosures: Upon request, you may receive an accounting of certain disclosures of your PHI made by us. This accounting will include the date, purpose, and recipient of the disclosure.

Complaints:
If you believe that your privacy rights have been violated, you have the right to file a complaint with us or with the Department of Health and Human Services (HHS), Office for Civil Rights. We encourage you to first contact us with any concerns about our privacy practices. We are committed to resolving any issues promptly and will not retaliate against you for filing a complaint.

Bay Star Dental
1098 Foster City Blvd
Foster City, CA 94404
(650) 573-1336

Obligation to Protect PHI:
We take our obligation to protect the privacy and confidentiality of your PHI seriously. We have implemented physical, administrative, and technical safeguards to ensure the security of your health information and prevent unauthorized access, use, or disclosure. Our staff undergoes regular training on privacy policies and procedures to ensure compliance with HIPAA and other applicable regulations.

Further Information:
If you have any questions or concerns about this Statement of Privacy Practices or our privacy practices in general, please contact us at the address above.

Conclusion:
Your privacy is important to us, and we are committed to maintaining the confidentiality of your PHI. By entrusting us with your health information, you can be assured that we will handle it with the utmost care and respect. Thank you for choosing Bay Star Dental for your dental care needs.