Notice of Privacy Practices

Treatment, payment and health care operations

The law allows us to use and disclose your health information for these three purposes without asking you each time. The examples below are examples rather than a complete list.

For treatment

We use your health information to provide dental care and to coordinate it with others involved in that care. A dental assistant reviews your chart and your radiographs before an appointment. We send an impression, a digital scan or a shade to a dental laboratory so a crown, a bridge or a partial denture can be made. We refer you to an oral surgeon, an endodontist, a periodontist or an orthodontist and send the records and images they need to see. We contact your physician about a medical condition, a medication or a blood thinner before a procedure, and we send prescriptions to your pharmacy.

For payment

We use and disclose your health information so that we can be paid for the care we provide. We submit claims to your dental or medical plan with the radiographs, periodontal charting and narratives a claim requires. We ask for a pre-treatment estimate before major work so you know your share in advance. We confirm your eligibility and benefits. If an account goes unpaid, we may disclose the minimum information necessary to a billing service or a collection agency, and we do not send clinical detail for that purpose beyond what is necessary.

For health care operations

We use your health information to run the practice and to keep the quality of care up. We review charts and radiographs internally to evaluate how treatment turned out. We train dental assistants, hygienists and students in the office. We prepare for a licensing survey, an audit or a peer review. We consult our attorney, our accountant, our insurance broker and our malpractice carrier, each of whom is bound to keep what they see confidential. We remove identifiers so that information can be used without identifying you.

Uses and disclosures that require your written authorization

Some uses and disclosures may not be made unless you sign an authorization. An authorization is a separate written form, not a line in your new patient paperwork.

Most marketing communications

We will not use or disclose your health information to market a product or a service to you where we receive payment from a third party for making that communication, without your written authorization, and the authorization will say that we are being paid. Talking with you face to face, and giving you a promotional item of nominal value such as a toothbrush, do not require an authorization.

Any sale of your health information

We will not sell your health information. A disclosure in exchange for payment requires your written authorization, and that authorization must state that the practice will receive payment for the disclosure.

Psychotherapy notes

Most uses and disclosures of psychotherapy notes require your written authorization. A dental practice does not ordinarily create such notes, and this practice does not.

Anything else not described in this notice

Any other use or disclosure of your health information will be made only with your written authorization.

Revoking an authorization

You may revoke an authorization in writing at any time. Revoking it stops any further use or disclosure made under it. It cannot undo a disclosure we already made while the authorization was in effect, and it does not apply where we are required to keep a record of the care we provided to you.

Disclosures we may make without your authorization

The law permits or requires us to disclose health information in the situations below. In each case we disclose only what that law allows.

As required by law

We will disclose your health information when federal, state or local law requires us to.

Public health activities

We may disclose information to a public health authority to prevent or control disease, injury or disability; to report births and deaths; to report reactions to medications or problems with products; to notify people of recalls; to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading it; and, where authorized by law, to report a suspected work related injury or illness to an employer.

Abuse, neglect or domestic violence

We may disclose information to a government authority authorized to receive reports of abuse, neglect or domestic violence. California law requires a dentist to report suspected child abuse and suspected abuse or neglect of an elder or dependent adult, and we comply with those requirements.

Health oversight activities

We may disclose information to a health oversight agency for audits, investigations, inspections, licensure and disciplinary actions, and other activities that oversee the health care system, government benefit programs and compliance with civil rights laws. The Dental Board of California is such an agency.

Judicial and administrative proceedings

We may disclose information in response to a court order or an administrative order. We may also disclose it in response to a subpoena, a discovery request or other lawful process that is not accompanied by a court order, if we receive satisfactory assurance that you were notified of the request or that an effort was made to obtain a protective order.

Law enforcement

We may disclose information to a law enforcement official as required by law or in response to a court order, warrant, subpoena or summons; to identify or locate a suspect, fugitive, material witness or missing person; about a victim of a crime in the limited circumstances the law allows; about a death we believe may have resulted from criminal conduct; about criminal conduct on our premises; and in an emergency to report a crime, the location of a crime or its victims, and the identity or description of the person who committed it.

Coroners, medical examiners and funeral directors

We may disclose information to a coroner or medical examiner to identify a deceased person or determine a cause of death, and to a funeral director as necessary to carry out their duties. Dental records are frequently the means by which a person is identified.

Organ and tissue donation

If you are an organ donor, we may disclose information to an organ procurement organization or to an entity that handles organ, eye or tissue donation and transplantation.

Research

We may use or disclose information for research where an institutional review board or a privacy board has reviewed the research proposal and approved a waiver of authorization, and in the limited circumstances the law allows for preparing a research protocol and for research on the information of people who have died.

To avert a serious threat to health or safety

We may use or disclose information when it is necessary to prevent or lessen a serious and imminent threat to the health or safety of you or of another person, and the disclosure is to someone able to prevent or lessen that threat, including the person threatened and law enforcement.

Specialized government functions

If you are a member of the armed forces, we may disclose information as required by military command authorities. We may also disclose information to authorized federal officials for national security and intelligence activities, for protective services for the President and others, and for determining eligibility for certain government benefits.

Inmates and correctional institutions

If you are an inmate of a correctional institution, or in the custody of a law enforcement official, we may disclose information to that institution or official where it is necessary for your health care, for the health and safety of others, or for the safety and security of the institution.

Workers compensation

We may disclose information as authorized by and to the extent necessary to comply with laws relating to workers compensation and similar programs that provide benefits for work related injuries or illness.

Business associates

We may disclose information to companies that perform services for the practice, such as a billing service, a practice management or records vendor, a document shredding company or an information technology contractor. Each is required by written contract to protect your information and to use it only for the work we hired it to do.

Your rights

You have the following rights over the health information we hold about you. Unless we say otherwise, each is exercised by a written request to the Privacy Officer at the address in the complaints section below.

Ask us to restrict uses and disclosures

You may ask us to limit the health information we use or disclose for treatment, payment or health care operations, or to limit what we disclose to a family member or friend involved in your care. Tell us what you want limited and to whom. We are not required to agree, except in the case immediately below. If we do agree, we will keep to the restriction unless the information is needed to give you emergency treatment.

Restrict a disclosure to your health plan when you pay in full

We must agree to a request not to disclose health information to your dental or medical plan about a particular treatment or service, if you pay for that treatment or service in full, out of pocket, and the disclosure is for payment or health care operations and is not otherwise required by law. Tell us before or at the time of the appointment so it can be handled correctly, and be aware that a plan will not apply an amount it never sees toward your deductible or your annual maximum.

Ask for confidential communications

You may ask us to contact you in a particular way or at a particular place, for example only at a work number, only by mail to a specific address, or with no message left on voicemail. You do not have to tell us why. We will accommodate reasonable requests.

See and get a copy of your record

You may inspect and get a copy of the dental record and billing record we use to make decisions about your care. If we hold the information electronically, you may ask for an electronic copy, and we will provide it in the form and format you ask for if we can readily produce it, or in another electronic form we agree with you. You may also ask us to send a copy to a person you name, in a written, signed request that clearly identifies that person and where the copy should go. We may charge a reasonable, cost based fee, and California law limits what a dental office may charge. We will respond within the time the law allows. In the limited circumstances where the law permits us to deny access, we will tell you in writing and explain how you may have that decision reviewed.

Ask us to amend your record

If you believe information in your record is incorrect or incomplete, you may ask us in writing to amend it, and you must give a reason for the request. We may deny it, for example where we did not create the information or where we believe the record is accurate and complete. If we deny it we will tell you in writing, and you may file a written statement of disagreement that we will include with the record from then on.

Get an accounting of disclosures

You may ask for a list of the disclosures we made of your health information in the six years before your request. The list does not include disclosures for treatment, payment or health care operations, disclosures you authorized, disclosures made to you, disclosures to people involved in your care, and certain others the law excludes. The first list in any twelve month period is free. We may charge a reasonable, cost based fee for further lists in the same period, and we will tell you the cost first so that you can withdraw or narrow the request.

Get a paper copy of this notice

You may ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. Ask at the front desk or call the office and we will hand you one or mail it.

Be told if there is a breach

You have the right to be notified if a breach occurs that compromises the privacy or security of your unsecured health information.

Choose someone to act for you

If you have given someone a medical power of attorney, or if someone is your legal guardian or the personal representative of your estate, that person can exercise these rights and make choices about your health information. We will verify that the person has that authority before we act on their request.

How to complain

If you believe your privacy rights have been violated, you may complain to the practice and to the federal government. We will not retaliate against you, and you will not lose any care or any benefit, because you filed a complaint.

Complain to the practice

Put your complaint in writing to the Privacy Officer, Robert J. Brosi, DDS Inc., PO Box 2407, Oakhurst, CA 93644-2407, or call the office at (559) 683-4694 and ask to speak with the Privacy Officer. Describe what happened and when. We will look into it and respond to you. The name and direct telephone number of the Privacy Officer are to be confirmed by the practice and inserted here before this notice is used.

Complain to the Secretary of the U.S. Department of Health and Human Services

You may file a complaint with the Secretary of the United States Department of Health and Human Services, Office for Civil Rights. Write to 200 Independence Avenue SW, Washington, DC 20201, call 1-877-696-6775, or file online at hhs.gov. A complaint must generally be filed within one hundred eighty days of when you knew, or should have known, of the act you are complaining about.

Complain to a California authority

You may also contact the Dental Board of California, which licenses dentists in this state, or the Office of the Attorney General of California.

How to reach the practice

Practice

Robert J. Brosi, DDS Inc., a California professional dental corporation

Dentist

Dr. Robert J. Brosi, DDS, General Dentist. California license 029875, Dental Board of California. National Provider Identifier 1205950839.

Office

49414 Road 426, Oakhurst, California 93644

Mail

PO Box 2407, Oakhurst, CA 93644-2407

Phone

(559) 683-4694

Fax

(559) 642-6219

Email

drbrosi@sti.net. Ordinary email is not secure. Please do not send health details to this address, and call the office instead.

In person

Hours, directions and parking are on our contact page.