Notice of Privacy Practices
THUC-DOAN DOAN, DDS PLLC AND MAZEN NATOUR, DMD PLLC
Effective Date: 01/01/2017
This notice describes how medical and dental information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Our Legal Duty
We are required by law to maintain the privacy of your health information, to provide you with this Notice of our legal duties and privacy practices, and to notify you following a breach of unsecured protected health information.
How We May Use and Disclose Health Information
We may use and share your health information without your written permission in the following ways:
Treatment – We may use or share your information to provide, coordinate, or manage your dental care and related services. For example, we may consult with another dentist, physician, or dental laboratory about your treatment.
Payment – We may use or share your information to bill and receive payment from health plans or other entities. For example, we may share your information with your dental insurance company to obtain pre-approval for treatment.
Healthcare Operations – We may use or share your information for practice management, quality assessment, and staff training.
Other Permitted or Required Uses and Disclosures
We may also disclose your information without your authorization for purposes such as:
Public health reporting (e.g., communicable diseases)
Reporting abuse, neglect, or domestic violence
Health oversight activities (e.g., audits, inspections)
Legal proceedings or law enforcement requests
Coroners, medical examiners, and funeral directors
Research approved by an institutional review board
Workers’ compensation claims
To prevent or lessen a serious threat to health or safety
As required by federal, state, or local law
Other Uses Requiring Authorization
Other uses and disclosures of your information will be made only with your written authorization, such as:
Marketing purposes
Sale of your health information
Psychotherapy notes
You may revoke your authorization in writing at any time.
Your Rights Regarding Health Information
Right to Inspect and Copy – You may request to see or get a copy of your records.
Right to Request Amendment – You may request changes to your records if you believe information is incorrect or incomplete.
Right to an Accounting of Disclosures – You may request a list of disclosures we have made about you.
Right to Request Restrictions – You may request limits on how we use or share your information.
Right to Confidential Communications – You may request that we contact you in a certain way (e.g. at work, by mail).
Right to a Paper Copy of This Notice – You may request a copy of this Notice at any time.
Right to Receive Breach Notification – You will be notified if a breach occurs that compromises your health information.
Our Responsibilities
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.
We must follow the duties and practices described in this Notice.
We will not use or share your information other than as described here unless you authorize it in writing.
Changes to This Notice
We reserve the right to change this Notice at any time. Any changes will apply to all information we have about you. The current Notice will always be available at our office and on our website (if applicable).
Questions or Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be retaliate against for filing a complaint.
Contact Information:
Silvia Marinova, Office Manager
Thuc-Doan Doan, DDS PLLC
Mazen Natour, DMD PLLC
30 Central Park South, #10D
New York, NY
(212) 518-6494 / Frontdesk@natourdmd.com