Disclaimer

Notice to Website Viewers:

This web site is provided for information and education purposes only. No doctor/patient relationship is established by your use of this site. No diagnosis or treatment is being provided. The information contained here should be used in consultation with an oral and maxillofacial surgeon of your choice. No guarantees or warranties are made regarding any of the information contained within this web site. This web site is not intended to offer specific medical, dental or surgical advice to anyone. Further, this web site and Drs. Libby Kutcipal and Sabrina Mahil take no responsibility for web sites hyper-linked to this site and such hyperlinking does not imply any relationships or endorsements of the linked sites.

Privacy Policy for www.seattleoralsurgeon.com

If you require any more information or have any questions about our privacy policy, please feel free to contact us. At www.seattleoralsurgeon.com, the privacy of our visitors is of extreme importance to us. This privacy policy document outlines the types of personal information that is received and collected by www.seattleoralsurgeon.com and how it is used.

HIPAA – Statement of Privacy Practices

Protected Healthcare Information (PHI)

It is important that you know not only that we limit requests for your personal information to that needed to provide quality health care, implement payment activities, and conduct normal health practice operations, but understand what “Protected Healthcare Information” is.   This may include your name, address, telephone number(s), Social Security Number, employment data, dental history, health records, and/or any personal information that is unique to you.

While most of the information will be collected from you, we may obtain information from third parties if it is deemed necessary.  Regardless of the source, your personal information will always be protected to the full extent of the law.

Protecting your Personal Healthcare Information

We use and disclose the information we collect from you only as allowed by the HIPAA and the state regulations.  This includes when it is used and disclosed to perform treatment, obtain payment, and conduct operational activities. Your personal health information will never be otherwise given to anyone – even family members – without your written consent.  You, of course, may give written authorization for us to disclose your information to anyone you choose, for any purpose. 

Our Statement of Privacy Practices applies to all personal health information collected or created by our employees or received from outside healthcare providers.  This information may identify you, relate to your past, present or future physical or mental condition, the care provided, or any reference to payment for your health care.

For example, protected health information includes symptoms, test results, diagnoses, health information from other providers, as well as billing and payment information relating to these services.  This information is protected because it is often part of your health or dental record, which we can use as:

  1. A method of communication among health professionals who contribute to your care,
  2. A legal record describing the care you received,
  3. A means by which you can verify that services billed were provided,
  4. A tool to educate health professionals,
  5. A source of data for dental research,
  6. A source of information for public health officials,
  7. A source of information for facility planning,
  8. A tool to assess and improve the care we provide,
  9. A method by which we can provide a better understanding of your record,
  10. A method by which we can ensure your record’s accuracy,
  11. A system to assist you to more clearly understand the circumstances and conditions in and by which others may have access to your personal information.
  12. A tool for us to make more informed decisions when authorizing disclosures to others.

PHI Use and Disclosure– Without your Authorization

As stated above we may, under allowed circumstances use and disclose protected health information (PHI) without your specific authorization. Examples of such instances are included below: 

Treatment:  We may use and disclose your PHI to provide treatment. For example, we can:

  1. Use your information to find out whether certain tests, therapies, and medicines should be ordered,
  2. Provide your information to staff members to better understand what your healthcare needs are how to evaluate your response to treatment,
  3. Disclose your PHI to another one of your treatment providers in order to provide you with the best possible health care.
  4. Share, with your consent and authorization, PHI relating to substance use disorder with substance disorder treatment programs, doctor’s offices, and health care businesses for those activities

Payment:  We may use your health information for payment purposes. Such instances may include:

  1. Preparation of claims for payment of services,
  2. Billing your insurance directly, including information that identifies you, as well as your diagnosis, the procedures performed, and supplies used so that we can be paid for the treatment provided,
  3. Collection activities (if necessary) to obtain payment for services.

Health Care Operations: We may use and disclose your health information to support the daily activities related to health care. Examples include:

  1. Use and disclosure to monitor and improve our health services.
  2. Use by authorized staff to review at portions of your record to perform administrative activities.

Train Staff and Students:  We may use and disclose your information to teach and train staff how to review patient health information.

Contact You for Information: Your PHI may also be used to contact you. In example, we may call you or send you a letter to remind you about your appointment, provide test results, inform you about treatment options, or advise you about other health-related benefits and services.

Business Associates. Your PHI may be used and disclosed as needed to individuals, organizations, or companies to comply with our legal obligations described in this Notice. An example is disclosure of your PHI to consultants, attorneys, or third parties to assist in our business activities.  All such entities must sign a Business Associate Agreement to protect the confidentiality of your private information.

Additional Uses and Disclosures

We also use and disclose your information to enhance health care services, protect patient safety, safeguard public health, ensure that our facilities and staff comply with government and accreditation standards, and when otherwise compelled or allowed by law not in conflict with exceptions established under HIPAA’s Substance Use Disorder requirements.  For example, we may provide or disclose information:

  1. About FDA-regulated drugs and devices to the U.S. Food and Drug Administration.
  2. To government oversight agencies with data for health oversight activities such as auditing or licensure.
  3. To public health authorities with information on communicable diseases and vital records.
  4. To your employer, findings relating to the evaluation of work-related illnesses or injuries.
  5. To workers’ compensation agencies and self-insured employers for work-related illness or injuries.
  6. To appropriate government agencies when we suspect abuse or neglect.
  7. To appropriate agencies or persons when we believe it necessary to avoid a serious threat to health or safety or to prevent serious harm.
  8. To organ procurement organizations to coordinate organ donation activities.
  9. To law enforcement when required or allowed by law, including the Office of Civil Rights to conduct OCR investigations.
  10. For court order or lawful subpoena (see note below).
  11. To coroners, medical examiners, and funeral directors.
  12. To government officials when required for specifically identified functions such as national security.
  13. When otherwise required by law, such as to the Secretary of the United States Department of Health and Human Services for purposes of determining compliance with our obligations to protect the privacy of your health information.
  14. If you are a member of the armed forces, we may release dental information about you as required by military command authorities. We may also release dental information about foreign military personnel to the appropriate foreign military authority.

NOTE: If PHI is disclosed pursuant to the HIPAA Privacy Rules’ Substance Use Disorder allowances and requirements, the records could potentially be redisclosed and will no longer be protected under the HIPAA Privacy Rule.

Your Rights to Object

Disclosure to Family, Friends, or Others.   You may object to our disclosing your general health condition (“good”, “fair”, “critical”, etc.) to an individual, or individuals, you have identified who have an active interest in your care, payment for your health care, or who may need to notify others about your general condition, location, or death.  If you do not so indicate, we will use our best professional judgment to provide relevant protected health information to your family member, friend, or another identified person.

Use and Disclosures Requiring Authorization

Our offices and electronic systems are secure from unauthorized access and our employees are trained to make certain that the confidentiality of your records is always protected.  Our privacy policy and practices apply to all former, current, and future patients, so you can be confident that your protected health information will never be improperly disclosed or released.

Other than the uses and disclosures described above, we will not use or disclose your protected health information without your written authorization. You may revoke your written authorization, at any time unless prohibited by law, or disclosure is required for us to obtain payment for services already provided, or we have otherwise relied on the authorization.

Your PHI will not be released for use in legal proceedings against your unless (a) you consent or otherwise authorize its release or the release is based on a Part 2 court order and a subpoena, or similar legal requirement.

 

Additional Protection

Special state and federal laws apply to certain classes of patient health information. For example, additional protections may apply to information about sexually transmitted diseases, drug and alcohol abuse treatment records, mental health records, and HIV/AIDS information. When required by law, we will obtain your authorization before releasing this type of information.

Your Individual Rights

You may contact us to exercise your rights related to the use and disclosure of your protected health information.

Your specific rights are listed below and include:

  1. The right to request restricted use: You may request in writing that we not use or disclose your information for treatment, payment, and/or operational activities except when authorized by you, when required by law, or in emergency circumstances. We are not legally required to agree to your request. If you request that we restrict the use of your private information, we will provide you with written notice of our decision about your request.
  2. The right to request non-disclosure to health plans: You have the right to request in writing that health care items or services for which you self-pay for in full in advance of your visit not be disclosed to your health plan.
  3. The right to receive confidential communications: You have the right to request that we communicate with you about dental matters in a particular way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the address above. We will grant all reasonable requests. Your request must specify how or where you wish to be contacted.
  4. The right to inspect and receive copies: In most cases, you have the right to inspect and receive a copy of certain health care information including certain dental and billing records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
  5. The right to request an amendment to your record: If you believe that information in your record is incorrect or that important information is missing, you have the right to request in writing that we make a correction or add information. In your request for the amendment, you must give a reason for the amendment. We are not required to agree to the amendment of your record, but a copy of your request will be added to your record.
  6. The right to know about disclosures: You have the right to receive a list of instances in which we have disclosed your health information. Certain instances will not appear on the list, such as disclosures for treatment, payment, or health care operations or when you have authorized the use or disclosure. Your first accounting of disclosures in a calendar year is free of charge. Any additional request within the same calendar year requires a processing fee.
  7. The right to make complaints: If you believe that we have violated your privacy, or you disagree with a decision we made about access to your records, you may file a complaint directly to our doctor or any member of our workforce with directions that it be relayed to our doctor in charge.

You may also contact:

U.S. Department of Health and Human Services,

Office for Civil Rights:

2201 Sixth Avenue – Mail Stop RX-11

Seattle, WA 98121-1831

206-615-2290; 206-615-2296 (TTY)

206-615-2297 (fax)

Toll free: 1-800-362-1710; 1-800-537-7697 (TTY)

Breach Notification

If it is found that your patient information is used or disclosed in a manner that is not consistent with the practices described in this notice, the incident will be fully investigated to assess if there was a breach in the protection of your PHI.  The assessment will be conducted to determine whether the information disclosed has significant risk of physical, financial, or reputational harm to you. If so, we will notify you and submit appropriate information to OCR and the United States Department of Health and Human Services in writing.

Privacy Notice Changes

We are required by law to protect the privacy of your information, to provide this Statement of Privacy Practices and to follow the privacy practices that are described herein.  We reserve the right to change the privacy practices described and the right to make the revised or changed Statement effective for protected health information we already have as well as any information we may receive in the future.

We have posted a copy of our current Statement for your review and reference.  Additionally, each time you visit our office for treatment or health care services, you may request a copy of our current Statement of Privacy Practices.  An electronic version of the notice is posted on our web site.

By entering your full name, email address, and phone number, you are providing personal information that will be used by Ballard Oral Surgery for the sole purpose of returning your request to be contacted by us. We will only use this information to contact you in order to assist you in scheduling an appointment to be seen by Dr. Kutcipal and Dr. Mahil, and/or to answer any questions you may have indicated in the comments section. Our intention is to only use your personal information to return your request for contact regarding a dental appointment, and/or a dental related question.

Opt-Out Option

Please contact us if you wish to opt-out/unsubscribe from receiving any future communication.

Log Files

Like many other Web sites, www.seattleoralsurgeon.com makes use of log files. The information inside the log files includes internet protocol (IP) addresses, type of browser, Internet Service Provider (ISP), date/time stamp, referring/exit pages, and number of clicks to analyze trends, administer the site, track user’s movement around the site, and gather demographic information. IP addresses, and other such information are not linked to any information that is personally identifiable.

Accessibility

We strive to make the Ballard Oral Surgery website universally accessible and we are continuously working to improve the accessibility of content on our website. If this website does not meet your needs, please contact us at Ballard Oral Surgery Phone Number 206-783-9672 for assistance.