HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: 01/06/2025
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can request to see or get an electronic or paper copy of your medical record and other health information we have about you. Please contact our office to submit a request.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. A reasonable, cost-based fee may apply.
Ask us to correct your medical record
- You may request corrections to health information you believe is incorrect or incomplete.
- We may deny your request but will notify you in writing within 60 days.
Request confidential communications
- You may request that we contact you through specific means (e.g., home or office phone, alternative mailing address).
- We will accommodate all reasonable requests.
Limit what we use or share
- You may request limitations on the use or disclosure of certain health information for treatment, payment, or operations. We are not required to agree, but will consider your request.
- If you have paid for a service or healthcare item out-of-pocket in full, you may request that we not disclose that information to your health insurer, unless legally required to do so.
Get a copy of this privacy notice
- You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights.
File a complaint if you believe your rights are violated
- To file a complaint, please contact us at:
- Keystone Oral Surgery & Implant Center
- Phone: (570) 884-8321
- Email: hippa@keystoneomfs.com
- You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
Your Choices
You may instruct us on sharing information in certain circumstances:
- Share information with family, close friends, or others involved in your care.
- Share information in a disaster relief situation.
We may share your information if you are unable to express your preferences and sharing is deemed to be in your best interest or necessary to lessen serious health or safety threats.
We will not share your information without written permission for:
- Marketing purposes
- Sale of your information
- Most uses of psychotherapy notes
We may contact you for fundraising purposes, but you may opt out.
Our Uses and Disclosures
We typically use or share your health information in the following ways:
Treat you
- We may use your health information and share it with other healthcare professionals involved in your care.
Run our organization
- We may use and share your information to operate our practice, improve care, and manage administrative functions.
Bill for your services
- We may use and share your health information to obtain payment from insurance companies and other payers.
Other Ways We May Use or Share Your Information
We are allowed or required to share your information for public good and legal reasons, including:
- Public health activities such as preventing disease, reporting adverse drug reactions, and reporting suspected abuse or neglect.
- Health research under federal guidelines.
- Compliance with federal or state law and regulatory agencies.
- Organ and tissue donation requests.
- Work with medical examiners or funeral directors.
- Workers' compensation claims.
- Law enforcement or government functions.
- Lawsuits and legal proceedings.
For more information, visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Electronic Communication: Texting and Email
Keystone Oral Surgery & Implant Center may use email, text messaging (SMS), or other electronic means to communicate with patients for appointment reminders, scheduling, billing, pre- and post-operative instructions, and other healthcare-related communications.
By providing your email address and/or mobile phone number, you are consenting to receive electronic communications from our practice.
Risks of Electronic Communication
While we make every effort to protect your information, please be aware that:
- Email and text messaging are not fully secure methods of communication.
- There is a risk that messages may be intercepted, misdirected, or read by unintended recipients.
- Electronic communications may not always be encrypted or fully HIPAA-secure depending on the device, platform, or network used.
Patient Responsibilities
- You are responsible for providing accurate and current contact information.
- You may revoke your consent to receive electronic communications at any time by notifying our office in writing.
Use of Electronic Communication is Limited
- We will not use email or text to discuss sensitive clinical information unless explicitly requested and consented to by the patient.
- Emergency or urgent matters should not be communicated via email or text. In case of emergency, please call 911 or visit the nearest emergency facility.
Opt-Out
You may opt out of electronic communication at any time by contacting our office:
- Phone: (570) 884-8321
- Email: hippa@keystoneomfs.com
We will honor your opt-out request and continue to communicate with you using alternative methods if requested.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will notify you promptly if a breach occurs.
- We will only use or share your information as outlined unless you authorize otherwise.
- You may revoke consent in writing at any time.
For full details, visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to This Notice
We reserve the right to amend this notice. Updated versions will be available at our office and on our website.