Privacy Policy

Notice of Privacy Practices

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)



Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI, health information). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice, our legal duties, and the privacy practices that we maintain in our practice concerning your health information. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect.

We realize that these laws are complicated, but we must provide you with the following important information:

How we may use and disclose your health information,

Your privacy rights in your health information,

Our obligations concerning the use and disclosure of your health information,

This notice is effective 2-14-05

The terms of this notice apply to all records containing your health information which are created and retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created and maintained in the past, and for any of your records that we may create and maintain in the future.

Understanding Your Health Record/Information

Each time you visit Crete Dental Group, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatments. This information, often referred to as your health or medical record, serves as:

  • Basis for planning your care and treatment,
  • Means of communication among the many health professionals who contribute to your care,
  • Legal document describing the care you received,
  • Means by which you or a third-party payer can verify that services billed were actually provided,
  • A tool in educating health professionals,
  • A source of information for public health officials charged with improving the health of this state and the nation,
  • A source of data for planning and marketing,
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: Ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosures to others.

You’re Health Information Rights

Although your health record is the physical property of Crete Dental Group, the information within it belongs to you. You have the right to:

  • Obtain a paper copy if this notice of Privacy Practices on request,
  • Request to inspect and receive a copy of your health records as provided for in 45 CFR 164.524 (HIPAA Regulations),
  • Request to amend your health record as provided in 45 CFR 164.528 (HIPAA Regulations),
  • Obtain an accounting of disclosure of your health information as provided in 45 CFR 164.528 (HIPAA Regulations)
  • Request that our practice communicate with you about your health and related issues in a particular manner, with a particular person, or at a certain location,
  • Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522 (HIPAA Regulations), and
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities

Crete Dental Group is required to:

  • *Maintain the privacy of your health information,
  • *Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
  • *Abide by the terms of this notice,
  • *Notify you if we are unable to agree to a requested restriction, and
  • *Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post a revised notice and make the best effort to distribute our updated Notice of Privacy Practices.

You have the right to request a restriction to our use or disclosure of your health information for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your health information, you must make your request in writing to the practice's Privacy Officer.

Examples of Disclosures for Treatment, Payment and Health Operations

1.         Treatment:  Our practice may use your health information to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your health information in order to write a prescription for you, or we might disclose your health information to a pharmacy when we order a prescription for you. Many of the people who work for our practice - including, but not limited to, our doctors and nurses - may use or disclose your health information in order to treat you or to assist others in your care, such as your spouse, children or parents. Finally, we may also disclose your health information to other health care providers for purposes related to your treatment.

2.         Payment:  Our practice may use and disclose your health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment, or disclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your health information to bill you directly for services and items. We may disclose your health information to other health care providers and entities to assist in their billing and collection efforts.

3.         Health Care Operations: Our practice may use and disclose your health information to operate our business. Examples of the way in which we may use and disclose your information for our operations, our practice may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your health information to other health care providers and entities to assist in their health care operations.

4.         Public Health:  As required by law we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

5.         Law Enforcement:  We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

6.         Research:   We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

7.         Funeral Directors:   We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

8.         Organ Procurement Organization:   Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

9.         Food and Drug Administration (FDA):   We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.

10.       Workers Compensation:   We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

11.       Notification:  We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. We may leave a message on your answering machine or on voicemail as a means of communication. We may mail you a postcard or written notice as a means of communication. We may e-mail you or our transcriptionists as a means of communication.

12.       Communication with Family:   Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

13.       Business Associates:  There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, copy services we use when making copies of your heath record, and common couriers for medical records and specimen transportation. Your health information is kept in both electronic and paper form. We have business associates who help install, maintain, restore and report your health information. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

For More Information or to Report a Problem

If you have questions and would like additional information you may contact the practice's Privacy Officer:

If you believe your privacy rights have been violated, you can file a complaint with the practice's Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.

The address for the OCR is listed below:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, DC 20201