Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are committed to maintaining the privacy of your protected health information (PHI) as required by law. This Notice explains your rights and our obligations regarding the use and disclosure of your health information. It is effective as of 1/1/2021 and will remain in effect until replaced.

We reserve the right to change this Notice and our privacy practices, as permitted by law. Any significant changes will be clearly posted at our practice, and copies of the updated Notice will be available upon request.

For questions or more information about this Notice, please contact us at the address or phone number provided at the end of this document.

How We May Use and Disclose Your Health Information

  1. Treatment
    We may use and disclose your health information to provide, coordinate, or manage your treatment. For example, we may share your health information with a specialist treating you.
  2. Payment
    Your health information may be used or disclosed to obtain payment for the services provided to you, including billing, claims management, and eligibility verification. For example, we may submit your health information to your dental insurance provider for reimbursement.
  3. Healthcare Operations
    We may use and disclose your health information for operational purposes, such as quality improvement activities, staff training, and licensing. For instance, we may use your information to evaluate our services.
  4. Individuals Involved in Your Care
    Your health information may be shared with family members, friends, or others identified by you who are involved in your care or payment for your care.
  5. Disaster Relief
    We may share your health information to assist with disaster relief efforts.
  6. Required by Law
    We may disclose your health information when required by federal, state, or local laws.
  7. Public Health Activities
    Your health information may be disclosed for public health purposes, such as:

    • Preventing disease.
    • Reporting abuse, neglect, or domestic violence.
    • Addressing product recalls.
  8. Law Enforcement and National Security
    We may disclose health information for law enforcement purposes, such as compliance with legal orders, and to authorized federal officials for national security activities.
  9. Worker’s Compensation
    We may share your health information as required to comply with worker’s compensation laws.
  10. Judicial and Administrative Proceedings
    Your health information may be disclosed in response to legal proceedings, such as court orders or subpoenas.
  11. Research
    We may share health information for research purposes if approved by a review board that ensures your privacy is protected.
  12. Coroners, Medical Examiners, and Funeral Directors
    We may provide health information to these professionals to carry out their duties, such as identifying a deceased person or determining a cause of death.
  13. Fundraising
    We may contact you about fundraising activities. You can opt out of these communications at any time.

Other Uses and Disclosures of PHI

For uses beyond those listed, including psychotherapy notes or marketing, your written authorization is required. You may revoke this authorization at any time in writing.

Your Health Information Rights

  1. Access
    You have the right to view or obtain copies of your health information. Requests must be submitted in writing.
  2. Disclosure Accounting
    You have the right to request an accounting of certain disclosures made about your health information.
  3. Request Restrictions
    You may request restrictions on the use or disclosure of your health information.
  4. Alternative Communications
    You can request that we communicate with you by alternative means or at specific locations.
  5. Amendment
    You may request an amendment to your health information if you believe it is incorrect or incomplete.
  6. Breach Notification
    You will be notified if there is a breach of your unsecured health information.
  7. Paper Copy
    You may request a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Questions and Complaints

If you have concerns about our privacy practices or believe your rights have been violated, you may contact us or file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact Information

Privacy Official:
Dr. Sehat
3575 Story Rd. W., Suite 100
Irving, TX 75038

Telephone: 972 -200-1710