As a patient of Guilford Dental Arts (referred to, from this point as GDA) we want to provide you with the best possible care and we want you to feel free to make full disclosure of information to the Doctor and/or staff so that effective treatment can be provided. As required by the privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), GDA is providing you, the patient or the patient’s legal representative, with a copy of our Privacy Notice. HIPAA regulations require us to provide this information to you and obtain your signature or the signature of your legal representative as proof that you have received our Privacy Notice.
The policy of GDA is to protect the confidentiality, integrity, and security of the protected health and personal information of our patients and to prevent unauthorized access to, or the use of this information. This policy applies to both current and former patients.
Protected Health Information (PHI) is individually identifiable health and personal information and includes any information obtained by GDA in connection with providing healthcare treatment, obtaining payment and related healthcare operations. This relates to past, present or future information that GDA receives from you as our patient.
We will use this information to provide caring and quality medical care to you. Examples of PHI include diagnosis, treatment, and communications, both oral and written including answering machines and voice mail, used for follow-up and appointment scheduling and reminders. As part of our standard healthcare operations, we may share information with a facility such as a hospital, laboratory, diagnostic services or healthcare provider to coordinate your treatment plan in the most effective manner. For insurance carriers, your information will be used for claims submission and to obtain payment for services provided. We will exchange data with your insurance carrier for activities such as confirming your eligibility with the plan, benefits and coverage determinations and precertification/authorizations and utilization review.
Your information is maintained in our office in our practice management information system. We also maintain information about you in your medical/dental chart. GDA limits access to your PHI to those employees and business associates who need to know this information and we restrict the types and amount of provided to that which, is “minimally necessary” in order to carry out their work.
We do not disclose PHI to third parties for purposes other than treatment, payment or healthcare operations unless the following exceptions occur:
We received authorization from you to release your individually identifiable information. GDA will provide you with an Authorization Form that will need to be signed by you, the patient, or in the case of a minor, by his/her guardian. This authorization will be for a defined period of time and may be cancelled by you, the patient, or in the case of a minor, by his/her guardian, at any time. Federal, State, Workers’ Compensation purposes, or other applicable law requires us to share PHI.
You have the right to request a review of your PHI, to amend your records, and request restrictions on how your PHI has been disclosed. Any requests for amendments or restriction of the use of your PHI must be in writing. You have a right to request a copy of your medical/dental records and GDA will make every effort to provide you with your records within a reasonable amount of time and subject to normal copying charges.
If you have any questions, comments or complaints regarding the management of your PHI, please contact Sue at our office at 203-453-4344.
To Schedule Your Appointment (203) 453-4344
If you'd like to contact the office outside of regular work hours, you can leave a message or complete the Schedule Appointment form and we will call you back within 24 hours.