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our mission statement
To have our practice outshine all expectations. To give patients every reason to come in and every reason to stay. To serve our patients so well that they rave about how friendly, professional, and genuinely caring we are. To provide our patients with honest and quality dental care that they all deserve. To promote good oral hygiene in all of our patients so they have a lifetime of healthy smiles. To develop a highly motivated and enthusiastic team of valued employees and to provide an enjoyable, positive, and very fun atmosphere for us all! |
Copyright 2006 Normandy Dentistry, PA. All Rights Reserved
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Call: 904.783.1633 |
our notice of privacy practices
This notice describes how health information about you may be used and disclosed and how you can get access to this information.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy
practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect.
This Notice take effect on April 14, 2003 and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this Notice at
any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice
effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in
our privacy practices, we will change this Notice and make the new Notice available upon request. You may request a copy of our Notice at any time. For more
information about our privacy practices, or for additional copies of this Notice, please contact us at 5425 VERNA BOULEVARD, JACKSONVILLE, FLORIDA 32205.
TELEPHONE 904.783.1633.
USES AND DISCLOSURE OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment and healthcare operations. For example:
Treatment: We may use or disclose your health information to another dentist or other healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provided to you.
Healthcare operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment
and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training
programs, certification, licensing or credentialing activities.
Your authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your
health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect
any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information
for any reason except those described in this Notice.
To your family and friends: We must disclose your health information to you, as described in the Patient Rights section in this Notice. We may disclose your health
information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that
we may do so.
Persons involved in care: We may use or disclose health information to notify, or assist in the notification of (including or locating) a family member, your personal
representative or another person responsible for your care, of your location or your general condition. If you are present, then prior to use or disclosure of your health
information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose
health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your
healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x-rays or other similar forms of health information.
Marketing Health-related services: We will not use your health information for marketing communications without your written authorization.
Required by law: We may use or disclose your health information, when we are required to do so by law.
Abuse or neglect: We may disclose your health information to appropriate authorities, if we reasonably believe that you are a possible victim or abuse, neglect or domestic
violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health and safety or the
health and safety of others.
National security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized
federal officials health information required for lawful intelligence, counterintelligence and other national security activities. We may disclose to correctional institution or
law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
Appointment reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail, messages, postcards or letters.)
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than
photocopies. (You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information
listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. You may also request access by sending us a
letter to the address at the end of this Notice. If you request copies, we will charge you $1.00 per page for the first 25 pages and $.25 per page for additional pages to
locate and copy your health information and postage if you want the copies mailed to you. If you prefer, we will prepare a summary or an explanation of your health
information for a fee. Contact us using the information listed at the end of this Notice for a full explanation of our fee structures.)
Disclosure accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than
treatment, payment, healthcare operations and certain other activities for the last 6 years, but not before April 14, 2003. If you request this accounting more than once, we
may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional restrictions on our use of disclosure of your health information. We are not required to agree to these
additional restrictions, but if we do, we will abide by our agreement (except in an emergency.)
Alternative communication: You have the right to request that we amend your health information by alternative means or to alternative locations. (You must make your
request in writing.) Your request must specify the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative
means or location you request.
Amendment: You have the right to request that we amend your health information. (Your request must be in writing, and it must explain why the information should be
amended.) We may deny your request under certain circumstances.
Questions and complaints: If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may
have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or
restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using
the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide
you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health
information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
This notice describes how health information about you may be used and disclosed and how you can get access to this information.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy
practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect.
This Notice take effect on April 14, 2003 and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this Notice at
any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice
effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in
our privacy practices, we will change this Notice and make the new Notice available upon request. You may request a copy of our Notice at any time. For more
information about our privacy practices, or for additional copies of this Notice, please contact us at 5425 VERNA BOULEVARD, JACKSONVILLE, FLORIDA 32205.
TELEPHONE 904.783.1633.
USES AND DISCLOSURE OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment and healthcare operations. For example:
Treatment: We may use or disclose your health information to another dentist or other healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provided to you.
Healthcare operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment
and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training
programs, certification, licensing or credentialing activities.
Your authorization: In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your
health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect
any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information
for any reason except those described in this Notice.
To your family and friends: We must disclose your health information to you, as described in the Patient Rights section in this Notice. We may disclose your health
information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that
we may do so.
Persons involved in care: We may use or disclose health information to notify, or assist in the notification of (including or locating) a family member, your personal
representative or another person responsible for your care, of your location or your general condition. If you are present, then prior to use or disclosure of your health
information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose
health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your
healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x-rays or other similar forms of health information.
Marketing Health-related services: We will not use your health information for marketing communications without your written authorization.
Required by law: We may use or disclose your health information, when we are required to do so by law.
Abuse or neglect: We may disclose your health information to appropriate authorities, if we reasonably believe that you are a possible victim or abuse, neglect or domestic
violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health and safety or the
health and safety of others.
National security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized
federal officials health information required for lawful intelligence, counterintelligence and other national security activities. We may disclose to correctional institution or
law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.
Appointment reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail, messages, postcards or letters.)
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide copies in a format other than
photocopies. (You must make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information
listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. You may also request access by sending us a
letter to the address at the end of this Notice. If you request copies, we will charge you $1.00 per page for the first 25 pages and $.25 per page for additional pages to
locate and copy your health information and postage if you want the copies mailed to you. If you prefer, we will prepare a summary or an explanation of your health
information for a fee. Contact us using the information listed at the end of this Notice for a full explanation of our fee structures.)
Disclosure accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than
treatment, payment, healthcare operations and certain other activities for the last 6 years, but not before April 14, 2003. If you request this accounting more than once, we
may charge you a reasonable, cost-based fee for responding to these additional requests.
Restriction: You have the right to request that we place additional restrictions on our use of disclosure of your health information. We are not required to agree to these
additional restrictions, but if we do, we will abide by our agreement (except in an emergency.)
Alternative communication: You have the right to request that we amend your health information by alternative means or to alternative locations. (You must make your
request in writing.) Your request must specify the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative
means or location you request.
Amendment: You have the right to request that we amend your health information. (Your request must be in writing, and it must explain why the information should be
amended.) We may deny your request under certain circumstances.
Questions and complaints: If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may
have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or
restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using
the contact information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide
you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health
information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.