LEgal

Privacy

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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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

We are required by applicable federal and state laws to maintain the privacy of your protected health information (PHI). We must give you this notice about our privacy practices, our legal duties, and your rights concerning your PHI, and we must follow the practices described here while this notice is in effect. This notice takes effect April 14, 2003, and remains in effect until replaced.

We reserve the right to change our privacy practices and the terms of this notice at any time, as permitted by law. Changes will apply to all PHI we maintain, including information created or received before the changes. You may request a copy of this notice at any time using the contact information at the end of this notice.

Uses and disclosures of protected health information

We use and disclose PHI for treatment, payment, and health care operations. The examples below are not exhaustive.

  • Treatment: Coordinating or managing your care, including sharing PHI with other providers involved in your treatment (e.g., specialists, labs, home health).
  • Payment: Using PHI to obtain payment for services, verify coverage, or secure authorizations (e.g., pre-approvals for procedures).
  • Health care operations: Quality assessment, training, licensing, business planning, appointment reminders, contacting you about treatment alternatives or health-related benefits, and working with business associates under contracts that safeguard your PHI.

Other uses and disclosures occur only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization in writing at any time, which will not affect prior uses and disclosures made while the authorization was in effect.

Unless you object, we may share PHI with family or others you identify who are involved in your care or payment. If you cannot agree or object, we may share relevant information based on professional judgment and your best interest, including to notify family or representatives about your condition or location.

Additional permitted disclosures

  • Marketing: We may contact you with information about treatment alternatives or health-related services. You may opt out of these communications.
  • Research; death; organ donation: Limited disclosures for research; to coroners, examiners, funeral directors, or organ procurement organizations as allowed by law.
  • Public health and safety: Disclosures to public health authorities, oversight agencies, or to avert serious threats to health or safety.
  • Health oversight: For audits, investigations, inspections, and other oversight activities authorized by law.
  • Abuse or neglect: To report suspected child abuse, neglect, or domestic violence as required by law.
  • FDA-related purposes: To report adverse events, product issues, recalls, or to conduct required post-marketing surveillance.
  • Criminal activity and law enforcement: To prevent or lessen a serious and imminent threat, to aid identification or apprehension, or as otherwise permitted by law.
  • Required by law: When law mandates disclosure, including to the U.S. Department of Health and Human Services for compliance.
  • Process and proceedings: In response to court or administrative orders, subpoenas, discovery requests, or other lawful processes.
  • Law enforcement: Limited information about suspects, fugitives, material witnesses, crime victims, missing persons, inmates, or persons in lawful custody, as permitted by law.
  • Workers’ compensation and similar laws: As authorized for benefits or coverage determinations.

Patient rights

  • Access: Request to look at or get copies of your PHI, with limited exceptions. Requests must be in writing. Reasonable fees may apply for copies, summaries, or mailing.
  • Accounting of disclosures: Request a list of certain disclosures made after April 14, 2003 (up to six years after April 14, 2009). Fees may apply for multiple requests within 12 months.
  • Restriction requests: Request additional restrictions on use or disclosure. We are not required to agree, but if we do, we will honor the restriction unless needed in an emergency. Any agreement must be in writing.
  • Confidential communications: Request that we communicate with you by alternative means or at alternative locations. We will accommodate reasonable requests that still allow billing and payment.
  • Amendment: Request corrections to your PHI in writing with reasons. We may deny requests in certain cases (e.g., we did not create the information). If denied, you may submit a statement of disagreement to be included with the record.
  • Electronic notice: If you receive this notice electronically, you may request a paper copy at any time.

Questions and complaints

If you want more information about our privacy practices or believe your privacy rights have been violated, contact us using the information below. You may also submit a complaint to the U.S. Department of Health and Human Services. We will provide the address upon request. We will not retaliate against you for filing a complaint.

Contact: Otto Qahwash, DDS
Telephone: (815) 741-9697
Address: 850 Brook Forest Ave, Shorewood, IL 60404