Privacy Policy

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION OUT YOU MAYBE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

We are required by applicable federal state law to maintain the privacy of your health information. We are alsorequired to give you this Notice about our privacy practices, our legal duties, and your rights concerning yourhealth information. We must follow the privacy practices that are described in this Notice while its in effect ThisNotice takes effect (07/01/09). and will remain in effect until we replace it. We reserve the right to change ourprivacy practices and the terms of this Notice at any time, provided such changes are permitted by applicablelaw. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effectivefor all health information that we maintain, including health information we created or received before we madethe changes. Before we make a significant change in our privacy practices, we will change this Notice and makenew Notice available upon request. You may request a copy of our Notice at any time. For more informationabout our privacy practices, or for additional copies of this Notice. please contact us using the information listedat the end of this Notice.

USES AND DISCLOSURES 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 a physician or other healthcare providerproviding treatment to you.

Payment:We may use and disclose your health information to obtain a payment for services we provide toyou.

Healthcare Operations: We may use and disclose your health information in connection with our healthcareoperations. Healthcare operations include quality assessment and improvement activities, renewing thecompetence or qualifications of healthcare professionals, evaluating practitioner and provider performance,conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization: In addition to our use of your health information for treatment, payment, or healthcareoperations, you many give us written authorization to use your health information or to disclose it toanyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Yourrevocation will not affect any use or disclosures permitted by your authorization while it was in effectUnless you give us a written authorization, we cannot use or disclose your health information for anyreason except

To Your Family and Friends: We must disclose your health information to you, as described in the PatientRights section of this Notice. We may disclose your health information to a family member, friend, or another 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 notificationof (including identifying or locating) a family member, your personal representative, or another personresponsible for your care, of your location, your general condition, or death. If you are present, then prior touse or disclosure of your health information, we will provide you with an opportunity to object to such usesor disclosures. In the event of your incapacity or emergency circumstances, we will disclose healthinformation based on a determination using our professional judgment disclosing only health informationthat is directly relevant to the person's involvement in your healthcare. We will also use our professionaljudgment and our experience with common practice to make reasonable inferences of your best interest inallowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of healthinformation.

Marketing Health-Related Services: We will not use your health information for marketing communicationswithout 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 reasonablybelieve that you are a possible victim of abuse, neglect, or domestic violence, or the possible victim ofother crimes. We may disclose your health information to the extent necessary to avert a serious threat toyour health or safety, and/ or the health or safety of others.

National Security: We may disclose to military authorities the health information of Armed Forces personnelunder certain circumstances. We may disclose to authorized federal officials health information required forlawful intelligence, counterintelligence, and other national security activities. We may disclose tocorrectional institution or law enforcement official having lawful custody of protected health information ofinmate or patient under certain circumstances.

Appointment Reminders: We may use or disclose your health information to provide you with appointmentreminders (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. Youmay request that we provide copies in a format other than photocopies. We will use the format you requestunless we cannot practicably do so. (You must make a request in writing to obtain access to your healthinformation. You may obtain a form to request access by using the contact information listed at the end ofthis 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 requestcopies, we will charge you a reasonable cost-based fee that may include labor, copy and cost, andpostage. If you request an alternative format, we will charge a cost-based fee for providing your healthinformation in that format. If you prefer, we will prepare a summary or an explanation of your healthinformation for a fee. Contact us using the information listed at the end of this Notice for a full explanationof our fee structure.)

Disclosure Accounting: You have the right to receive a list of instances in which we or our businessassociates disclosed your health information for purposes, other than treatment, payment, healthcareoperations and certain other activities, for the last 6 years, but not before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee forresponding to these additional requests.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure ofyour health information. We are not required to agree to these additional restrictions, but if we do, we willabide by our agreement (except in an emergency).

Alternative Communication: You have the right to request that we communicate with you about your healthinformation by alternative means or to alternative locations. {You must make your request in writing.} Yourrequest must specify the alternative means or location, and provide satisfactory explanation how paymentswill 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 bein writing, and it must explain why the information should be amended.) We may deny your request undercertain circumstances.

Electronic Notice: If you receive this Notice on our Web site or by electronic mail (e-mail), you are entitledto receive this Notice in written form.

No mobile opt-in message consent will be shared with third parties or affiliates for marketing purposes.

QUESTIONS AND COMPLAINTS If you want more information about our privacy practices or have questions orconcerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagreewith a decision we made about access to your health information or in response to a request you made to amendor restrict the use or disclosure of your health information or to have us communicate with you by alternativemeans or at alternative locations. you may complain to us using the contact information listed at the end of thisNotice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We willprovide you with the address to file your complaint with the U.S. Department of Health and Human Services uponrequest We support your right to the privacy of your health information. We will not retaliate in any way if youchoose to file a complaint with us or with the U.S. Department of Health and Human Services. Contact ManagerTelephone: 914-396-0366 Email: cotingkehdental@gmail.com Address: 30 Central Park South #11D New York,NY 10019 @2002, 2009 American Dental Association. All Rights Reserved Reproduction and use of this form bydentists and their staff is permitted. Any other use, duplication or distribution of this form by any other partyrequires the prior written approval of the American Dental Association. (August 14. 2002; April 30. 2009).