HIPAA Privacy Notice
Notice of Privacy Practice
This notice describes how medical information about your child may be used and disclosed and how you can get access to this information. Please review it carefully.
The Smiles for Students Dental Program is required by law to maintain the privacy of the participants’ health information and to provide you with this Notice of the Smiles for Students Program’s legal duties and privacy practices with respect to your child’s protected health information (PHI). The Smiles for Students Program is required to abide by the terms of the notice currently in effect.
How we may use and disclose your child’s PHI
For Treatment. The Smiles for Students Program may use your protected health information (PHI) to coordinate care with other health professionals.
The Smiles for Students staff may notify school personnel of the need for additional dental care services, or may need to contact your child’s physician related to medical issues (e.g., heart murmur or organ transplant) prior to providing dental treatment. The school nurse may be able to refer you to appropriate sources for needed dental care.
For Payment. We may include your child’s PHI to collect payment from Medicaid or a Medicaid managed care plan (MCP) for dental treatment your child receives through the Smiles for Students program.
Health Care Operations. We may use or disclose PHI in order to facilitate the general administration of the program. For example, your child’s health information may be used to evaluate staff performance or it may be combined with that of others to evaluate how to more effectively serve all the program recipients.
Business Associates. We may share your child’s PHI with third-party “business associates” who perform activities for us (e.g., billing). Whenever an arrangement with a business associate involves the use or disclosure of PHI, we will have a written contract that contains terms that will protect the privacy of this PHI.
Other uses and disclosures
As Required by Law. The Smiles for Students Program will disclose your child’s PHI when required to do so by any federal, state or local law.
Public Health and Communicable Disease. We may disclose your child’s PHI for public health reasons, activities and purposes in order to prevent or control disease, injury or disability or to report reactions to products regulated by the Food and Drug Administration, or to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading disease.
To Report Abuse, Neglect or Domestic Violence. The Smiles for Students dental professionals are required by law to notify government authorities if they believe a patient is the victim of abuse, neglect or domestic violence.
Legal Proceedings and Law Enforcement. We may disclose PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process. The Smiles for Students Program may disclose your child’s PHI to law enforcement officials for certain law enforcement purposes such as locating a missing person or under certain limited circumstances, when your child is the victim of a crime.
Research, Health and Safety, and Certain Specialized Government Functions. Although it is highly unlikely your child’s PHI will be needed for these purposes, the Smiles for Students Program may in certain circumstances share PHI with coroners or funeral directors; for research purposes; or to avert a serious threat to the health and safety of an individual or the public. PHI may be shared for specialized government functions such as disclosures related to military personnel and veterans; national security and intelligence gathering; medical suitability determinations; correctional institutions and other law enforcement custodial situations; government programs providing public benefits; and disclosures related to Workers’ Compensation.
Required Uses and Disclosure. Under the law, we must make disclosures to you, with certain exceptions, and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the law.
Authorized Uses and Disclosures. Additional uses and disclosure may be made if you have given written authorization, which may be revoked at any time in writing delivered to the site compliance contact, except to the extent the Smiles for Students Program acted in reliance on the authorization.
Your rights
Restrictions. You have the right to request restriction on the use and disclosure of your child’s PHI; however, the Smiles for Students Program will be bound by the restrictions only if you are notified in writing that the Smiles for Students Program has agreed to the requested restriction.
Confidentiality. You have the right to have the Smiles for Students Program use only confidential means of communicating with you about your child’s PHI. This means you may have information mailed to your home instead of sent home with your child.
Access. You have the right to see and receive a copy of the PHI kept about your child by the Smiles for Students Program under most circumstances.
Amendment. You have the right to have the Smiles for Students Program amend its records of PHI about your child. The program may refuse to amend information that is accurate, that was created by someone else or is not disclosable to you.
Accounting. You have the right to see a list of disclosures of PHI about your child, which includes the purposes and recipients of the information.
Copy. You have the right to receive a paper copy of this notice. Privacy Notice. The Smiles for Students Dental Program is required by law to keep PHI about your child private and to give you this notice; however, the Smiles for Students Program reserves the right to amend this notice and make such change applicable to all health information maintained without prior notice. A revised notice will be provided to schools included in the Smiles for Students Program. Complaints. You may complain to the Smiles for Students Dental Program if you believe your child’s privacy rights have been violated, by giving a written complaint to the Smiles for Students Program’s compliance contact, Garfield County Public Health at 2014 Blake Ave, Glenwood Springs, CO 81601. You may also complain to the Secretary of the Office for Civil Rights, U.S. Department of Health & Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601; (312) 886-2359;(312) 353-5693 (TDD); (312) 886-1807 FAX. You will not be retaliated against in any way for filing a complaint.
Effective Date. This notice is effective from (1/1/2016) until revised by the Smiles for Students Dental Program.
You may be asked to sign an acknowledgment that you received this Notice of Privacy Practices.