Stephen H. Hook, DDS (as of 1/1/2010)

In this notice we address what medical and personal information may be used and disclosed by our office and how you may gain access to this information.  This information can be changed at any time subject to applicable law.  We are required to give you this notice and follow these privacy practices.  You may request a copy of this notice or any subsequent revision at any time. Should you have any questions about these policies please contact us at the phone number listed at the end of this notice.

Permitted Uses and Disclosures of Information

We will use your protected health information for the purpose of providing your treatment, obtaining payment for your treatment and normal health care operations.  Examples of times we may need to use or disclose your information include but are not limited to:

Coordination or managing your care between other professionals such as being certain that all relevant medical information is available to all treating parties.

Making relevant information available to any home health agency that might be providing care for you or your family.

We would need to disclose pertinent billing information to your insurer to obtain payment for your covered health care services. This would include making information available to your insurer for their determination of eligibility and benefits prior to commencement of treatment.

We need to make your records available for certain business and operational activities such as quality assessment and employee reviews, licensing and other business activities.

We will use third party business associate partners to electronically convey claims information to your insurer.  In cases involving third parties, written contracts guaranteeing your privacy will be in place.

We may use your personal information to send you information about advances in dental research and treatment alternatives or financing opportunities.  We may also may send you information concerning appointment times and intervals.

We are required to release relevant information to law enforcement agencies if we believe it is necessary to prevent or mitigate any threat to the health or safety of a person or the public or in an attempt to identify a victim or a person of interest in any criminal matter.

We would be required to comply with any legal subpoena requiring the production of any documents for any civil or criminal proceedings as directed by a court.

There are a number of other specific situations where we would use and disclose your personal medical information that are similar to those enumerated above.  All would fall into the categories of compliance with legal compliance with authorities, cooperating with your insurance carrier’s requirements, insuring proper, safe and timely coordination of treatment and communicating with you about our dental practice.  If you have any specific concerns please call or write us and we will discuss them with you.

Your Rights

You have the right to request that we restrict our use and disclosure of your information and we have a right to decline your request.

You may request reasonable alternative methods and locations of communications of your personal information.

With some exceptions, you have a right to inspect and even copy your personal protected health information subject to copying charges.  These exceptions would include:

Psychotherapy notes compiled by a mental health professional

Information compiled in reasonable anticipation of a criminal or administrative action

Protected health information (lab tests) when required by law

Information compiled as part of a long term research project still in progress

Other exceptions would stem from the determination of another licensed health care professional’s determination that the release of such information would be harmful to you.  In such a case, you have the right to have our denial reviewed by independent authority.

You have the right to request a correction to your protected health information and we have a right to deny your request if:

The error is not part of your medical or billing records

If we were not responsible for or the originator of the error

You have the right to a complete billing record reflecting the complete charges forwarded to your insurance carrier for all procedures.

Complaints

If you believe your rights have been violated please contact our office in writing at:

Stephen H. Hook, DDS, Privacy Compliance Officer

Westchester Medical Plaza

8540 S. Sepulveda Blvd, Suite 1108

Los Angeles CA 90045

Or by telephone at :  310 836-0101