Notice of Privacy
Arctic Oral Surgery
Effective Date: March 1, 2018
THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are committed to protecting the privacy of your medical and dental information. We are required by law to maintain the confidentiality of information that identifies you and the care you receive. This Notice describes your rights and our legal duties regarding your Protected Health Information (“PHI”). “Protected Health Information” means any information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this Notice, we call that protected information, “Medical and dental information”. If you have any questions about this notice, please contact the HIPAA Officer for Arctic Oral Surgery.
How Arctic Oral Surgery may use or disclose your medical and dental information
THE INFORMATION AUTHORIZED FOR RELEASE MAY INCLUDE RECORDS WHICH MAY INDICATE THE PRESENCE OF A COMMUNICABLE OR NON-COMMUNICABLE DISEASE.
YOUR MEDICAL AND DENTAL INFORMATION RIGHTS
You have the right:
Changes to this Notice:
We reserve the right to change or amend this Notice of Privacy Practices at any time in the future. After an amendment is made, the revised Notice of Privacy Practices will apply to all protected health information that we maintain. A copy of any revised Notice of Privacy Practices will be made available to you at each appointment.
Complaints about this Notice of Privacy Practices:
To file a complaint on how Arctic Oral Surgery handles your medical and dental information should be directed to the attention of our Privacy Officer at Arctic Oral Surgery. There will be no retaliation for filing a complaint. You may also submit a complaint to the Secretary of The Department of Health and Human Services. You will not be penalized for filing a complaint.
Arctic Oral Surgery complies with applicable Federal civil rights laws and does not discriminate on the basis race, color, national origin, age, disability or sex.
Arctic Oral Surgery does not exclude people or treat them differently because of race, color, national origin, age disability or sex.
Arctic Oral Surgery:
Provides free aid and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (large print, audio, accessible electronic formats)
Provides free language services to people whose primary language is not English, such as:
Information written in other languages
If you need these services, contact Kari Jenski (Office Manager)
If you believe that Arctic Oral Surgery has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with the U.S. Department of Health and Human Services, Office of Civil Rights, electronically through the Office of Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Proudly Serving Eagle River AK area and the surrounding communities includingAnchorage, Wasilla, Palmer, Homer, Seward, Kenai, Houston, Willow, Delta AK