Notice of Privacy Practices

Who This Notice Covers

This notice applies to Clinton Braces, Inc., including our Clinton Braces office (6306 Kirby Road, Suite 201, Clinton, MD 20735) and our Anacostia Braces office (1345 Marion Barry Ave SE, Washington, DC 20020), and to the doctors, staff, and contractors who work with us.

Our Privacy and Security Officer

Julian Park, Privacy and Security Officer, is responsible for this notice, for our HIPAA privacy and security program, and for responding to privacy questions, requests, complaints, and security concerns.

• Email: info@clintonbracesmd.com (subject: "Attn: Privacy Officer")
• Phone: (301) 868-1331 (ask for the Privacy Officer)
• Fax: (301) 868-5003
• Mail: Privacy Officer, Clinton Braces, Inc., 6306 Kirby Road, Suite 201, Clinton, MD 20735

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by letting us know in writing.

How We Typically Use and Share Your Information

Treatment. We use your information to provide orthodontic care and share it with other professionals treating you, such as your general dentist, oral surgeon, or a dental laboratory.

Payment. We use and share your information to bill and get paid by your dental or medical plan, Medicaid, or other payers, including to request pre-authorization for treatment.

Health care operations. We use your information to run our practice, improve your care, train staff, and contact you when necessary. This includes appointment reminders and other messages by phone, text message, or email at the contact information you give us.

Business associates. We share information with companies that perform services for us, such as billing, payment processing, scheduling, communication, data storage, and technology services. They must protect your information under a written agreement with us.

Other Ways We May Use or Share Your Information

We are allowed or required to share your information in other ways, usually to contribute to the public good. We have to meet many conditions in the law before we can share your information for these purposes.

• Public health and safety, such as reporting suspected abuse or neglect or preventing a serious threat to health or safety.
• Health oversight activities, such as audits, inspections, and licensing.
• Complying with the law, including when federal or state agencies, such as the Department of Health and Human Services, ask for it.
• Responding to lawsuits, court or administrative orders, and subpoenas.
• Law enforcement purposes, workers' compensation claims, and specialized government functions.
• Research, under conditions the law requires.
• Medical examiners, coroners, and funeral directors, and organ and tissue donation requests.

Your Choices

You can tell us your choices about what we share in these situations: sharing with family, close friends, or others involved in your care or payment for your care, and sharing in a disaster relief situation. If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest.

We never share your information for marketing purposes or sell your information unless you give us written permission.

Your Rights

• Get a copy of your records. You can ask to see or get an electronic or paper copy of your dental and health records. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• Ask us to correct your records. You can ask us to correct information you think is incorrect or incomplete. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way, such as a different phone number or address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain information for treatment, payment, or our operations. We are not required to agree. If you pay for a service in full out of pocket, you can ask us not to share that information with your health plan, and we will say yes unless a law requires us to share it.
• Get a list of those with whom we have shared information. You can ask for a list (accounting) of the times we have shared your information for six years prior to the date you ask, who we shared it with, and why. This does not include disclosures for treatment, payment, health care operations, or those you asked us to make. We provide one list a year for free.
• Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. Parents and guardians generally act for patients who are minors.

To make any of these requests, contact our Privacy and Security Officer using the information above.

File a Complaint

If you believe your privacy rights have been violated, you can file a complaint with our Privacy and Security Officer using the information above.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mail at 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or online at www.hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint.

Reporting a Security Concern

If you believe information held by Clinton Braces has been exposed, or you have found a security issue affecting our systems, website, or patient communications, please email our Privacy and Security Officer at info@clintonbracesmd.com. Please do not include your own health information in the report.

Changes to This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our offices, and on this website.