1311 Jackson Ave Dental
Notice of Privacy Practices
- Long Island City, NY 11101.

This notice describes how medical information about you may be used and disclosed.

This notice describes the privacy practices of 1311 Jackson Ave Dental. "We" and "our" means the dental office 1311 Jackson Ave Dental. "You" and "your" means all of our patients.

The privacy of your health information is very important to us and we are committed to protecting it. This notice describes how we may use and disclose your protected health information so that we can carry out treatment, payment, and other health care operations that are permitted/required by law. Your protected health information includes demographic information that may identify you whether it be your past, present, or future state.

Requirements by law:

  • Maintain the privacy of your protected health information

  • Give you this notice of our legal duties and privacy practices

  • Uphold and abide by the terms of our notice

How we may use or disclose your protected health information.

These are some common uses:

  • Treatment - We use your health information so that we may provide you with dental treatment. We may also disclose your information to other healthcare professionals such as dental specialists and physicians, who may be involved in your care.

  • Payment - We use your health information to file claims on your behalf from your insurance companies in order to obtain payment.

  • Health care operations - We use your information for health care operations necessary to run our practice. Treatment, services, training, quality assurance, financial matters, legal matters, and business development.

  • Appointment reminders - We may contact you by using mail, phone calls, text messages, and emails.

  • Treatment alternatives and health related benefits and services - We may use your information to tell you about treatment options and alternative treatment options which may be of interest to you.

  • Disclosure to certain family members and friends - We may disclose your information to any person that is involved in your care or payment. You may choose to opt out.

  • Disclosure to Business associates - We may disclose your information to third-party service providers such as "Business associates" who function on behalf of our office. All of our business associates are under contract to not disclose your information outside of the scope of our relationship.

These are some less common uses:

  • Disclosures required by Law - We are required to disclose your information to the US Department of health and human services so that it can investigate complaints or determine our compliance with HIPAA.

  • Public Health Activities - Information may be disclosed for public health purposes such as: controlling disease, injury, disability, reporting births/deaths, child abuse, child neglect, adverse reactions to medications, adverse reactions to foods, product defects, product recalls, and etc.

  • Victims of Abuse, Neglect, or Domestic Violence - We are obligated to disclose information to the appropriate government authority about any patient whom we may believe is a victim.

  • Health Oversight Activities - We may disclose information to government associated health oversight agencies for the health care system, benefit programs, and civil rights laws.

  • Lawsuits and Legal Actions - Information may be disclosed in response to a court/administrative order or subpoena, discovery request, or other lawful processes.

  • Law Enforcement Purposes - Information may be disclosed to law enforcement officials for law enforcement purposes such as for identifying persons of interest.

  • Coroners, Medical Examiners, and Funeral Directors - We may disclose information in order for the above to carry out their duty.

  • Organ, Eye, and Tissue Donations - We may disclose your information for organ procurement organizations or others that obtain them.

  • Research Purposes - We may disclose information for research purposes pursuant to patient authorization waiver approval by an Institutional Review board or Privacy Board.

  • Serious Threat to health/Safety - We may disclose your health information if we believe it is necessary to minimize harm to others.

  • Specialized Government Functions - We may disclose your protected health information to the military about its members for national security and protective services for the President and other heads of state, to the government for security clearance reviews. We may also disclose to prisons about inmates.

  • Workers Compensation - Your information may be disclosed to comply with worker's compensation laws that provide benefits for work related injuries or illnesses.

  • Your Written Authorization for any other uses or disclosures - Other uses and disclosures will only be made with your written authorization. This authorization may be revoked at any time with written consent.

Your Rights with Respect to Your Health Information

  • To exercise any of these rights, simply submit a written request.

    • Right to Access and Review - You may request access to a copy of your health information. Although your request may be denied under certain circumstances and if it is you will receive a notice. Otherwise, your health information is stored electronically and you may direct us to send it to your destination of choice. We may charge a convenience fee if it is in a form other than electronic.

    • Right to Amend - You may request to have your information amended if you believe it to be erroneous.

    • Right to Restrict Use - You may request our office to restrict the disclosure of your protected health information to any individual. For example if you pay out of pocket in full for a service and you request us to not submit the claim to your insurance on your behalf.

    • Right to Confidential Communications, Alternative Means and Locations - You may request to receive communication about your health information via alternative means of your choice.

    • Right to an Accounting of Discolosures - You have the right to receive an accounting of disclosures of your health information for up to six years prior to the date of accounting disclosure request.

    • Right to a Paper Copy of this Notice - You may request us to print a paper copy of this notice or you may do so yourself.

    • Right to Receive Notification of a Security Breach - We are required by law to notify you if the privacy or security of your health information has been breached. The notification will be sent out via first class mail USPS within 60 days of occurrence. The breach notification will contain a brief description of what happened, the date it occurred, the steps you should take, and the steps we will take to mitigate the effects.

Special Protections for HIV, Alcohol, and Substance Abuse, Mental Health and Genetic Information - Some parts of this HIPAA notice of privacy practices may not apply to some of these types of information due to certain federal and state laws.

Our Right to Change Our Privacy Practices and This Notice

We reserve the right to change the terms of this Notice at any time. It will be posted here and updated as needed.

How to Make Privacy Complaints

If you have any complaints about your privacy rights and the use of your protected health information, you may file a complaint with us. You may also file a written complaint with the secretary of the US department of health and human services, office for civil rights. We will not retaliate against you in any way if you choose to do so.

If you have any further questions please contact our office at:

1311 Jackson Ave Dental

1311 Jackson Ave

Long Island City, NY 11101