Oxford Family Dentistry
Notice of Privacy Practices
for Drs. Colleen Oleynik & Jonathan Batlle
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
OUR LEGAL DUTY
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
OUR LEGAL DUTY
We are committed to protecting the privacy of your health information. As required by applicable federal and state law, we maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect.
This Notice takes effect on January 1st 2025, and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We may make these changes effective for all health information that we maintain, including health information we created or received before the changes. If we make any significant changes to our privacy practices, we will update this Notice and make the new version available upon request.
You may request a copy of this Notice at any time. For more information about our privacy practices or to request additional copies of this Notice, please contact us using the information provided at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We may use and disclose health information about you for the following purposes:
1. Treatment: We may use or disclose your health information to a physician or other healthcare provider who is involved in your treatment. For example, we may share information with a specialist or refer you for further care.
2. Payment: We may use or disclose your health information to obtain payment for the services we provide to you. For example, we may share your information with your insurance provider to verify coverage or process claims.
3. Healthcare Operations: We may use or disclose your health information to carry out our healthcare operations. Healthcare operations include activities such as quality assessment and improvement, reviewing healthcare providers’ competence, evaluating performance, and conducting training programs.
4. Your Authorization: In addition to the uses and disclosures described above, you may provide written authorization to use or disclose your health information for any purpose. You may revoke your authorization at any time, but this will not affect any uses or disclosures that occurred before the revocation. Without your written authorization, we will not use or disclose your health information for any purpose except those described in this Notice.
5. To Your Family and Friends: We may disclose your health information to a family member, friend, or other person involved in your healthcare or payment for healthcare, but only if you agree to this disclosure. You have the right to limit the information we share, and we will respect your preferences.
6. Persons Involved in Your Care: We may use or disclose health information to notify a family member, personal representative, or another person responsible for your care about your location, condition, or death. If you are present, we will give you the opportunity to object before making this disclosure. In emergency situations, we will use our professional judgment to share only the information necessary.
7. Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization. However, we may contact you with information about your treatment or health-related services without your authorization.
8. Required by Law: We may disclose your health information when required to do so by law.
ADDITIONAL DISCLOSURES
1. Abuse or Neglect: We may disclose your health information to appropriate authorities if we believe you are a possible victim of abuse, neglect, or other crimes. We may also disclose information to help prevent or respond to a serious threat to health or safety.
2. National Security: We may disclose health information to military authorities or authorized federal officials for lawful intelligence, counterintelligence, or national security activities. We may also disclose information if required by law for correctional or law enforcement purposes.
3. Appointment Reminders: We may use or disclose your health information to send appointment reminders by phone, voicemail, text or postcards.
PATIENT RIGHTS
You have the following rights regarding your health information:
1. Access: You have the right to review or obtain copies of your health information, with certain exceptions. You may request that we provide your information in an alternative format, and we will accommodate your request if possible. To obtain copies, please submit a written request. A reasonable fee may apply for copying, staff time, and postage.
2. Disclosure Accounting: You have the right to receive a list of disclosures we have made of your health information, except for disclosures for treatment, payment, healthcare operations, and certain other activities. You may request this list for up to the last 6 years.
3. Restriction: You have the right to request additional restrictions on the use or disclosure of your health information. We are not required to agree to these requests, but if we do, we will abide by the agreement (except in an emergency).
4. Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. Please make your request in writing, specifying the alternative method and providing an explanation of how payment will be handled.
5. Amendment: You have the right to request that we amend your health information if you believe it is incorrect or incomplete. Your request must be in writing and explain why the information should be amended. We may deny your request under certain circumstances.
6. Electronic Notice: If you receive this Notice electronically, you are entitled to receive it in written form upon request.
HOW TO FILE A COMPLAINT
If you believe that we have violated your privacy rights, or if you disagree with a decision we made regarding your health information, you may file a complaint with us using the contact information below. You also have the right to file a complaint with the U.S. Department of Health and Human Services (HHS). We will not retaliate against you for filing a complaint.
If you would like more information about our privacy practices or have concerns, please contact us using the information listed below.
CONTACT INFORMATION
Oxford Family Dentistry
Drs. Colleen Oleynik & Jonathan Batlle
252 Main Street, Oxford, MA 01540
Phone: 508-987-8114