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relationship is established by your use of this site. No
diagnosis or treatment is being provided. The information
contained here should be used in consultation with a dentist of
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of the information contained within the web site. This web site
is not intended to offer specific medical or dental advice to
anyone. Joe Pierce, D.D.S., is licensed to practice in the
state of Texas and this web site is not intended to
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Joe Pierce, D.D.S. take no responsibility for web sites
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HEALTH INFORMATION PRIVACY
POLICIES & PROCEDURES
These Health Information Privacy Policies &
Procedures implement our obligations to protect the privacy of
individually identifiable health information that we create,
receive, or maintain as a healthcare provider.
We implement these Health Information Privacy
Policies and Procedures as a matter of sound business practice;
to protect the interests of our patients; and to fulfill our
legal obligations under the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA"), its implementing
regulations at 45 CFR Parts 160 and 164 (65 Fed. Reg 82462 (Dec.
28, 2000)) ("Privacy Rules"), as amended (67 Fed. Reg. 53182
[Aug. 14, 2002]), and state law that provides greater protection
or rights to patients than the Privacy Rules.
As a member of our workforce or as our
Business Associate, you are obligated to follow these Health
Information Privacy Policies & Procedures faithfully. Failure to
do so can result in disciplinary action, including termination
of your employment or affiliation with us.
These Policies & Procedures address the
basics of HIPAA and the Privacy Rules that apply in our dental
practice. They do not attempt to cover everything in the Privacy
Rules. The Policies & Procedures sometimes refer to forms we use
to help implement the policies and to the Privacy Rules
themselves when added detail may be needed.
Please note that while the Privacy Rules
speak in terms of "individual" rights and actions, these
Policies & Procedures use the more familiar word "patient"
instead; "patient" should be read broadly to include prospective
patients, patients of record, former patients, their authorized
representatives, and any other "individuals" contemplated in the
If you have questions or doubts about any use
or disclosure of individually identifiable health information or
about your other obligations under these Health Information
Privacy Policies & Procedures, the Privacy Rules or other
federal or state law, please contact our office. This policy was
adopted effective 4/14/03
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1. General Rule: No Use or Disclosure
Our dental office must not use or disclose
protected health information (PHI), except as these Privacy
Policies & Procedures permit or require.
2. Acknowledgement and Optional Consent
Our dental office will make a good faith
effort to obtain a written acknowledgement of receipt of our
Notice of Privacy Practices (see Section 9) from a patient
before we use or disclose his or her protected health
information (PHI) for treatment, to obtain payment for that
treatment, or for our healthcare operations (TPO).
Our dental office’s use or disclosure of PHI
for our payment activities and healthcare operations may be
subject to the minimum necessary requirements (see Section 7).
Our dental office will become familiar with
our state’s privacy laws. If required by our state law, or as
directed by the dentist, we will also seek Consent from a
patient before we use or disclose PHI for TPO purposes – in
addition to obtaining an Acknowledgement of receipt of our
Notice of Privacy Practices.
a) Obtaining Consent
– If consent is to be obtained, upon the
individual’s first visit as a patient (or next visit if
already a patient), our dental office will request and obtain
the patient’s written Consent for our use and
disclosure of the patient’s PHI for treatment, payment, and
Any consent we obtain must be on our
Consent form, which we may not alter in any way. Our
dental office will include the signed Consent form in
the patient’s chart.
Exceptions – Our dental office does not have to obtain the
patient’s Consent in emergency treatment situations; when
treatment is required by law; or when communications barriers
Consent Revocation – A patient from whom we obtain consent
may revoke it at any time by written notice. Our dental office
will include the revocation in the patient’s chart. There is
space at the bottom of our Consent form where the
patient can revoke the consent.
– Consent for use or disclosure of PHI should not be confused
with informed consent for dental treatment. This section applies
to our practice.
In some cases we must have proper, written
Authorization from the patient (or the patient’s personal
representative) before we use or disclose a patient’s PHI for
any purpose (except for TPO purposes) or as permitted or
required without consent or authorization (see Sections 3, 4, or
Our dental office will use the
Authorization form. We will always act in strict accordance
with an Authorization.
Authorization Revocation – A patient may revoke an
authorization at any time by written notice. Our dental office
will not rely on an Authorization we know has been
Authorization from Another Provider – Our dental office will
use or disclose PHI as permitted by a valid Authorization
we receive from another healthcare provider.
Our dental office may rely on that covered
entity to have requested only the minimum necessary protected
PHI. Therefore, our dental office will not make our own "minimum
necessary" determination, unless we know that the
Authorization is incomplete, contains false information, has
been revoked, or has expired.
Authorization Expiration – Our dental office will not rely
on an Authorization we know has expired.
4. Oral Agreement
Our dental office may use or disclose a
patient’s PHI with the patient’s Oral Agreement or if the
patient is unavailable subject to all applicable requirements.
Our dental office may use professional
judgment and our experience with common practice to make
reasonable inferences of the patient’s best interest in allowing
a person to act on behalf of the patient to pick up
dental/medical supplies, X-rays, or other similar forms of PHI.
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5. Permitted Without Acknowledgement, Consent
Authorization or Oral Agreement
Our dental office may use or disclose a
patient’s PHI in certain situations, without Authorization
or Oral Agreement. In our dental office, these
disclosures are not likely to be frequent.
a) Verification of Identity
– Our dental office will always verify the identity of any
patient, and the identity and authority of any patient’s
personal representative, government or law enforcement official,
or other person, unknown to us, who requests PHI before we will
disclose the PHI to that person.
Our dental office will obtain appropriate
identification and, if the person is not the patient, evidence
of authority. Examples of appropriate identification include
photographic identification card, government identification card
or badge, and appropriate document on government letterhead. Our
dental office will document the incident and how we responded.
b) Uses or
Disclosures Permitted under this Section 5 – The situations
in which our dental office is permitted to use or disclose PHI
in accordance with the procedures set out in this Section 5 are
For public health activities;
To health oversight agencies;
To coroners, medical examiners, and funeral
To employers regarding work-related illness
To the military;
To federal officials for lawful
intelligence, counterintelligence, and national security
To correctional institutions regarding
In response to subpoenas and other lawful
To law enforcement officials;
To report abuse, neglect, or domestic
As required by law;
As part of research projects; and
As authorized by state worker’s
6. Required Disclosures
Our dental office will disclose protected
health information (PHI) to a patient (or to the patient’s
personal representative) to the extent that the patient has a
right of access to the PHI (see Section 10); and to the U.S.
Department of Health and Human Services (HHS) on request for
complaint investigation or compliance review.
Our dental office will use the disclosure log
to document each disclosure we make to HHS.
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7. Minimum Necessary
Our dental office will make reasonable
efforts to disclose, or request of another covered entity, only
the minimum necessary protected health information (PHI)
to accomplish the intended purpose.
There is no minimum necessary
requirement for disclosures to or requests by one another in our
dental office or by a healthcare provider for treatment;
permitted or required disclosures to, or for disclosure
requested and authorized by, a patient; disclosures to HHS for
compliance reviews or complaint investigations; disclosures
required by law; or uses or disclosures required for compliance
with the HIPAA Administrative Simplification Rules.
a) Routine or Recurring Requests or
Disclosures – Our dental office
will follow the policies and procedures that we adopt to limit
our routine or recurring requests for our disclosures of PHI to
the minimum reasonably necessary for the purpose.
b) Non-Routine or Non-Recurring Requests or
Disclosures – No non-routine or
non-recurring request for or disclosure of PHI will be made
until it has been reviewed on a patient-by-patient basis against
our criteria to ensure that only the minimum necessary PHI for
the purpose is requested or disclosed.
c) Other’s Requests
– Our dental office will rely, if reasonable for the situation,
on a request to disclose PHI being for the minimum necessary, if
the requester is: (a) a covered entity; (b) a professional
(including an attorney or accountant) who provides professional
services to our practice, either as a member of our workforce or
as our Business Associate, and who represents that the
requested information is the minimum necessary; (c) a public
official who represents that the information requested is the
minimum necessary; or (d) a researcher presenting appropriate
documentation or making appropriate representations that the
research satisfies the applicable requirements of the Privacy
d) Entire Record
– Our dental office will not use, disclose, or request an entire
record, except as permitted in these Policies & Procedures or
standard protocols that we adopt reflecting situations when it
e) Minimum Necessary Workforce Use
– Our dental office will use only the minimum necessary PHI
needed to perform our duties.
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8. Business Associates
Our dental office will obtain satisfactory
assurance in the form of a written contract that our Business
Associates will appropriately safeguard and limit their use
and disclosure of the protected health information (PHI) we
disclose to them.
These Business Associate requirements
are not applicable to our disclosures to a healthcare provider
for treatment purposes. The Business Associate Contract Terms
document contains the terms that federal law requires be
included in each Business Associate Contract.
a.) Breach by Business Associate
– If our dental office learns that a Business Associate
has materially breached or violated its Business Associate
Contract with us, we will take prompt, reasonable steps to
see that the breach or violation is cured.
If the Business Associate does not
promptly and effectively cure the breach or violation, we will
terminate our contract with the Business Associate, or if
contract termination is not feasible, report the Business
Associate’s breach or violation to the U.S. Department of
Health and Human Services (HHS).
9. Notice of Privacy Practices
Our dental office will maintain a Notice
of Privacy Practices as required by the Privacy Rules.
a) Our Notice –
Our dental office will use and disclose PHI only in conformance
with the contents of our Notice of Privacy Practices. We
will promptly revise a Notice of Privacy Practices
whenever there is a material change to our uses or disclosures
of PHI to legal duties, to the patients’ rights or to other
privacy practices that render the statements in that Notice no
Form 1, Notice of Privacy Practices, found in
this Privacy Kit, contains the terms that federal law requires.
b) Distribution of Our Notice
– Our dental office will provide our Notice of Privacy
Practices to any person who requests it, and to each patient
no later than the date of our first service delivery after April
Our dental office will have our Notice of
Privacy Practices available for patients to take with them.
We will also post our Notice of Privacy Practices in a
clear and prominent location where it is reasonable to expect
patients seeking services from us will be able to read the
c) Acknowledgement of Notice
– Our dental office will make a good faith effort to obtain from
the patient a written Acknowledgement of receipt of our
Notice of Privacy Practices.
Our dental office shall use Form 2,
Acknowledgement of Receipt of Notice of Privacy Practices,
found in this Privacy Kit, to obtain the Acknowledgement. If we
cannot obtain written Acknowledgement from the patient, we will
use the form to document our attempt and the reason why written
Acknowledgement was not signed by the patient.
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10. Patients’ Rights
Our dental office will honor the rights of
patients regarding their PHI.
a) Access –
With rare exceptions, our dental office must permit patients to
request access to the PHI we or our Business Associates
No PHI will be withheld from a patient
seeking access unless we confirm that the information may be
withheld according to the Privacy Rules. We may offer to provide
a summary of the information in the chart. The patient must
agree in advance to receive a summary and to any fee we will
charge for providing the summary. Our dental office will contact
our Business Associates to retrieve any PHI they may have
on the patient.
b) Amendment –
Patients have the right to request to amend their PHI and other
records for as long as our dental office maintains them.
Our dental office may deny a request to amend
PHI or records if: (a) we did not create the information (unless
the patient provides us a reasonable basis to believe that the
originator is not available to act on a request to amend); (b)
we believe the information is accurate and complete; or (c) we
do not have the information.
Our dental office will follow all procedures
required by the Privacy Rules for denial or approval of
amendment requests. We will not, however, physically alter or
delete existing notes in a patient’s chart. We will inform the
patient when we agree to make an amendment, and we will contact
our Business Associates to help assure that any PHI they
have on the patient is appropriately amended. We will contact
any individuals whom the patient requests we alert to any
amendment to the patient’s PHI. We will also contact any
individuals or entities of which we are aware that we have sent
erroneous or incomplete information and who may have acted on
the erroneous or incomplete information to the detriment of the
When we deny a request for an amendment, we
will mark any future disclosures of the contested information in
a way acknowledging the contest.
Accounting – Patients have the right to an accounting of
certain disclosures our dental office made of their PHI within
the 6 years prior to their request. Each disclosure we make,
that is not for treatment payment or healthcare operations, must
be documented showing the date of the disclosure, what was
disclosed, the purpose of the disclosure, and the name and (if
known) address of each person or entity to whom the disclosure
was made. The Authorization or other documentation must
be included in the patient’s record. We use the patient’s chart
to track each disclosure of PHI as needed to enable us to
fulfill our obligation to account for these disclosures.
We are not required to account for
disclosures we made: (a) before April 14, 2003; (b) to the
patient (or the patient’s personal representative); (c) to or
for notification of persons involved in a patient’s healthcare
or payment for healthcare; (d) for treatment, payment, or
healthcare operations; (e) for national security or intelligence
purposes; (f) to correctional institutions or law enforcement
officials regarding inmates; or (g) according to an
Authorization signed by the patient or the patient’s
representative; (h) incident to another permitted or required
We will temporarily suspend the accounting of
any disclosure when requested to do so pursuant according to the
Privacy Rules by health oversight agencies or law enforcement
officials. We may charge for any accounting that is more
frequent than every 12 months, provided the patient is informed
of the fee before the accounting is provided. We will contact
our Business Associates to assure we include in the
accounting any disclosures made by them for which we must
d) Restriction on Use or Disclosure
– Patients have the right to request our dental office to
restrict use or disclosure of their PHI, including for
treatment, payment, or healthcare operations. We have no
obligation to agree to the request, but if we do, we will comply
with our agreement (except in an appropriate dental/medical
We may terminate an agreement restricting use
or disclosure of PHI by a written notice of termination to the
patient. We will contact our Business Associates whenever
we agree to such a restriction to inform the Business
Associate of the restriction and its obligations to abide by
the restriction. We will document in the patient’s chart any
such agreed to restrictions.
e) Alternative Communications –
Patients have the right to request us to use alternative means
or alternative locations when communicating PHI to them. Our
dental office will accommodate a patient’s request for such
alternative communications if the request is reasonable and in
Our dental office will inform the patient of
our decision to accommodate or deny such a request. If we agree
to such a request, we will inform our Business Associates of the
agreement and provide them with the information necessary to
comply with the agreement.
– Our dental office will be aware of and respect these patients’
rights regarding their PHI, even though in most situations
patients are unlikely to exercise them.
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11. Staff Training and Management, Complaint
Procedures, Data Safeguards, Administrative Practices
a) Staff Training and Management
* Training –
Our dental office will train all members of our workforce in
these Privacy Policies & Procedures, as necessary and
appropriate for them to carry out their functions. We will
complete the privacy training of our existing workforce by April
After April 14, 2003, our dental office will
train each new staff member within a reasonable time after the
member starts. We will also retain each staff member whose
functions are affected either by a material change in our
Privacy Policies and Procedures or in the member’s job
functions, within a reasonable time after the change.
Form 7, Staff Review of Policies and
Procedures, can be used to have workforce members
acknowledge they have received and read a copy of these Policies
*Discipline and Mitigation
– Our dental office will develop, document, disseminate, and
implement appropriate discipline policies for staff members who
violate our Privacy Policies & Procedures, the Privacy Rules, or
other applicable federal or state privacy law.
Staff members who violate our Privacy
Policies & Procedures, the Privacy Rules or other applicable
federal or state privacy law will be subject to disciplinary
action, possibly up to and including termination of employment.
b) Complaints –
Our dental office will implement procedures for patients to
complain about our compliance with our Privacy Policies and
Procedures or the Privacy Rules. We will also implement
procedures to investigate and resolve such complaints.
The Complaint form can be used by the
patient to lodge the complaint. Each complaint received must be
referred to management immediately for investigation and
resolution. We will not retaliate against any patient or
workforce member who files a Complaint in good faith.
c) Data Safeguards
– Our dental office will "add to" and strengthen these Privacy
Policies & Procedures with such additional data security
policies and procedures as are needed to have reasonable and
appropriate administrative, technical, and physical safeguards
in place to ensure the integrity and confidentiality of the PHI
Our dental office will take reasonable steps
to limit incidental uses and disclosures of PHI made according
to an otherwise permitted or required use or disclosure.
d) Documentation and Record Retention
– Our dental office will maintain in written or electronic form
all documentation required by the Privacy Rules for six years
from the date of creation or when the document was last in
effect, whichever is greater.
e) Privacy Policies & Procedures
– Only Joe Pierce, D.D.S.
may change these Privacy Policies & Procedures.
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12. State Law Compliance
Our dental office will comply with the
privacy laws of each state that has jurisdiction over our
practice, or its actions involving protected health information
(PHI), that provide greater protections or rights to patients
than the Privacy Rules.
13. HHS Enforcement
Our dental office will give the U.S.
Department of Health and Human Services (HHS) access to our
facilities, books, records, accounts, and other information
sources (including individually identifiable health information
without patient authorization or notice) during normal business
hours (or at other times without notice if HHS presents
appropriate lawful administrative or judicial process).
We will cooperate with any compliance review
or complaint investigation by HHS, while preserving the rights
of our practice.
14. Designated Personnel
Our dental office will designate a Privacy
Officer and other responsible persons as required by the Privacy
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