Privacy Policy
Donald G. Hooie DDS – Family Dentistry
Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
- Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. - Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, 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 (for example, home or office phone) or send mail to a different address.
• We will say “yes” to all reasonable requests. - Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide a paper copy promptly. - Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations.
• We are not required to agree, and we may say “no” if it would affect your care.
• If you pay for a service or health item out-of-pocket in full, you can ask us not to share that information with your insurer. We will say “yes” unless required by law. - Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years before the date you ask, who we shared it with, and why.
• We’ll include all disclosures except those about treatment, payment, and healthcare operations, and certain others. One free accounting per year; we may charge a fee for additional requests. - Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can make choices about your health information.
• We will verify their authority before taking action. - File a complaint if you feel your rights are violated
• Contact us: Donald G. Hooie DDS – Family Dentistry, 788 S. Main Street, Crossville, TN 38555, 931-456-1950.
• Or file with the U.S. Department of Health and Human Services at www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference in the situations below, let us know:
- Share information with your family, friends, or others involved in your care
- Share in a disaster relief situation
- Include your info in a hospital directory (if applicable)
- Contact you for fundraising efforts (you can opt out)
If you are unable to tell us your preference (e.g., unconscious), we may share information if we believe it is in your best interest or necessary to prevent a serious threat to health or safety.
We never share your information unless you give written permission for:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
Our Uses and Disclosures
How do we typically use or share your health information?
- Treat you: Share your information with other professionals treating you.
Example: A doctor treating you for an injury asks another about your condition. - Run our organization: Use and share your info to manage operations and improve care.
Example: We use your info to coordinate your treatment and services. - Bill for your services: Share your information with insurers for payment.
Example: We give your insurer info so they’ll pay for your services.
Other ways we may use or share your info (with conditions):
- Public health and safety (disease prevention, product recalls, abuse/neglect reporting, etc.)
- Health oversight (audits, investigations, inspections)
- Legal and law enforcement requests
- Research (under certain conditions)
- Organ and tissue donation
- Medical examiner or funeral director needs
- Workers’ compensation
- National security and presidential protective services
- Court orders, subpoenas, or legal actions
Other Permitted Disclosures
- Students: We may share PHI with students for educational purposes. Let your provider know if you prefer not to have student involvement.
- Appointment Reminders:
• We may contact you by phone, text, or postcard.
• You can provide your preferred contact method.
• Only minimal info is left on voicemail or shared with others.
• Appointment reminders are considered part of treatment.
Contact Information
Shalena Hooie
Donald G. Hooie DDS – Family Dentistry
788 S. Main Street, Crossville, TN 38555
info@hooie-dental.com
931-456-1950
Our Responsibilities
- We are required by law to protect your health information.
- We will notify you promptly if a breach compromises your data.
- We must follow the practices in this notice and provide you a copy.
- We will not use/share your info beyond what’s listed without your written permission. You can revoke this anytime in writing.
For more information, visit: https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to This Notice
We may change the terms of this notice at any time, and changes will apply to all information we have. Updated versions will be posted in our office and on our website: www.hooie-dental.com
This notice is effective 2/14/2023 and remains in effect until replaced.
