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.
Tennessee Centers for Laser Dentistry ("TNCLD," "we," "our," or "us") is required by federal law to protect the privacy of your protected health information (PHI). PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health, dental health, the provision of healthcare to you, or the payment for that care.
This Notice of Privacy Practices describes:
- How we may use and disclose your PHI
- Your rights regarding your PHI
- Our legal duties with respect to your PHI
- How to contact us for further information or to file a complaint
We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, to:
- Maintain the privacy of your PHI
- Provide you with this notice of our legal duties and privacy practices with respect to your PHI
- Notify you following a breach of your unsecured PHI
- Abide by the terms of the notice currently in effect
We may use and disclose your PHI for the following purposes without your written authorization:
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your dental care and any related services. This includes communicating with other healthcare providers about your treatment. Example: A dentist treating you for a periodontal condition may need to know if you have diabetes, because diabetes may impact the healing process. We may also share your PHI with another provider, such as your primary care physician or oral surgeon, when we refer you for treatment.
Payment
We may use and disclose your PHI so that we can bill and collect payment for the services and items you may receive from us. Example: We may contact your insurance company to verify coverage for a particular procedure, or to obtain prior authorization. The information on or accompanying the bill may include information that identifies you, your diagnosis, and the services and items provided.
Healthcare Operations
We may use and disclose your PHI to operate our practice. Examples: quality assessment and improvement activities, employee review and training, conducting or arranging for medical review and audit services, business planning, and general practice administration.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits
We may contact you using the contact information you provide (phone, voicemail, text, email, or mail through our patient communication system, Weave) to:
- Remind you of upcoming appointments
- Tell you about treatment alternatives
- Tell you about health-related benefits or services that may be of interest to you
If you do not wish to be contacted by one of these methods, you may opt out at any time by contacting our office.
Individuals Involved in Your Care
Unless you object, we may disclose to a family member, other relative, close personal friend, or any other person you identify, your PHI that directly relates to that person's involvement in your healthcare.
Required by Law
We will use and disclose your PHI when required to do so by federal, state, or local law.
Public Health and Safety
We may disclose your PHI for public health activities (such as reporting communicable diseases), to report abuse or neglect, for health oversight activities, in response to a court order or subpoena, to law enforcement under specific circumstances, to coroners or funeral directors, for organ donation purposes, for research approved by an Institutional Review Board, to avert a serious threat to health or safety, for specialized government functions, and for workers' compensation claims as authorized by law.
Business Associates
We contract with certain outside individuals and organizations ("business associates") to perform functions on our behalf — for example, our practice management software vendor (Eaglesoft), our patient communication platform (Weave), and our billing service (Vyne Dental). When we share PHI with a business associate, we require them by written contract to safeguard your information in accordance with HIPAA.
The following uses and disclosures of your PHI will be made only with your written authorization:
- Marketing communications, except as permitted by HIPAA (e.g., face-to-face communication or a promotional gift of nominal value)
- Sale of your PHI
- Most uses and disclosures of psychotherapy notes, where applicable
You may revoke any authorization, in writing, at any time. Revocation will not affect any use or disclosure already made in reliance on your prior authorization.
You have the following rights regarding the PHI we maintain about you:
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI in our designated record set. To request access, submit a written request to our Privacy Officer (contact information below). We will respond within 30 days. We may charge a reasonable, cost-based fee for copies and supplies.
Right to Request Electronic Copies
If we maintain your PHI electronically, you have the right to obtain an electronic copy.
Right to Request Amendment
If you believe information in your record is incorrect or incomplete, you may request that we amend it. The request must be in writing and include a reason. We may deny the request under certain circumstances; if we do, we will provide a written explanation and you may submit a written statement of disagreement.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to a restriction except that we must agree to restrict disclosure to a health plan if the disclosure is for payment or healthcare operations and you have paid for the related service in full out of pocket.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a specific way or at a specific location. For example, you may ask that we contact you only at work or by mail. We will accommodate reasonable requests.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures of your PHI we have made over the past six years. The list will not include disclosures made for treatment, payment, or healthcare operations, disclosures made to you, or disclosures made pursuant to your authorization.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Right to Be Notified of a Breach
You have the right to be notified following a breach of your unsecured PHI.
Right to File a Complaint
You have the right to file a complaint if you believe your privacy rights have been violated. See "How to File a Complaint" below. You will not be retaliated against for filing a complaint.
To exercise any of these rights, contact our Privacy Officer in writing using the contact information at the end of this notice.
We are required by law to:
- Maintain the privacy of your PHI
- Provide you with this notice of our legal duties and privacy practices
- Notify you following a breach of your unsecured PHI
- Abide by the terms of the notice currently in effect
We reserve the right to change this notice. The new notice will be effective for all PHI we maintain at that time. We will post a copy of the current notice in our office and on our website at tncld.com/legal/notice-of-privacy-practices and will provide a copy to anyone who requests one.
The named Privacy Officer for Tennessee Centers for Laser Dentistry is:
Annette Reed
Tennessee Centers for Laser Dentistry
204 Miller Springs Ct
Franklin, TN 37064
Email: info@tncld.com
Phone: (615) 595-8070
The Privacy Officer is responsible for handling questions about this notice, requests for access to or amendment of your PHI, requests for restrictions or confidential communications, accounting requests, and complaints.
With our practice. Submit a written complaint to our Privacy Officer at the address above. Your complaint should include your name and a way to reach you, the date and nature of the alleged privacy violation, and any documentation you wish to include. We will acknowledge receipt within five business days and provide a written response within thirty days. You will not be retaliated against for filing a complaint.
With the federal government. You may also file a complaint directly with the U.S. Department of Health and Human Services, Office for Civil Rights:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W., Room 509F, HHH Building
Washington, D.C. 20201
Phone: 1-877-696-6775 · 1-800-368-1019 · TDD 1-800-537-7697
Online: hhs.gov/ocr/complaints
You have 180 days from the date of the alleged violation to file with OCR.
This online Notice of Privacy Practices summarizes the same notice provided in our office. Submitting a website contact form, online appointment request, or other web communication is not a secure method of transmitting protected health information. Please do not include diagnostic information, treatment details, insurance information, or other PHI in our website forms. For matters involving PHI, contact our office directly by phone at (615) 595-8070 or visit us in person.
Tennessee Centers for Laser Dentistry
204 Miller Springs Ct
Franklin, TN 37064
info@tncld.com
(615) 595-8070
TTY/Hearing-impaired: Dial 711
tncld.com
This Notice of Privacy Practices is provided in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR §§ 164.520. It is not legal advice. For specific questions about your privacy rights, contact our Privacy Officer or the U.S. Department of Health and Human Services, Office for Civil Rights.
We are a family, cosmetic and general dental practice that uses lasers and other advanced technologies to provide a modern, pleasant dental experience.
