Notice of Privacy Practices

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.

Who this notice covers

This notice is from Suncoast Dental Partners PLLC, doing business as The Destination Smile, 16654 N Dale Mabry Hwy, Ste 1030, Tampa, FL 33618, phone (813) 908-2444. It describes how we may use and share your health information and the rights you have over that information. It applies to the records of your care at this practice.

How we may use and share your health information

To treat you

We use your records to plan and provide your dental care, and we may share them with other professionals involved in that care. Example: sharing your record with the anesthesiologist involved in your treatment, or with the dental laboratory making your teeth.

To bill for your care

We may use and share your information to bill and collect payment. Example: sending a claim to your dental plan with the information the plan needs to pay it.

To run the practice

We may use your information to schedule visits, improve care, train staff, and manage the office. Example: contacting you about an upcoming appointment.

When the law allows or requires it

We may also share health information without your written permission in situations defined by law:

When a law requires us to report or disclose it.
For public health purposes, such as reporting a communicable disease.
To health oversight agencies for audits, inspections, and licensing.
In response to a court order, and in limited cases a subpoena.
To law enforcement in the narrow cases the federal privacy rule allows.
To a medical examiner or funeral director when the law permits it.
For workers’ compensation claims.
To prevent a serious threat to anyone’s health or safety.
With family or friends involved in your care or in paying for it, unless you object.

Uses that need your written permission

We will not use your health information for marketing, and we will not sell it, without your written authorization. That includes using your photographs or your words on this website. Any use not described in this notice also needs your written authorization. You can revoke an authorization at any time, in writing. The revocation does not undo uses we already made while it was in effect.

Substance use disorder treatment records

If we hold treatment records protected by the federal confidentiality rule at 42 CFR Part 2, those records, and testimony about them, will not be used against you in a civil, criminal, administrative, or legislative proceeding without your written consent or a court order entered after you had notice and a chance to be heard.

Your rights

See and copy your records. You can ask to see your dental records and get a copy, on paper or electronically.
Ask us to correct your records. If you believe something in your record is wrong or incomplete, you can ask us to amend it. If we decline, we will tell you why in writing.
Ask for confidential communications. You can ask us to contact you in a specific way, for example only at a certain number, and we will accommodate reasonable requests.
Ask us to limit what we use or share. We are not required to agree to every request. One exception: if you pay for a service in full out of pocket and ask us not to tell your dental plan about it, we must agree, unless a law requires the disclosure.
Get a list of disclosures. You can ask for an accounting of certain disclosures we have made of your information.
Get a paper copy of this notice. Ask at any time, even if you agreed to receive it electronically.
Choose someone to act for you. A legal guardian, or a person you have given medical power of attorney, can exercise these rights for you.

Our duties

The law requires us to keep your health information private, to give you this notice, and to follow the notice currently in effect. If a breach of unsecured health information affects you, we will notify you. We may change this notice; a changed notice applies to the information we already hold as well as to new information. The current notice is posted on this website and available at the office, and you can always ask for a copy.

Information shared outside the practice may be shared again by the person or organization that receives it. Once that happens, it may no longer be protected by federal privacy law.

Complaints

If you believe your privacy rights have been violated, you can complain to us and to the federal government. We will not retaliate against you for complaining.

To the practice: contact our Privacy Officer at The Destination Smile, or call (813) 908-2444.
To the U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue SW, Washington, DC 20201; phone 1-877-696-6775; or online at hhs.gov/hipaa/filing-a-complaint.

Contact and effective date

Privacy Officer: The Destination Smile. Phone (813) 908-2444. Fax (813) 908-2420.

This notice takes effect on the date it is first published on this website.