HIPAA Compliant

Privacy Policy

Last updated: September 17, 2024

Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.

Your Rights

You have the following rights regarding your health information:

Access Your Records

Request an electronic or paper copy of your medical record and other health information we maintain. A reasonable, cost-based fee may apply.

Correct Your Record

Request correction of health information you believe is incorrect or incomplete. We may deny requests in writing within 60 days with an explanation.

Confidential Communications

Request we contact you via specific methods or at a specific address. We will accommodate all reasonable requests.

Limit What We Share

Request we not use or share certain health information for treatment, payment, or operations. We are not always required to agree.

Accounting of Disclosures

Request a list of those with whom we've shared your information over the prior six years. One free accounting per year; additional requests may incur a fee.

File a Complaint

File a complaint with us at (813) 308-9489 or with the U.S. Department of Health and Human Services. We will never retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. You have the right and choice to tell us to:

  • Share information with family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

If you are unable to communicate your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest. We may also share information when necessary to prevent a serious and imminent threat to health or safety.

Cases where written permission is required

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

We may contact you for fundraising efforts, but you can request not to be contacted again at any time.

Consumer Data Protection

Consumer data will not be shared or transferred between organizations unless explicitly stated. To stop receiving future communications, you can opt out by texting STOP, QUIT, END, REVOKE, OPT OUT, CANCEL, or UNSUBSCRIBE to any message you receive from us.

How We Use Your Information

To Treat You

We use your health information and may share it with other professionals treating you — for example, a specialist we refer you to.

To Run Our Organization

We may use and share your health information to operate our practice, improve your care, and contact you when necessary.

To Bill for Your Services

We use and share your health information to bill and receive payment from health plans or other entities — for example, billing your dental insurance for a cleaning.

Other Uses & Disclosures

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good. We must meet many conditions in the law before sharing your information for these purposes. These include:

Public Health and Safety

  • Disease prevention and reporting
  • Product recalls
  • Reporting adverse medication reactions
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing serious threats to anyone's health or safety

Research

We can use or share your information for health research, subject to applicable laws and ethical standards.

Compliance with Law

We will share information if state or federal laws require it, including with the Department of Health and Human Services to verify compliance with federal privacy law.

Organ and Tissue Donation

We can share health information with organ procurement organizations if applicable.

Medical Examiners or Funeral Directors

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Government Requests & Legal Actions

We can use or share health information for workers' compensation claims, law enforcement purposes, health oversight agencies, and special government functions such as military, national security, and presidential protective services. We may also share information in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information
  • We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information
  • We must follow the duties and privacy practices described in this notice and provide you a copy upon request
  • We will not use or share your information other than as described here unless you give us written permission — which you may change or revoke at any time by notifying us in writing

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to This Notice

We can change the terms of this notice at any time. Changes will apply to all information we maintain about you. The updated notice will be available upon request, in our office, and on this website.

Email & Website Communication Notice

Email communication via our website may not be done through a secure platform. Although it is unlikely, there is a possibility that information you include in your submission can be intercepted and read by parties other than the intended recipient. To protect your confidential information, please do not include personal identifying information such as your birth date or personal medical information in any emails or website submissions you send to us.

Contact Us

If you have questions about this Privacy Policy or wish to exercise your rights, please contact us:

  • Phone: (813) 308-9489
  • Email: contact@elevatesmilesdental.com
  • Address: 206 N Howard Ave, Suite 2, Tampa, FL 33606
  • HHS Office for Civil Rights: File a complaint online or call 1-877-696-6775