Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities
Effective on March 09, 2011, and Revised on November 22, 2021. 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.
We understand that information regarding your health is personal, and we are committed to protecting that information. We create a record of the care and dental services that you receive at Celebration Pediatric Dentistry. This notice will tell you about how Celebration Pediatric Dentistry may use and disclose certain information about you.
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated.
You have some choices in the way that we use and share information as we:
• Share information with your family, close friends, or others involved in your care.
Our Uses and Disclosures
How do we typically share your health information?
We may use and share your information as we:
• Treat you: We can use your health information and share it with other treating professionals (i.e., orthodontist, oral surgeons, physician for medical consults)
• Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
• Bill for your services: We can use and share your health information to bill and get payment from health plans or other entities.
• Comply with the law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
• For law enforcement purposes or with a law enforcement official.
• Respond to lawsuits and legal actions: We can share health information about you in response to a court or administrative order or a subpoena.
How else can we use or share your information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
We are required by law to maintain the privacy and security of your protected health information.
We will let you know 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 give you a copy of it.
We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with Celebration Pediatric Dentistry Business Department. To file a complaint contact Celebration Pediatric Dentistry Business Administrator.
Celebration Location: Privacy Officer, 1530 Celebration Blvd Suite 411, Celebration, Florida 34747, or email [email protected] , Attention: HIPAA Complaint Process
Winter Garden Location: Privacy Officer, 1310 Windermere Road, Winter Garden, Florida 34787, or email [email protected], Attention: HIPAA Complaint Process
Lake Nona Location: Privacy Officer, 13250 Narcoossee Road, Suite 101, Orlando, Florida 32832, or email [email protected], Attention: HIPAA Complaint Process