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.

Dentistry by Dr. Kaplansky, PLLC ("the Practice") is required by law to maintain the privacy of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices. We are required to follow the practices described in this Notice.

Treatment. We use your PHI to provide, coordinate, and manage your dental care. For example, we share information with specialists, labs, or other providers involved in your treatment.

Payment. We use and disclose your PHI to obtain payment for your dental services. For example, we submit claims to your dental insurance plan that describe your diagnosis and treatment.

Health Care Operations. We use PHI for internal administrative purposes such as quality assessment, staff training, and practice management.

As Required by Law. We disclose PHI when required by federal, state, or local law — for example, to report certain communicable diseases or in response to a valid court order.

Public Health Activities. We may disclose PHI to public health authorities for activities such as disease surveillance or reporting adverse events to the FDA.

Business Associates. We share PHI with certain vendors and service providers ("Business Associates") who perform functions on our behalf, subject to written agreements that require them to protect your PHI.

Other Uses. All other uses and disclosures of your PHI require your written authorization. You may revoke any authorization in writing at any time.

• Right to inspect and copy — You have the right to review and obtain a copy of your dental records and other PHI. We may charge a reasonable fee for copies.
• Right to request corrections — You may request that we correct PHI you believe is inaccurate or incomplete. We may deny your request under certain circumstances.
• Right to an accounting of disclosures — You may request a list of certain disclosures we have made of your PHI in the past six years.
• Right to request restrictions — You may request that we restrict how we use or disclose your PHI. We are not required to agree, except for certain disclosures to health plans when you have paid for a service in full out-of-pocket.
• Right to request confidential communications — You may request that we communicate with you in a specific way or at a specific location (e.g., only by text, not by voicemail).
• Right to a paper copy of this Notice — You may request a paper copy of this Notice at any time.
• Right to be notified of a breach — You have the right to be notified if your PHI is involved in a breach of unsecured PHI.

We reserve the right to change this Notice. If we make material changes, we will post the revised Notice in our office and on this Site. The effective date of any revised Notice appears at the top of the page.

If you believe your privacy rights have been violated, you may file a complaint with our Practice or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized for filing a complaint.

To file a complaint with the Practice, contact our Privacy Officer:

Privacy Officer — Dentistry by Dr. Kaplansky, PLLC
8038 Rochester Rd, Gasport, NY 14067
Phone: (716) 772-7500
Email: info@drkaplansky.com

To file with HHS OCR: www.hhs.gov/hipaa/filing-a-complaint/