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Harper College Dental Hygiene Clinic

HIPAA: Health Information Privacy Policies and Procedures

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
 

The Harper College Dental Hygiene Clinic, including students, faculty, and supervising dentists, are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured 
protected health information. The Harper Dental Hygiene Clinic must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect 06/01/2021 and will remain in effect until the Harper Dental Hygiene Clinic replaces it.  

The Harper Dental Hygiene Clinic reserves the right to change the privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that the Harper Dental Hygiene Clinic maintains. When the Harper Dental Hygiene Clinic makes a 
significant change in the privacy practices, Harper Dental Hygiene Clinic will change this Notice and post the new Notice clearly and prominently at the practice location and will provide copies of the new Notice upon request.   

You may request a copy of the Notice at any time. For more information about the Harper Dental Hygiene Clinic privacy practices, or for additional copies of this Notice, please contact the Harper Dental Hygiene Clinic using the information listed at the end of this Notice.  

HOW THE HARPER DENTAL HYGIENE CLINIC MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU  
The Harper Dental Hygiene Clinic may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, the Harper Dental Hygiene Clinic have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or 
substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. The Harper Dental Hygiene Clinic will abide by these special protections as it pertains to applicable cases involving these types of records.  

Treatment: The Harper Dental Hygiene Clinic may use and disclose your health information for your treatment. For example, the Harper Dental Hygiene Clinic may disclose your health information to a specialist providing treatment to you.  

Payment: The Harper Dental Hygiene Clinic may use and disclose your health information to obtain payment for the treatment and services you receive from the clinic or another entity involved with your care. For example, the Harper Dental Hygiene Clinic may send communication to you containing certain health information to receive payment.  

Healthcare Operations: The Harper Dental Hygiene Clinic may use and disclose your health information in connection with our healthcare operations. For example, healthcare operations include quality assessment, accreditation documentation, conduction of training programs, and licensing activities.  

Individuals Involved in Your Care or Payment for Your Care: The Harper Dental Hygiene Clinic may disclose your health information to your family or friends, or any other individual identified by you when they are involved in your care or in the payment for your care. Additionally, the Harper Dental Hygiene Clinic may disclose information about you to a patient 
representative. If a person has the authority by law to make health care decisions for you, the Harper Dental Hygiene Clinic will treat that patient representative the same way the clinic would treat you with respect to your health information.  

Disaster Relief: The Harper Dental Hygiene Clinic may use or disclose your health information to assist in disaster relief efforts.  

Required by Law: The Harper Dental Hygiene Clinic may use or disclose your health information when it is required to do so by law. 

Public Health Activities: The Harper Dental Hygiene Clinic may disclose your health information for public health activities, including disclosures to:  

    • Prevent or control disease, injury or disability;
    • Report child abuse or neglect;
    • Report reactions to medications or problems with products or devices;
    • Notify a person of a recall, repair, or replacement of products or devices;
    • Notify a person who may have been exposed to a disease or condition; or
    • Notify the appropriate government authority if the Harper Dental Hygiene Clinic believe a patient has been the victim of abuse, neglect, or domestic violence.

National Security: The Harper Dental Hygiene Clinic may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. The Harper Dental Hygiene Clinic may disclose to authorized federal official's health information required for lawful intelligence, counterintelligence, and other national security activities. The 
Harper Dental Hygiene Clinic may disclose to correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient.  

Secretary of HHS: The Harper Dental Hygiene Clinic will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.  

Worker’s Compensation: The Harper Dental Hygiene Clinic may disclose your personal health information (PHI) to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.  

Law Enforcement: The Harper Dental Hygiene Clinic may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.  

Health Oversight Activities: The Harper Dental Hygiene Clinic may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil 
rights laws.  

Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, the Harper Dental Hygiene Clinic may disclose your PHI in response to a court or administrative order. The Harper Dental Hygiene Clinic may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone 
else involved in the dispute, but only if efforts have been made, either by the requesting party or the clinic, to tell you about the request or to obtain an order protecting the information requested. 

Research: The Harper Dental Hygiene Clinic may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.  

Coroners, Medical Examiners, and Funeral Directors: The Harper Dental Hygiene Clinic may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. The Harper Dental Hygiene Clinic may also disclose PHI to funeral directors consistent with applicable law to enable 
them to carry out their duties.  

Other Uses and Disclosures of PHI  
Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. The Harper Dental Hygiene Clinic will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for in this Notice (or as otherwise permitted or required 
by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, the Harper Dental Hygiene Clinic will stop using or disclosing your PHI, except to the extent that the clinic has already taken action in reliance on the authorization.  

Your Health Information Rights  
Access: You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing. You may obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending the Harper Dental Hygiene Clinic a letter to the address at the end of this 
Notice. If you request information that the Harper Dental Hygiene Clinic maintains on paper, the clinic may provide photocopies. If you request information that the Harper Dental Hygiene Clinic maintains electronically, you have the right to an electronic copy. The Harper Dental Hygiene Clinic will use the form and format you request if readily producible. The 
Harper Dental Hygiene Clinic will charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for postage if you want copies mailed to you. Contact the Harper Dental Hygiene Clinic using the information listed at the end of this Notice for an explanation of our fee structure.  

If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.  

Disclosure Accounting: With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit your request in writing to the Privacy Official. If you request this accounting more than once in a 12-month period, the Harper Dental Hygiene Clinic may charge you a reasonable, cost-based fee for responding to the additional requests.  

Right to Request a Restriction: You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official. Your written request must include (1) what information you want to limit, (2) whether you want to limit the Harper Dental Hygiene Clinic use, disclosure or both, and (3) to whom you want the limits to apply. The Harper Dental Hygiene Clinic is not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan), has paid our practice in full.

Alternative Communication: You have the right to request that the Harper Dental Hygiene Clinic communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location and provide satisfactory explanation of how payments will 
be handled under the alternative means or location you request. The Harper Dental Hygiene Clinic will accommodate all reasonable requests. However, if the Harper Dental Hygiene Clinic is unable to contact you using the ways or locations you have requested the Harper Dental Hygiene Clinic may contact you using the information it has.  

Amendment: You have the right to request that the Harper Dental Hygiene Clinic amend your health information. Your request must be in writing, and it must explain why the information should be amended. The Harper Dental Hygiene Clinic may deny your request under certain circumstances. If the Harper Dental Hygiene Clinic agree to your request, the clinic will amend your record(s) and notify you of such. If the Harper Dental Hygiene Clinic deny your request for an amendment, the clinic will provide you with a written explanation of why the clinic denied it and explain your rights.  

Right to Notification of a Breach: You will receive notifications of breaches of your unsecured protected health information as required by law.

Electronic Notice: You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our Web site or by electronic mail (email).  

Questions and Complaints  
If you want more information about our privacy practices or have questions or concerns, please contact us.  

If you are concerned that the Harper Dental Hygiene Clinic may have violated your privacy rights, or if you disagree with a decision the Harper Dental Hygiene Clinic made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have the clinic communicate with you by alternative means or at alternative locations, you may complain to the Harper Dental Hygiene Clinic using the contact
information listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. The Harper Dental Hygiene Clinic will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.  

The Harper Dental Hygiene Clinic supports your right to the privacy of your health information. The Harper Dental Hygiene Clinic will not retaliate in any way if you choose to file a complaint with the Harper Dental Hygiene Clinic or with the U.S. Department of Health and Human Services. 

Our Privacy Official: Dr. Sandi Ferencz                 
Telephone: 847-925-6530
Fax: 847-925-6024
Address: 1200 W. Algonquin Road Palatine, Illinois 60067
E-mail:sferencz@harpercollege.edu