Namay Dentistry

Notice of Privacy Practices

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that health providers keep your medical and dental information private. THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO NAMAY DENTISTRY. PLEASE READ THIS NOTICE CAREFULLY.

TOLEDO OFFICE

George L. Namay, DDS
6800 Central Ave., Suite A1
Toledo, OH 43617
419.843.7884

SYLVANIA OFFICE

Dr. George L. Namay, DDS
4913 Harroun Rd., Suite 2
Sylvania, OH 43560
419.882.6896

MAUMEE OFFICE

Dr. James Ziemiecki
959 Illinois Ave., Suite A
Maumee, OH 43537
419.891.0527

NORTHWOOD OFFICE

Dr. Michael Stubblefield, DDS
555 Commerce Park Blvd.
Northwood, OH 43619
419.698.5500

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our obligations to help you. You have a right to:

Get an electronic or paper copy of your medical record:

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record:

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Your request must be in writing and explain why the information should be amended.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications:

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. Your request must be in writing and specify the alternate means or location and provide a satisfactory explanation of how the payments will be handled under the alternative request.
  • We will say “yes” to all reasonable requests.

Ask us to limit what information we use or share:

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information:

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice:

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you:

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated:

  • You can complain if you feel we have violated your rights by contacting us using the information at the end of this Notice.
  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information

In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses & Disclosures

We typically use or share your health information in the following ways:

  • To treat you: We can use your health information and share it with other professionals who are treating you. Example: A dentist treating you asks consults another dentist about your overall treatment plan or health condition.
  • To bill for your services: We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
  • For our healthcare operations: We can use and share your health information to run our practice, improve your care, and contact you when necessary. Some health care operations include quality assessment and improvement activities, managing your treatment and services, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing credentialing activities. Example: We use health information about you to manage your treatment and services.
  • Appointment reminders: We may use or disclose your health information to provide you with an appointment reminder such as a voicemail, text message, postcard or letter.

How else can we use or share your health 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 have to meet many conditions in the law before we can share your information for these purposes. For more information see: hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

To help with public health and safety issues: We can share health information about you for certain situations, such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

To do research: We can use or share your information for health research.

To 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.

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

To address workers’ compensation, law enforcement, and other government requests: We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

To respond to lawsuits and legal actions: We can share health information about you 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 must follow the duties and privacy practices described in this Notice and give you a copy of it upon request.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We will not use or share your information other than for treatment, payment or our healthcare operations, unless you tell us we can in writing. If you tell us we can, you may change your mind and revoke it in writing at any time.
  • For more information see: hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice

  • This Notice is effective January 1, 2021 and will remain in effect until we replace it.
  • 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.

Questions or Concerns

If you want information about Namay Dentistry privacy practices or if you have questions or want to file a complaint, please email us.