September 7, 2013

Privacy

This is a description of the privacy policies of our office and websites, and how we use and disclose your protected health information (PHI). PHI is any identifiable information about your health, your treatment, or your payment for treatment. Witte Family Dentistry (WFD) is required by law to maintain your privacy and to inform you how your health information is used.

This policy may be changed or updated at any time. A current copy will be made available upon request and can be found on our website at http://www.wittefamilydentistry.com/privacy/.

Collection of Online Information

Our website, www.wittefamilydentistry.com, www.wittefd.com, or www.wittedentistry.com, may place small files called “cookies” on your computer to aid in login or store preferences/settings; this setting may be blocked by changing your web browser’s preferences. We may collect information from any online form you fill out, including information not readily submitted (for example, your computer’s “IP address,” which may be specific to you). This information may be used for analytic purposes, but will not be sold or used for marketing purposes.

Online forms are not considered secure and no confidential information should be submitted by that method. We may use third party tools for advertising and/or delivery of services via our website, which may have access to your computer’s IP address and any information disclosed via online forms.

Disclosure of Information

WFD may disclose your PHI for treatment, payment, and health care operations without your express authorization. For any other purpose, your written authorization is needed except as noted as an exception below. Your written authorization may be canceled or revoked at any time if you give written notification; this will stop future disclosures but will not revoke previous disclosures as already acted upon based on your previous authorization.

Your PHI may be disclosed to doctors, hygienists, assistants and other staff members during the rendering of treatment, in order to provide treatment or develop a treatment plan. Your PHI may be shared with other health care providers as needed for consultation, to obtain prescriptions, lab work, and other necessary treatment purposes. WFD may disclose your PHI during billing/payment collection, including disclosing your PHI to a program such as Medicaid or a third-party payer in order to receive payment, or to get prior approval or support a claim/bill. Your PHI may be used/disclosed among the staff of WFD during administrative duties, audits, compliance programs, training, credentialing, or certification.

WFD may use your PHI to remind you of appointments or to discuss treatment or alternatives.

Exceptions to the Need for Written Authorization

  • Certain judicial proceedings
  • For protection of victims in cases of abuse/neglect
  • To correctional facilities, if you are an inmate
  • For federal or state investigations as in the case of fraud, incident reporting, or protection/advocacy activities
  • If required by law, or for law enforcement or national security
  • To the Department of Health & Hospitals as required by the state
  • To avoid a serious and imminent threat to public health or safety
  • For public health activities such as disease tracking or vital statistic reporting
  • If you give verbal or other consent, your PHI may be shared with your family and/or friends who are involved with your treatment or the financial arrangements agreed upon

Patient Rights

You or your legal representative have the right to request that WFD use a specific address or phone number to contact you, but this does not constitute an obligation on the part of WFD to use such an address or phone number. You may obtain a printed copy of this notice if requested.

The following requests must be made in writing. You have the right to review and/or copy your PHI; WFD may charge a fee for duplication of records. You may request additions or corrections to your PHI, to which WFD is not under obligation to comply; you may have further rights if WFD does not comply. You may request a list of disclosures from WFD listing those individuals or organizations who currently have, or have had, access to your PHI, excluding disclosures made for treatment, payment, and health care operations and some disclosures required by law. You may request that WFD further limit its use or disclosure of your PHI, but WFD is not obligated to agree.

Your PHI will be retained, at a minimum, the duration required by law, after which time it may be destroyed.

Questions or Complaints

Questions or concerns about our privacy practices may be directed to the contact person below. If you believe a violation of your privacy has occurred, or you disagree with WFD’s decision regarding the disclosure of your PHI, you may complain to the contact person below. You may also submit a written complaint to the U.S. Department of Health and Human Services; WFD will provide you this address upon request. WFD supports your right to privacy and will not retaliate if a complaint is filed.

Name of Contact Person

Scott Witte, DDS
137 E. Kings Hwy
Shreveport, LA 71104

Last updated October 2nd, 2013