Privacy Policy for Brinley Orthodontics
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.
Our Responsibilities
We are required by law to:
• Maintain the privacy of your protected health information.
• Provide you with this notice of our legal duties and privacy practices.
• Notify you if there is a breach of your health information.
• Follow the terms of this notice that are currently in effect.
How We May Use and Disclose Health Information
We may use and share your health information for:
• Treatment: To provide, coordinate, or manage your dental care (e.g., sharing information with a specialist).
• Payment: To bill and collect payment from you, your insurance company, or a third party.
• Healthcare Operations: For quality assessment, staff training, and improving our services.
Other uses and disclosures permitted or required by law include:
• Public health activities (e.g., reporting communicable diseases).
• Health oversight agencies (e.g., audits, investigations).
• Law enforcement, court orders, or legal proceedings.
• To prevent serious threats to health or safety.
Other uses and disclosures will be made only with your written authorization. You may revoke that authorization at any
time.
Special protection for SUD records: Substance Use Disorder (SUD) Treatment records have enhanced protections. They cannot be used in legal proceedings without your consent or court order.
Additional Restrictions on use and disclosure: Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. “Highly Confidential Information” may include confidential information under Feral laws governing reproductive rights, alcohol and drug abuse information and genetic information as well as state laws that often protect the following types of information: 1: HIV/AIDS 2: Mental Health 3: Genetic Tests (in accordance with GINA2009) 4: Alcohol and drug abuse 5: Sexually transmitted diseases and reproductive health information and : Child or adult abuse or neglect, including sexual assault
Your Rights
You have the right to: •
• Access your medical and billing records.
• Request an amendment to your records if you believe they are incorrect. Request restrictions on certain uses and
disclosures of your information.
• Request confidential communications (e.g., have information sent to a different address or phone number).
• Receive an accounting of disclosures we have made of your information.
• Receive a paper copy of this notice at any time.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of
Health and Human Services. We will not retaliate against you for filing a complaint.
Contact Information
For questions or to exercise your rights, please contact:
Brinley Orthodontics
1 of 2
2023 Vadalabene Drive Ste 252
Maryville, IL 62062
Phone: 618-288-3384
Email: brinleyortho@yahoo.com
