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.
AJAY B. SETYA, DDS, MSD
ROBERT C. HIRST, DDS, MS
CHRISTEN S. BERGMAN, DDS, MS
Periodontics and Dental Implants respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.
The law protects the privacy of the health information we create and obtain in providing our care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.
Information for Treatment, Payment and Health Operations
Information obtained by a nurse, physician, or other member of our health care team will be recorded in your medical record and used to help decide what care may be right for you.
We may also provide information to others providing you care. This will help them stay informed about your care.
We request payment from your or your health insurance plan. Health plans need information from us about your medical care. Information provided to health plans may include your diagnoses, procedures performed, or recommended care.
For health care operations:
We use your medical records to assess quality and improve services.
We may use and disclose medical records to review the qualifications and performance of our health care providers and to train our staff.
We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services.
We may use and disclose your information to conduct or arrange for services, including:
- Medical quality review by your health plan.
- Accounting, legal, risk management, and insurance services.
- Audit functions, including fraud and abuse detection and compliance programs.
Your Health Information Rights
The health and billing records we create and store are the property of the practice/health care facility. The protected health information in it, however, generally belongs to you. You have a right to:
- Receive, read, and ask questions about this Notice.
- Ask us to restrict certain uses and disclosures. You must deliver this request in writing to us. We are not required to grant the request. But we will comply with any request granted.
- Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information (“Notice”).
- Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request.
- Have us review a denial of access to your health information—except in certain circumstances.
- Ask us to change your health information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
- When you request, we will give you a list of disclosures of your health information. The list will not include disclosures to third-party payors. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
- Ask that your health information be given to you by another means or at another location. Please sign, date, and give us your request in writing.
- Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
For help with these rights during normal business hours, please contact us at 949-482-6089.
We are required to:
- Keep your protected health information private.
- Give you this Notice.
- Follow the terms of this Notice.
We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our office to pick one up.
To Ask for Help
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact us.
If you believe your privacy rights have been violated, you may discuss your concerns with any staff member. You may also file a complaint with the U.S. Secretary of Health and Human Services.
We respect your right to file a complaint with us or with the U.S. Secretary of Health and Human Services. If you complain, we will not retaliate against you.
Other Disclosures and Uses of Protected Health Information
Notification of Family and Others
Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. In addition, we may disclose health information about you to assist in disaster relief efforts.
You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it.
Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.
What personal information do we collect from the people that visit our blog, website or app?
When using our contact form on our site, as appropriate, you may be asked to enter your name, email address, phone number or other details to help you with your experience.
When do we collect information?
We collect information from you when you fill out a form or enter information on our site.
How do we use your information?
We may use the information we collect from you when you register, make a purchase, sign up for our newsletter, respond to a survey or marketing communication, surf the website, or use certain other site features in the following ways:
- To allow us to better service you in responding to your customer service requests.
- To administer a contest, promotion, survey or other site feature.
How do we protect visitor information?
Our website is scanned on a regular basis for security holes and known vulnerabilities in order to make your visit to our site as safe as possible. We use regular Malware Scanning.
Do we use ‘cookies’?
Compile aggregate data about site traffic and site interactions in order to offer better site experiences and tools in the future. We may also use trusted third party services that track this information on our behalf.
You can choose to have your computer warn you each time a cookie is being sent, or you can choose to turn off all cookies. You do this through your browser (such as Google Chrome or Firefox) settings. Each browser is a little different, so look at your browser’s Help menu to learn the correct way to modify your cookies. If you disable cookies, some features will be disabled. It may affect the user experience that makes your site experience more efficient and some of our services will not function properly.
Third Party Disclosure
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information unless we provide you with advance notice. This does not include website hosting partners and other parties who assist us in operating our website, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others’ rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.
Third party links
We do not include or offer third party products or services on our website.
Google’s advertising requirements can be summed up by Google’s Advertising Principles. They are put in place to provide a positive experience for users. https://support.google.com/adwordspolicy/answer/1316548?hl=en
We have not enabled Google AdSense on our site.
California Online Privacy Protection Act
According to CalOPPA we agree to the following:
Users can visit our site anonymously.
Users are able to change their personal information:
By emailing us
How does our site handle do not track signals?
We honor do not track signals and do not track, plant cookies, or use advertising when a Do Not Track (DNT) browser mechanism is in place.
Does our site allow third party behavioral tracking?
It’s important to note that we allow third party behavioral tracking.
COPPA (Children Online Privacy Protection Act)
When it comes to the collection of personal information from children under 13, the Children’s Online Privacy Protection Act (COPPA) puts parents in control. The Federal Trade Commission, the nation’s consumer protection agency, enforces the COPPA Rule, which spells out what operators of websites and online services must do to protect children’s privacy and safety online.
We do not specifically market to children under 13.
Fair Information Practices
The Fair Information Practices Principles form the backbone of privacy law in the United States and the concepts they include have played a significant role in the development of data protection laws around the globe. Understanding the Fair Information Practice Principles and how they should be implemented is critical to comply with the various privacy laws that protect personal information.
In order to be in line with Fair Information Practices we will take the following responsive action, should a data breach occur:
We will notify the users via email
• Within 7 business days
We will notify the users via in site notification
• Within 7 business days
We also agree to the individual redress principle, which requires that individuals have a right to pursue legally enforceable rights against data collectors and processors who fail to adhere to the law. This principle requires not only that individuals have enforceable rights against data users, but also that individuals have recourse to courts or a government agency to investigate and/or prosecute non-compliance by data processors.
CAN SPAM Act
The CAN-SPAM Act is a law that sets the rules for commercial email, establishes requirements for commercial messages, gives recipients the right to have emails stopped from being sent to them, and spells out tough penalties for violations.
If at any time you would like to unsubscribe from receiving future emails, you can notify us via email and we will promptly remove you from ALL correspondence.
AJAY B. SETYA, DDS, MSD
ROBERT C. HIRST, DDS, MS
CHRISTEN S. BERGMAN, DDS, MS
Periodontics and Dental Implants
27871 Medical Center Rd
Mission Viejo, CA 92691