Sunbeam Dental, LLCDr. John Mamoun, DMD
Fellow, Academy of General Dentistry
Internaionally
Published Author
100 Craig Road,
Suite 106
Manalapan, NJ 07726
(732) 431-2888
For Patients:
Business Hours:
Monday: 8am-8pm
Tuesday: 8am-8pm
Wednesday: 8am-8pm
Thursday: 8am-8pm
Friday: 8am-8pm
Saturday: 8am-8pm
Sunday: 8am-8pm
Or By Appointment
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HIPPA Privacy Policy
Health Insurance Portability and Accountability Act
NOTICE OF PRIVACY PRACTICES. 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 US.
OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your
health information. We are also required to give you this Notice about our privacy
practices, our legal duties, and your rights concerning your health information. We
must follow the privacy practices that are described in this Notice while it is in effect.
This Notice will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at
any time, provided such changes are permitted by applicable law. We reserve the
right to make the changes in our privacy practices and the new terms of our Notice
effective for all health information that we maintain, including health information we
created or received before we made the changes. Before we make a significant
change in our privacy practices, we will change this Notice and make the new Notice
available upon request.
You may request a copy of our Notice at any time. For more information about our
privacy practices, or for additional copies of this Notice, please contact us using the
information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and
healthcare operations. For example:
Treatment: We may use or disclose your health information to a physician or other
healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for
services we provide to you.
Healthcare Operations: We may use and disclose your health information in
connection with our healthcare operations. Healthcare operations include quality
assessment and improvement activities, reviewing the competence or qualifications
of healthcare professionals, evaluating practitioner and provider performance,
conducting training programs, accreditation, certification, licensing or credentialing
activities.
Your Authorization: In addition to our use of your health information for
treatment, payment or healthcare operations, you may give us written authorization
to use your health information or to disclose it to anyone for any purpose. If you give
us an authorization, you may revoke it in writing at any time. Your revocation will
not affect any use or disclosures permitted by your authorization while it was in
effect. Unless you give us a written authorization, we cannot use or disclose your
health information for any reason except those described in this Notice.
To Your Family and Friends: We must disclose your health information to you, as
described in the Patient Rights section of this Notice. We may disclose your health
information to a family member, friend or other person to the extent necessary to
help with your healthcare or with payment for your healthcare, but only if you agree
that we may do so.
Persons Involved In Care: We may use or disclose health information to notify, or
assist in the notification of (including identifying or locating) a family member, your
personal representative or another person responsible for your care, of your location,
your general condition, or death. If you are present, then prior to use or disclosure of
your health information, we will provide you with an opportunity to object to such
uses or disclosures. In the event of your incapacity or emergency circumstances, we
will disclose health information based on a determination using our professional
judgment disclosing only health information that is directly relevant to the personŐs
involvement in your healthcare. We will also use our professional judgment and our
experience with common practice to make reasonable inferences of your best
interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays,
or other similar forms of health information.
Marketing Health-Related Services: We will not use your health information for
marketing communications without your written authorization.
Required by Law: We may use or disclose your health information when we are
required to do so by law.
Abuse or Neglect: We may disclose your health information to appropriate
authorities if we reasonably believe that you are a possible victim of abuse, neglect,
or domestic violence or the possible victim of other crimes. We may disclose your
health information to the extent necessary to avert a serious threat to your health or
safety or the health or safety of others.
National Security: We may disclose to military authorities the health information of
Armed Forces personnel under certain circumstances. We may disclose to authorized
federal officials health information required for lawful intelligence,
counterintelligence, and other national security activities. We may disclose to
correctional institution or law enforcement official having lawful custody of protected
health information of inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose your health information to
provide you with appointment reminders (such as voicemail messages, postcards, or
letters).
PATIENT RIGHTS
Access: You have the right to look at or get copies of your health information, with
limited exceptions. You may request that we provide copies in a format other than
photocopies. We will use the format you request unless we cannot practicably do so.
(You must make a request in writing to obtain access to your health information. You
may obtain a form to request access by using the contact information listed at the
end of this Notice. We will charge you a reasonable cost-based fee for expenses such
as copies and staff time. You may also request access by sending us a letter to the
address at the end of this Notice. If you request an alternative
format, we will charge a cost-based fee for providing your health information in that
format. If you prefer, we will prepare a summary or an explanation of your health
information for a fee. Contact us using the information listed at the end of this Notice
for a full explanation of our fee structure.)
Disclosure Accounting: You have the right to receive a list of instances in which
we or our business associates disclosed your health information for purposes, other
than treatment, payment, healthcare operations and certain other activities, for the
last 7 years.
Restriction: You have the right to request that we place additional restrictions on
our use or disclosure of your health information. We are not required to agree to
these additional restrictions, but if we do, we will abide by our agreement (except in
an emergency).
Alternative Communication: You have the right to request that we communicate
with you about your health information by alternative means or to alternative
locations. {You must make your request in writing.} Your request must specify the
alternative means or location, and provide satisfactory explanation how payments
will be handled under the alternative means or location you request.
Amendment: You have the right to request that we amend your health information.
(Your request must be in writing, and it must explain why the information should be
amended.) We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice on our Web site or by electronic mail
(email), you are entitled to receive this Notice in written form.
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 we may have violated your
privacy rights, or you disagree with a decision we 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 us communicate with you by
alternative means or at alternative locations, you may complain to us 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. We will provide
you with the address to file your complaint with the U.S. Department of Health and
Human Services upon request.
We support your right to the privacy of your health information. We will not retaliate
in any way if you choose to file a complaint with us or with the U.S. Department of
Health and Human Services.