Notice of Privacy Practice
West Virginia University School of Dentistry
And West Virginia University Dental Corporation d/b/a UHA
Effective date: April 14, 2003
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.
This Notice of Privacy Practices describes how West Virginia University School
of Dentistry and the West Virginia University Dental Corporation d/b/a/ UHA may
use and disclose your protected health information to carry out treatment,
payment or health care operations and for other purposes that are permitted or
required by law. It also describes your rights to access and control your
protected health information. “Protected health information” is
information about you, including demographic information, that may identify you
and that relates to your past, present or future physical or mental health or
condition and related health care services.
1. OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
The above listed organizations are required by law to (1) make sure that health
information that identifies you is kept private, (2) give you this notice of our
legal duties and privacy practices with respect to health information about you,
(3) follow the terms of the notice that is currently in effect, and (4)
communicate any changes to the Notice to you.
We reserve the right to change this Notice of Privacy Practices at any time in
the future. The Notice's effective date is found at the top of the first
page. We reserve the right to make the revised or changed notice effective
for protected health information we already have about you as well as any
information we receive in the future. You may request a copy of any
revised notice of Privacy Practices by: 1) calling the compliance number
at the end, 2) asking for one at your next visit to our organization, or 3) via
our website at www.health.wvu.edu. Until such amendment is made,
we are required by law to comply with this Notice.
We will also post a copy of the current Notice at certain designated
registration areas throughout our hospital and clinics.
2. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
A. Uses and Disclosures of Protected Health Information for Treatment,
Payment and Healthcare Operations
The law permits us to use or disclose your protected health information for the
following purposes:
1) Treatment. We will use and disclose your protected health
information to provide, coordinate, or manage your health care and any related
services. Dentists, physicians and/or residents, dental hygienists,
nurses, technicians, students, or other health care personnel who are involved
in taking care of you use health information about you.
For example, a physician, dentist or resident treating you for dental injuries
following a motor vehicle accident may need a copy of your dental record for
treatment in the hospital.
We may also disclose protected health information about you to your family
dentist whom may want to be informed about the treatment that you received while
you were a patient at our clinics, and the result of your treatment so that
(s)he may provide the appropriate follow-up care.
2) Payment. Your protected health information will be used or
disclosed, as needed, to obtain payment for your health care services.
This may include certain activities that we are required to undertake before
payment can be obtained from your dental/medical insurance plan or other third
party. These activities may include determining eligibility or coverage of
benefits, reviewing services provided to you as medically necessary, and
obtaining approval from your dental/medical insurance plan.
3) Health Care Operations. We will use or disclose, as
needed, protected health information about you in order to support the daily
activities of providing health care. These uses and disclosures are
necessary to run the clinics and make sure that all of our patients receive
quality care. These activities include, but are not limited to, quality
assessment activities, audits, investigations, oversight or staff performance
reviews, training of students, licensing, and conducting or arranging for other
health care related activities.
The majority of our patients will receive care within clinics with open bay
floor plan arrangements. All reasonable efforts will be made to maintain
your confidentiality in this setting.
Since we are a teaching institution, we may also disclose information to
dentists, residents, nurses, technicians, students in health related fields,
other health care personnel, and other clinic personnel for research studies and
teaching purposes. As much as possible, we will remove information that
identifies you from this set of health information so others may use it to study
health care delivery without learning who you are.
Information provided to you:
- Appointment Reminders: We may use and disclose your health information to
contact you as a reminder that you have an appointment for treatment at the
clinic.
- Treatment Alternatives: We may use and disclose your health information to
consultants so they can tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
- Medically-Related Benefits and Services: We may use and disclose your health
information to others to tell you about medical-related benefits or services
that may be of interest to you, such as smoking cessation classes, stress
management classes, eating disorders, Alcoholics Anonymous, etc.
B. Uses and Disclosures of Protected Health Information Based upon
Your Written Authorization
Except as described in this Notice of Privacy Practices, we will not use or
disclose your protected health information without your written authorization.
If you do authorize us to use or disclose your protected health information for
another purpose, you may revoke your authorization in writing at any time.
If you revoke your authorization, we will no longer use or disclose your
protected health information for the reasons covered by your written
authorization. We are unable to take back any disclosures we have already
made with your authorization, and we are required to retain records of the
disclosures that we provided for you under that written authorization.
C. Other Permitted and Required Uses and Disclosures That May Be Made
With Your Authorization or Opportunity to Object
We may use and disclose your protected health information in the situations
listed below. You have the opportunity to agree or object to the use or
disclosure of all or part of your protected health information. If you are
not present or able to agree or object to the use or disclosure of the protected
health information, the dentist or other health care provider(s) involved in
your care may, using their professional judgment, determine whether the
disclosure is in your best interest. In this case, only the protected
health information that is relevant to your health care will be disclosed.
Information Directories. Unless you object, we may tell your family
or friends your location in the facility and approximate treatment time while
you are a patient. This information may be provided to people who ask for you by
name. If you do not want us to release this information, tell either your
dentist or an admission clerk upon check in to our clinic.
Others Involved in Your Care. Unless you object, we may disclose
your protected health information to notify or assist in notifying a family
member, your personal representative or another person responsible for your care
about your location, your general condition or in the event of your death.
If you are able and available to agree or object, we will give you the
opportunity to object prior to making this notification. If you are unable
or unavailable to agree or object, our health care professionals will use their
best judgment in communicating with your family and others involved in your
care.
Marketing and Fundraising. We will not use or disclose your
protected health information for Marketing purposes until we obtain your written
authorization. We do not provide or sell your protected health information
to any outside marketing firms or agencies.
We may use certain information (name, address, telephone number, dates of
service, age and gender) to contact you in the future to raise money for West
Virginia University Hospitals, West Virginia University Children’s Hospital,
Mary Babb Randolph Cancer Center, the Eye Institute and the Schools and programs
of the Robert C. Byrd Health Sciences Center. We may also provide
your name to West Virginia University Foundation for the purpose of fundraising
for these entities. The money raised will be used to expand and improve
services and programs we provide the community. If you choose not to have
WVU Foundation contact you for fundraising efforts, you may opt out of any
future telephone calls or mailings by making your request to WVU Foundation at
P.O. Box 9008, Morgantown, WV 26506-9008 or call (304) 293-7086.
D. Other Permitted and Required Uses and Disclosures That May Be Made
Without Your Authorization or Opportunity to Object
We may use or disclose your protected health information in the following
situations without your authorization. These situations include:
Required by law. We may use or disclose your protected health
information when required to do so by federal, state or local law. The use
or disclosure will be made in compliance with the law and will be limited to the
relevant requirements of the law. For example, the Office of Civil Rights
or the Office of the Inspector General may require access to your protected
health information while conducting audits or investigations of reported privacy
breaches or violations. By law, we must make disclosures to you and when
required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of the Health
Insurance Portability and Accountability Act of 1996.
Public Health and Safety. As required by law, we may disclose your
protected health information to public health authorities for purposes related
to: 1) preventing or controlling disease; 2) reporting child abuse or
neglect; 3) reporting to the Food and Drug Administration problems with products
and reactions to medications; 4) notifying people of recalls of products they
may be using; and 5) reporting disease or infection exposure to a person who may
have been exposed or may be at risk for contracting or spreading a disease or
condition. We may also disclose your protected health information to
appropriate persons in order to prevent or lessen a serious and imminent threat
to your health or safety, or the health or safety of another person or the
general public. Any disclosure, however, would only be to someone able to
help prevent the threat.
Military Activity and National Security: When the appropriate
conditions apply, we may use or disclose protected health information of
individuals who are Armed Forces personnel or veterans (1) for activities deemed
necessary by appropriate military command authorities; (2) for the purpose of a
determination by the Department of Veterans Affairs of your eligibility for
benefits, or (3) to foreign military authority if you are a member of that
foreign military service. We may also disclose your protected health
information to authorized federal officials for conducting national security and
intelligence activities for the provision of protective services to the
President or others legally authorized.
Health Oversight Activities. We may disclose your protected health
information to health oversight agencies during the course of audits,
investigations, inspections, licensure and other proceedings required by the
government to monitor the health care system, government programs, and
compliance with civil rights laws.
Legal Proceedings. If you are involved in a lawsuit or a dispute,
we may disclose your protected health information in response to a court or
administrative order. We may also disclose your protected health
information in response to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but only if efforts have been
made to tell you about the request or to obtain an order protecting the
information requested.
Law Enforcement. We may disclose your protected health information
to law enforcement officials for purposes or in situations such as:
- identifying or locating a suspect, fugitive, material witness or missing person;
- in response to a court order, subpoena, warrant, summons or similar process;
- about the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person’s agreement;
- about a death we believe may be the result of criminal conduct;
- about criminal conduct in the clinic; and
- in emergency circumstances to report a crime, the location of the crime or
victims, or the identity, description or location of the person who committed
the crime.
Inmates. If you are an inmate of a correctional institution or
under the custody of a law enforcement official, we may disclose your protected
health information to the correctional institution or law enforcement official.
This disclosure would be necessary (1) for the institution to provide you with
health care; (2) to protect your safety or the safety of others; or (3) for the
safety and security of the correctional institution.
Coroners, Funeral Directors, and Organ Donation. We may disclose
protected health information to coroners or medical examiners for identification
purposes, determining cause of death or for the coroner or medical examiner to
perform other duties authorized by law.
Research. We may disclose your protected health information to
researchers conducting research that has been approved by an Institutional
Review Board, which has reviewed the research proposal and established protocols
to ensure the privacy of your protected health information. All research
projects, however, are subject to a special approval process called an
Institutional Review Board or Privacy Board. This process evaluates a
proposed research project and its use of health information, trying to balance
the research needs with the patient’s need for privacy of their health
information. Before we use or disclose protected health information for
research, the project will have been approved through this research approval
process, but we may disclose protected health information about you to people
preparing to conduct a research project, for example, to help them look for
patients with specific health care needs, so long as the health information they
review does not leave the facility, and so long as the information sought is
necessary for the research purpose. We will ask for your specific
permission if the research involves treatment. If you are asked for such
permission, you have the right to refuse.
Worker’s compensation. We may use and disclose your protected health
information as necessary to comply with worker’s compensation laws regarding
work-related injuries or illness.
Change of Ownership. In the event that West Virginia University
School of Dentistry or University Health Associates is sold or merged with
another organization, your health information/record will become the property of
the new owner.
3. YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the right to inspect and obtain a copy of your protected health
information. This means you may inspect and obtain a copy of your
protected health information about you that is contained in a designated record
set for as long as we maintain the protected health information. A
“designated record set” contains health and billing records and any other
records that your health care provider or clinic use for making treatment
decisions about you, except for psychotherapy notes.
To request a copy of your dental health information, contact the WVU
School of Dentistry, Office of Clinic Administration, P.O. Box 9401, Morgantown,
WV 26506-9401 or call (304) 293-2240. To request a copy of your
dental billing information, contact the UHA Dental Billing Office, P.O. Box
9401, Morgantown, WV 26506-9401 or call (304) 293-6129.
You have the right to request restrictions or limitations on certain uses and
disclosures of your protected health information. This means you may
ask us not to use or disclose any part of your protected health information for
the purposes of treatment, payment or healthcare operations. You may also
request that any part of your protected health information not be disclosed to
family members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. In your
request, you must tell us (1) what information you want restricted, (2) whether
you want to restrict our use, disclosure or both, (3) to whom you want the
restriction to apply, for example, disclosures to your spouse, and (4) an
expiration date.
We are not required to agree to a restriction that you may request. If the
health care provider believes it is in your best interest to permit use and
disclosure of your protected health information, then it will not be restricted.
If your health care provider does agree to the requested restriction, we may not
use or disclose your protected health information in violation of that
restriction unless it is needed to provide emergency treatment. With this in
mind, please discuss any restriction you wish to request with your health care
provider.
To request a restriction of your dental health information, please send
your written request to the WVU School of Dentistry, Office of Clinic
Administration, P.O. Box 9401, Morgantown, WV 26506-9401 or call (304)
293-2062
You have the right to request to receive confidential communications from us
by reasonable alternative means or at an alternative location. You
have the right to request that we communicate with you about dental matters in a
certain way or at a certain location. For example, you can ask that we
only contact you at work or by mail.
To request confidential communications of your dental health information,
contact the WVU School of Dentistry, Office of Clinic Administration, P.O. Box
9401, Morgantown, WV 26506-9401 or call (304) 293-2062. If you wish
that your dental billing information be sent to another address, contact the UHA
Dental Billing Office, P.O. Box 9401, Morgantown, WV 26506-9401 or call
(304) 293-6129.
You have a right to request that we amend your protected health information
that is in your designated record set. We will consider your request
and will make amendments based on the profesional opinion of the health care
provider who originated the entry. However, if the health care provider
believes the entry should not be amended, we are not required to make the
amendment. We will inform you about the denial and how you can disagree
with the denial.
For more information about requesting amendments to your dental
designated record set, contact the WVU School of Dentistry, Office of Clinic
Administration, P.O. Box 9401, Morgantown, WV 26506-9401 or call (304)
293-2062.
You have a right to receive a list of instances in which we disclosed your
health information for purposes other than treatment, payment or health care
operations and certain other activities for the last 6 years, but not before
April 14, 2003. This right does not apply to information provided to you,
information directory, and certain government functions as addressed in this
Notice of Privacy Practices.
To request an accounting of dental disclosures, contact the WVU School of
Dentistry, Office of Clinic Administration, P.O. Box 9401, Morgantown, WV
26506-9401 or call (304) 293-2062.
If you received this notice on our Web site or by electronic mail (e-mail), you
are entitled to receive this notice in written form. You may obtain a copy
of this Notice by calling 1-877-334-2209.
4. CONTACT INFORMATION AND COMPLAINTS
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 in confidence by
alternative means or at an alternative location, 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 protect the privacy of your health information.
You will not be penalized for filing a complaint. 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.
Concerns about this Notice of Privacy Practices or how your protected health
information is used or disclosed should be directed to any of the contacts
listed below:
Dental Clinic Administration
304-293-2062
University Health Associates Compliance Department
1-877-334-2209
West Virginia University Health Sciences Center
Legal Services/Risk Management
304-293-3584