Privacy Policy
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.
Sparkle Orthodontics is committed to maintaining and protecting the confidentiality of our patients’ personal health information,
also referred to as Protected Health Information (PHI). This Notice describes your privacy rights, our legal duties, and the ways
we may use and disclose your health information.
If you have any questions about this Notice or would like more information, please contact us at
hello@sparklevaorthodontics.com.
Our Commitment to Your Health Information
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, and follow the terms of the Notice currently in effect.
How We May Use and Disclose Health Information
For Treatment
We may use and disclose your health information to provide, coordinate, or manage your treatment and related health care services.
This may include sharing information with doctors, nurses, technicians, or other personnel involved in your care.
For Payment
We may use and disclose your health information to bill and collect payment from you, your insurance company, or another third party
for the services you received.
For Health Care Operations
We may use and disclose your health information for health care operations, including quality assessment, employee review, training,
licensing, and other business management activities necessary to operate our practice.
Appointment Reminders and Health-Related Services
We may use and disclose your health information to contact you with appointment reminders, information about treatment alternatives,
or other health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care
When appropriate, we may share your health information with a family member, friend, or other person involved in your care or payment
for your care, unless you object.
Research
Under certain circumstances, we may use and disclose your health information for research purposes, subject to applicable legal and
ethical requirements.
Special Situations
We may disclose your health information when required or permitted by law, including in the following situations:
- As required by federal, state, or local law
- To avert a serious threat to health or safety
- To business associates performing services on our behalf
- For public health activities
- For health oversight activities
- For workers’ compensation claims
- In response to court orders, subpoenas, or legal proceedings
- For law enforcement purposes
- To coroners, medical examiners, and funeral directors
- For national security and protective services
- For inmates or individuals in custody, when applicable
- For data breach notification purposes
Uses and Disclosures Requiring an Opportunity to Object
Unless you object, we may disclose relevant health information to a family member, relative, close friend, or other person you identify
as involved in your care or payment for your care. We may also disclose information to disaster relief organizations when appropriate.
Uses and Disclosures Requiring Your Written Authorization
Other uses and disclosures of your Protected Health Information not covered by this Notice will be made only with your written authorization.
This includes:
- Most uses and disclosures for marketing purposes
- Disclosures that constitute the sale of your Protected Health Information
You may revoke your authorization at any time in writing, except to the extent that we have already acted in reliance on it.
Your Rights Regarding Your Health Information
Right to Inspect and Copy
You have the right to inspect and request a copy of the health information that may be used to make decisions about your care or payment
for your care.
Right to an Electronic Copy
If your health information is maintained electronically, you may request an electronic copy of your record in a readily producible format.
Right to Get Notice of a Breach
You have the right to be notified if there is a breach involving your unsecured Protected Health Information.
Right to Amend
If you believe your health information is incorrect or incomplete, you may request that we amend it in writing.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures of your health information made by our office.
Right to Request Restrictions
You may request restrictions on how we use or disclose your health information for treatment, payment, or health care operations.
We are not always required to agree, except in certain cases such as out-of-pocket payment in full for a specific item or service.
Right to Request Confidential Communications
You may request that we communicate with you in a certain way or at a certain location, such as by mail or at a specific phone number.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Changes to This Notice
We reserve the right to change this Notice and make the revised Notice effective for all Protected Health Information we maintain.
Any updated Notice will be made available through our office and website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department
of Health and Human Services. All complaints must be made in writing. You will not be penalized for filing a complaint.
Contact Information
Sparkle Orthodontics
www.sparklevaorthodontics.com
3223 Duke Street. Suite H
Alexandria, VA. 22314
United States
Email: hello@sparklevaorthodontics.com
Phone: (703) 793-7705
Fax: (703) 423-0037