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HIPAA Policy


 The Health Insurance Portability & Accountability Act of 1996 (HIPAA) is a federal program that requires all medical/dental records and other individually identifiable health information use or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential.  HIPAA has generated a privacy rule, which has been mandated as of April 14, 2003.  This Act gives you, the patient significant new rights to understand and control how your health information is used. 

Any health care professional authorized to enter information into your dental record, all faculty, staff and dental hygiene students at this clinic who may need access to your information must abide by this Notice.  Our clinic teaching program is dedicated to maintaining the privacy of your “Protected Health Information” or “PHI” and to provide you with this Notice of our legal duties and privacy practices with respect to health information. 


Other uses and disclosures of medical and dental information not covered by this Notice or the laws that apply to us will be made only with your written authorization.  If you give us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time.  You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care we have provided you.


 You have the right to:

  • request that additional restrictions be placed on the use and 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).
  • request that we communicate with you about your health information by alternative means or locations.
  • request that we amend your health information.  Again your request must be in writing, and we hold the right to deny your request under certain circumstances.
  • obtain a paper copy of this notice form upon request in writing.
  • receive confidential communications of protected health information.
  • request in writing if you believe there is a mistake in your health information, or that a piece of important information is missing.  If we approve the request, we will make the change to your health information and tell you that we have done so.


We use and disclose information about you without authorization for the following purposes:

Treatment:  We may use your health information to provide you with medical/dental treatment or services.  We may disclose health information about you to physicians, technicians or other office personnel who are involved in your medical care and treatment.

Health Care OperationsWe may use and disclose medical information about you for health care operations to assure that you receive quality care.

Appointment RemindersWe may use and disclose your health information in connection with our efforts to remind you that you have an appointment or give you information about treatment alternatives or other health care services that may be of interest to you.  This would include calling patients at home and/or at work (including leaving voice messages). 

As Required by Law:  We will use and disclose your health information when we are required to do so by federal, state or local law.