Garret S. Madderra, DDS,LP
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.
Garret S. Madderra, DDS,LP. uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Garret S. Madderra, DDS,LP.
How Garret S. Madderra, DDS, LP. May Use or Disclose Your Health Information
For Treatment: Garret S. Madderra, DDS ,LP may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider,such as a physician, nurse or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment: Garret S. Madderra, DDS, LP may use and disclose your health information to others for purpose of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis and treatment or supplies used in the course of treatment.
For Health Care Operations: Garret S. Madderra, DDS, LP may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk, or quality improvement, personnel and others to:
- evaluate the performance of our staff
- assess the quality of care and outcomes in your case and similar cases
- learn how to improve our facilities and services
- determine how to continually improve the quality and effectiveness of the health care we provide
Appointments: Garret S. Madderra, DDS LP may use your information to provide appointment reminders and information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.
Required by Law: Garret S. Madderra, DDS, LP may use and disclose information about you as required by law. For example, Garret S. Madderra, DDS, LP may disclose information for the following purposes:
- for judicial and administrative purposes
- to report information related to victims of abuse,neglect or domestic violence
- to assist law enforcement officials in their enforcement duties
Public Health: Your health information may be used to disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
Decedents: Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Organ/Tissue Donation: Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
Health and Safety: Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person persuant to applicable law.
Government Functions: Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.
Workers Compensation: Your health information may be used or disclosed in order to comply with laws and regulations related to Workers Compensation.
Other Uses: Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent Garret S. Madderra DDS LP has taken action in reliance on such.
Your Health Information Rights
You have the right to:
- request a restriction on certain uses and disclosures or your information as provided by 45 C.F.R. S164.522: however, Garret S. Madderra DDS LP is not requires to agree to a requested restriction.
- obtain a paper copy of the notice of information practices upon request, inspect, and obtain a copy of your health record as provided for in 45 C.F.R. S164.524.
- request that your health record be amended as provided in 45 C.F.R S164.526.
- request communications of your health information by alternative means or at alternative locations.
- receive an accounting of disclosures made of your health information.
The California State Dental Board updated the Dental Materials Fact Sheet on May 14, 2004 to a more consumer-friendly format. The Business & Professions Code, Section 1648.15, requires that we provide access to an updated fact sheet to every new patient and to patients of record before performing restorative dental treatment. This form only needs to be provided once, but will be available for your perusal at anytime at the link provided above through the Dental Board of California website or on this web page to the right. You can read through the Dental Materials Fact Sheet by clicking through the pages. If you prefer, you may request a printed copy of the most recent Dental Materials Fact Sheet at our office. We ask that you carefully read the Dental Materials Fact Sheet, then sign the acknowledgement form prior to starting restorative dental work in our office. If you have any questions regarding the form, please feel free to ask.