Get Started Today!

In Whitesboro, Texas

We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy that are described in this Notice while it is in effect. The Notice takes effect 10/26/2020 and will remain in effect until we replace it.

We reserve the right to change our privacy practices and terms of this Notice at any time, provided such changes are permitted by applicable law, and to make Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request. 

For Treatment. We may use your health information to provide you with dental treatment or services. For example, we may disclose your health information to a specialist providing treatment to you.

For Payment. We may use and disclose your health information so that we may bill and collect payment from you, an insurance company, or someone else for dental care services you receive from MSDS. We may also tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will pay for the treatment.

Individuals Involved in Your Care or Payment for Your Care. We may disclose your health information to your family or friends, or any other individual identified by you when they are involved in your care. If a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.

OTHER PERMITTED USES AND DISCLOSURES OF HEALTH CARE INFORMATION.
We may use or disclose your health information without your permission in the following circumstances, subject to all applicable legal requirements and limitations:

1. Required By Law. As required by federal, state, or local law.
2. Public Health Activities. For public health reasons to prevent or control disease, injury or disability; or to report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications, school immunizations under certain circumstances or problems with products.
3. Victims of Abuse, Neglect or Domestic Violence. To a government authority authorized by law to receive reports of abuse, neglect or domestic violence when we reasonably believe you are the victim of abuse, neglect or domestic violence and other criteria are met.
4. Health Oversight Activities. To a health oversight agency for audits, investigations, inspections, licensing purposes, or as necessary for certain government agencies to monitor the health care system, government programs, and compliance with civil rights laws.
5. Lawsuits and Disputes. In response to a subpoena, discovery request or a court or administrative order, if certain criteria are met.
6. Law Enforcement. To a law enforcement official for law enforcement purposes as required by law; in response to a court order, subpoena, warrant, summons or similar process; for identification and location purposes if requested; to respond to a request for information on an actual or suspected crime victim; to report a crime in an emergency; to report a crime on OHSU premises; or to report a death if the death is suspected to be the result of criminal conduct.
7. Coroners, Medical Examiners and Funeral Directors. To a coroner or medical examiner, (as necessary, for example, to identify a deceased person or determine the cause of death) or to a funeral director, as necessary to allow him/her to carryout his/her activities.
8. Research. For research purposes under certain limited circumstances. Research projects are subject to a special approval process. Therefore, we will not use or disclose your health information for research purposes until the particular research project, for which your health information may be used or disclosed, has been approved through this special approval process.
9. Serious Threat to Health or Safety; Disaster Relief. To appropriate individual(s)/organization(s) when necessary (i) to prevent a serious threat to your health and safety or that of the public or another person, or (ii) to notify your family members or persons responsible for you in a disaster relief effort.
10. National Security; Intelligence Activities; Protective Service. To federal officials for intelligence, counterintelligence, and other national security activities authorized by law, including activities related to the protection of the President, other authorized persons or foreign heads of state, or related to the conduct of special investigations.
11. Workers’ Compensation. As necessary to comply with laws relating to workers’ compensation or similar work-related injury program.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION. You have certain rights regarding your health information which we list below. In each of these cases, if you want to exercise your rights, you must do so in writing by completing a form that you can obtain from the OHSU Information Privacy and Security Office, Mail Code ITG09, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, or on the Web at http://www.ohsu.edu/xd/about/services/information-technology/information-privacy-security-ips/policies-forms.cfm. In some cases, we may charge you for the costs of providing materials to you. You can get information about how to exercise your rights and about any costs that we may charge for materials by contacting the MSDS Information Privacy and Security Office at 903-564-3451.

1. Right to Inspect and Copy. With some exceptions, you have the right to inspect and get a copy of the health information that we use to make decisions about your care. For the portion of your health record maintained in our electronic health record, you may request we provide that information to or for you in an electronic format. If you make such a request, we are required to provide that information for you electronically (unless we deny your request for other reasons). We may deny your request to inspect and/or copy in certain limited circumstances, and if we do this, you may ask that the denial be reviewed.
2. Right to Amend. You have the right to amend your health information maintained by or for MSDS or used by MSDS to make decisions about you. We will require that you provide a reason for the request, and we may deny your request for an amendment if the request is not properly submitted, or if it asks us to amend information that (a) we did not create (unless the source of the information is no longer available to make the amendment); (b) is not part of the health information that we keep; (c) is of a type that you would not be permitted to inspect and copy; or (d) is already accurate and complete.
3. Right to an Accounting of Disclosures. You have the right to request a list and description of certain disclosures by MSDS of your health information.
4. Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you (a) for treatment, payment, or healthcare operations, (b) to someone who is involved in your care or the payment for it, such as a family member or friend, or (c) to a health plan for payment or health care operations purposes when the item or service for which MSDS has been paid out of pocket in full by you or someone on your behalf (other than the health plan). For example, you could ask that we not use or disclose information about a surgery you had, a laboratory test ordered, or a medical device prescribed for your care. Except for the request noted in 4(c) above, we are not required to agree to your request. Any time MSDS agrees to such a restriction, it must be in writing and signed by the MSDS Privacy Officer or his or her designee.
5. Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain place. MSDS will accommodate reasonable requests. For example, you can ask that we only contact you at work or by mail.
6. Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice, whether you may have previously agreed to receive the Notice electronically.
7. Right to be Notified of a Breach. You have the right to be notified if there is a breach – a compromise to the security or privacy of your health information -due to your health information being unsecured. MSDS is required to notify you within 60 days of discovery of a breach.

QUESTIONS OR COMPLAINTS.
If you have any questions about this Notice, please contact MSDS 903-564-3451. If you believe your privacy rights have been violated, you may file a complaint with MSDS or with the Secretary of the Department of Health and Human Services. To file a complaint with MSDS, contact Jackie Gonzalez at 903-564-3451. You will not be penalized for filing a complaint.

Request Your Appointment Today!

Main Street Dental Smiles makes requesting your appointment easy. Fill out the form and we’ll be in touch to set your appointment time. We can’t wait to see you.

Request Appointment