The Office of Dr. Julie Staggers

      Federal law now requires all health care professionals to maintain the privacy of protected health information.  This notice describes how your medical and personal information may be used and disclosed and how you can obtain access to this information.  Dr. Staggers' office policies regarding your health information and your personal information (address, phone number, social security number, etc.) have not changed.  However, a new federal law requires that you be informed of the office's policies regarding the use of information that you provided to the office.  Please review this carefully.

      "Protected health information" includes any information obtained from you or others that relates to your physical or mental health, your dental health, the type and dates of treatment and payments for that treatment.  This also includes, but is not limited to, telephone numbers, home address, social security number, place of employment, patient age and identity of person paying for treatment.  Protected health information also includes any information provided by you on behalf of your child.  This notice provides you with information about your rights and this office's legal duties and practices with respect to the privacy of protected heath information.  This notice also discussed the uses and disclosures that this office will make of your protected health information.  This office complies with the provisions of this notice, but may revise the notice at any time and make the revised notice effective for all protected information maintained in this office.  You can always request a copy of the most current privacy notice.

Permitted Uses and Disclosures  

This office can use or disclose your or your child's protected health information for the purposes of treatment, payment or health care operations.

Treatment is the management of your or your child's orthodontic treatment, including consultations with other dentists, physicians or other health care professions.  These consultations may be over the telephone, by e-mail or written.  For example, Dr. Staggers may contact your physician to discuss your heart condition to see if there are any contraindications to orthodontic treatment or to see if special medications will be needed so that orthodontic treatment can be rendered.  Another example:  Dr. Staggers may send a letter to your general dentist describing the proposed orthodontic treatment, request extraction of certain teeth, request restoration of tooth decay or request some other dental treatment.  

Payment is any activity undertaken in order to receive money for the orthodontic treatment provided.  This includes all communications, verbal or written, to insurance companies,  cafeteria plans and collection agencies, if needed.  This also includes family or non-family members that are paying for orthodontic treatment.  This office routinely provides information including, but not limited to, a diagnosis, a treatment plan, a treatment fee, treatment dates, social security number and home address to insurance companies in order to file insurance claims.

Health care operations refers to any support function of this practice related to treatment and payment.  This includes, but is not limited to, communication with dental laboratories, audits, quality assurance programs, responding to patient complaints, business planning, case management and administrative activities.  Photographs may be used for educational purposes and may be placed in the office photography albums.

Disclosures Related to Communication with You, Your Family Members and Friend

  This office may contact you by mail or telephone to provide appointment reminders, to request the scheduling of appointments, to request information about insurance coverage, to provided information about problems arising during treatment or to provide other information related to orthodontic treatment.  Messages may be left on answering machines or with persons answering the telephone.  Specific messages regarding payments will NOT be left on answering machines.  Letters and bills from this office will be sent as first class mail and will be available to anyone who has access to your mail.  This office may disclose your protected information to family, friends or any other individual accompanying your child to an orthodontic appointment or anyone involved in payment for the orthodontic treatment.  This office will only disclose the protective health information that is directly relevant to their involvement.  If you are present at an appointment, you may request that private information not be disclosed.  If you are not present in the office, this office will determine whether a disclosure to your family member or person accompanying your child is in your best interest and will only disclose information that is directly relevant to their involvement in the patient's care.  For example:  If you can not attend an appointment and a neighbor brings your child to an orthodontic appointment with a check from you, Dr. Staggers may discuss orthodontic instructions or a problem with your child's treatment with your neighbor so that you can be made aware of the problem.  In addition, the office may provide a copy of your account to your neighbor showing that your payment was recorded.  However, Dr. Staggers would not disclose your child's HIV status, since that is not relevant to the neighbor's providing transportation and payment.

     In addition, this office will allow family members or other individuals sent by you to schedule appointments and pick up copies of X-rays, elastics, wax, dental models and other orthodontic devices and instructions on your behalf, when it is determined in Dr. Staggers' profession judgement, that it is in your best interest.  Please be aware that non-custodial parents will be granted access to a child's orthodontic and financial records unless a specific request is made to this office in writing.

Other Disclosure Situations

Military Veteran:  This office may release health information as requested by military command authorities.

Worker Compensation:  This office may release health information that relates to a work-related injury in this office.

Public Heath Risk:  This office may disclose health information about you or your child that relates to public health activities including, but not limited to, suspected child abuse, infectious diseases status and reactions to medications.

State Dental Board:  This office may disclose health information as requested by the Virginia Board of Dentistry or any other licensing or regulating board.

Law Suits and Law Enforcement:  This office may disclose protected information if you are involved in a law suit or at the request of any law enforcement official. 

Coroners, Medical Examiners, Funeral Directors, Disaster Relief:  This office may disclose protected information to identify a deceased person or to determine the cause of death.  This office may release health information to funeral directors as necessary to carry out their duties.

Serious Threats:  As permitted by law, this office may release protected information that in good faith is believed to be necessary to prevent or lessen the severity of an imminent threat to public health and safety.

Use of Records

Dr. Staggers may use before and after photographs of patients in the waiting room photograph albums, in computer presentations, advertisements, on a web site and scientific lecture presentations. Radiographs, photographs and models may be used in scientific lectures and for other educational purposes.  Photographs may also be used in office educational materials.  Patient names are not used in any of these materials.  If you do not want your records used in this manner, please notify Dr. Staggers.  

Your Rights

1. You have the right to request restrictions on the uses and disclosures of private information.  Within reason, this office will try to honor these requests.  However, this office is NOT LEGALLY required to honor to your request.

2. You have the right to request that communications regarding your private health or payment information be sent to a specific location (a home address only, a specific P. O. Box, etc. ) or that a certain mean of communication be used (by mail only, not by telephone, not by e-mail, etc.).  

3. You have the right to inspect or obtain a copy of protected health information contained in your chart or billing records.  A copy fee may be charged.  There may be some restrictions as designated by law.  

4. You have the right to request a correction of your protected health information.  This request can be rejected if the corrected information is not verifiable, not accurate, not complete or is not part of your medical or billing records.  Any corrections will be in addition to, not a replacement of, existing records.

5. You have the right to receive a record of whom this office has disclosed your protected health information, except for disclosures made in association with treatment, payment, health care operations, persons involved in your care or national security or intelligence purposes.  

6. You have the right to receive a copy of this privacy notice.  

7. The above rights may be exercised only in witting.  Any revocation or other modification of consent must be delivered in writing to this office.

Complaints

If you believe that your privacy rights have been violated, you should contact Dr. Staggers at 3052 Valley Ave., Suite 100 ; Winchester , VA   22601 .  All complaints must be submitted in writing.  You may also file a complaint with the Secretary or Health and Human Services.

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