Notice of Privacy Practices

NOTICE OF PRIVACY PRACTICES
Dr. Lawrence S. Brannon - 683 Berkmar Court - Charlottesville, Virginia 22901 (434-974-4555)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION.

Your health information is confidential. All forms of communication of health information will be treated in a confidential manner. It will be treated as such by all office personnel regardless of position. Every effort will be made to ensure that all patient information remains out of public access within the office. Additionally, every effort will be made to ensure that the total privacy of the information is maintained during all conversations between patient and office personnel including those involved in coordination of patient care and patient billings.
Further clarifications:

Information collected and documented regarding your health is strictly confidential. This includes all electronic, written or oral medical records and other individually identifiable health information involving topics covered before, during, and after an examination, during our office telephone conversations, while obtaining laboratory and x-ray results, and when receiving medical/dental information from other offices, etc.
This information is only to be used for the purpose of promoting your better health, submitting claims, and obtaining benefit information to/from your insurance company on your behalf. Examples of this would include speaking with or sending health information to other doctor/dentist offices, laboratories, and to your insurance company for billing purposes.
You may, at any time, request restrictions on the use of or disclosure of your health information. You may direct this office to share, or not to share, any or all of your personal health information with any specific person or entity. You should submit this in writing to the attention of Dr. Brannon. After review, such written request will be incorporated into your dental record. Further, you may request a disclosure history identifying all entities that have received any of your health information prior to the last 60 days of the date of such request.
You may request a review of your dental record at any time during office hours. Your request to review your record will be forwarded to Dr. Brannon, who shall, at a mutually convenient time, present you with your dental record. Other office personnel are not permitted to present you with your record.
You have the right to request amendments or corrections to potentially harmful errors that you may discover within your dental record. Corrections will be made to your record if an error is confirmed.
You have the right to receive copies of any portion of your dental record. Such request should be submitted in writing to the attention of Dr. Brannon. Any charges for making such copies shall be in compliance with Virginia State and Federal Guidelines.
Should you have any questions about the privacy policy or privacy practices of Dr. Brannon's office, you are encouraged to speak with the Office Manager or directly to Dr. Brannon.
In order to respect the privacy of other patient's health/dental information, we ask that you refrain from inquiring about friends and family members who may also receive care in this office.
Office personnel may attempt to contact you as a reminder of upcoming appointments. These reminders may be left on answering machines at the phone numbers you have supplied to us. If you wish to make other arrangements or desire for the office to refrain from leaving such messages, please advise the office in writing so that we may place such a request into your dental record.

* Acknowledgement of Receipt of Privacy Practices Notice *

Signature: ______________________________________________

Date: ___________________

© Copyright 2003- Dental WebSmith, Inc. and Lawrence S. Brannon, DMD. All rights reserved. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.