Contact Us

This Notice of Privacy Practices describes how your health information may be use and disclosed and how you can get access to this information. We are required by law to maintain the privacy of protected health information, provide notice of our legal duties with said information and inform of breaches of unsecured protected health information.We reserve the right to change our privacy practices and the terms of this Notice at any time permitted by law. A copy of this Notice is available upon request through the CONTACT information at the end of this form. We may use and disclose your health information for different purposes including treatment, payment and health care operations. Some information concerning HIV & Genetics, alcohol/substance abuse & mental health records may be entitled to special confidentiality protections under applicable state/federal law which we abide. We may use & disclose your health information for Treatment (specialists, etc), Payments (billing, collections, insurance eligibility & filing or 3rd party),Healthcare Operations (quality assessment, training, licensing), Individuals involved in your care determined by You or by Law, Disaster Relief & Recovery, anything Required by Law, Public Health Demands by Law (disease prevention or exposure, abuse, drug reactions,etc), National Security (armed forces & federal servicemen disclosures, correctional officer in custody of an inmate), Secretary of HHS (HIPPA), Worker's Compensation matters, Law Enforcement subpoena/court orders, Health Oversite Activities (audits, investigations, credentialing for licensure & government monitoring of healthcare systems and civil rights laws), Judicial & Administrative Proceedings (court orders, subpoena, discovery request after attempts to contact you first), Research, Coroners, Medical Examiners & Funeral Directors, SUD Treatment (substance use disorder covered by 42 CFR Part 2 Program by your consent), You may revoke an authorization in writing at any time and will cease at that time of reception except to the extent that we have already acted in reliance on the authorization. You have the right to look at or get copies of your health information, with limited exceptions by a request in writing using the Contact information. We will provide copies of information and will charge you a reasonable cost-based fee for supplies, labor & postage. Accounting Disclosures may also be available through written request and will be charged a reasonable fee if requested more than once per 12 month period. You have the Right to Request Restrictions by submitting a written request with the information you want to limit, whether to limit the use or disclosure or both and to whom you want the limits to apply.We are not required to agree with your request except in the case where the disclosure is to a health plan for the purpose of care item or service for which you  or a person on your behalf has paid our practice in full. Alternative communications may be requested and we will use the new methods but if we are unable to contact you we may contact you using the information we have. You may Amend your health information in writing and explain Why amending is requested. If we deny your request we will provide you a written explanation. You have the Right to Notification of a Breach of your unsecured protected health information as required by law. If you have any concerns about your Privacy Rights, you may contact us in any manner below. You may also submit a written complaint to the US Department of Health and Human Services as we support your right to privacy of your health information and we will not retaliate in any way if you choose to file a complaint with us or DHHS.  CONTACT: Office Manager: Tracey Fowler, 205-648-3212, or Office@SumitonDental.com or 44 Oak Drive, Sumiton, AL 35148