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- 3 Locations
- (316) 630-9339
You have the right to inspect and obtain a copy of your health information that may be used to make decisions about your benefits under the applicable plans. If you request a copy, we may charge a fee for the costs of copying, mailing, or other supplies related to your request.
We may deny access in certain limited circumstances. If you are denied access, you may request a review of the denial. If we do not maintain the health information but know where it is kept, we will inform you where to direct your request.
If you believe that any of your health information is incorrect or incomplete, you may request an amendment. You may do so as long as the information is maintained by or for your benefit plan. Your request must be in writing and include a reason to support the amendment.
We may deny your request if:
It is not in writing or does not include a valid reason.
The information was not created by us (unless the creator is no longer available to amend it).
The information is not part of the medical records you’re allowed to inspect.
The information is accurate and complete.
You have the right to request that we communicate with you about health-related matters in a specific way or at a specific location (e.g., only by mail or only at work). You don’t need to give a reason for your request, and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
You have the right to request a restriction on how we use or disclose your health information for treatment, payment, or healthcare operations. You may also limit disclosures to people involved in your care or payment for your care (e.g., family or friends).
While we are not required to agree to every request, if we do agree, the restriction may only be removed by:
Your written request,
Mutual agreement, or
A unilateral decision by us (applicable only to future records and with prior notice).
To request a restriction, your written request must include:
What information you want to limit,
Whether you want to limit use, disclosure, or both, and
To whom the restrictions should apply (e.g., your spouse).
We are required to comply with your restriction request if:
The disclosure is to your benefit plan for payment or healthcare operations (not treatment), and
The information pertains solely to a service or item paid out-of-pocket in full.
You have the right to request a list (an “accounting of disclosures”) showing certain disclosures of your health information made by the Plan.
You may receive an accounting if the disclosure was:
Required by law,
Made for public health activities, or
Otherwise permitted under specific conditions.
You do not have the right to an accounting for disclosures made:
For treatment, payment, or healthcare operations,
To yourself,
As incidental to permitted disclosures,
With your authorization,
To family or friends involved in your care (when permitted),
For national security, intelligence, or law enforcement purposes, or
As part of a limited data set without identifying information.
To request an accounting:
Submit a written request with the time period (up to 6 years),
Specify your preferred format (paper or electronic),
The first request in a 12-month period is free; additional requests may incur a fee (you will be notified in advance and may adjust your request).
If requesting an accounting of disclosures of electronic health records, your time frame must not exceed 3 years prior to the request date. This only applies to disclosures made after the electronic record was acquired.
You may request a copy of this notice at any time, in print or electronic format.
For a detailed explanation of your rights, visit the HHS Consumer Rights Page.
At Wichita Family Dental, we may collect:
Treatment: When and as appropriate, we may use or disclose health information about you to facilitate treatment or services by health care providers, as well as to provide and manage your dental care. We may disclose health information about you to healthcare providers.
Payment: When and as appropriate, we may use and disclose health information about you to determine your eligibility for plans’ benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility and coverage under benefit plans, or to coordinate your coverage. For example, we may disclose information about your health history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to decide if your benefit plan will cover the treatment. Additionally, we may share health information with another entity to assist with the adjudication or subrogation of health claims, or with another health plan to coordinate benefit payments.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities. For example, we may disclose your protected health information to accrediting agencies as part of an accreditation survey. We may also call you by name while you are at our facility. We may use or disclose your protected health information, as necessary, for improving services, scheduling appointments, and quality assurance.
Legal Requirements: We may use or disclose your protected health information in the following situations without your authorization: as required by law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, Food and Drug Administration requirements, legal proceedings, law enforcement, criminal activity, inmates, military activity, national security, and Workers’ Compensation.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
We will always try to ensure that the health information used or disclosed is limited to a “Designated Record Set” and to the “Minimum Necessary” standard, including a “limited data set,” as defined in HIPAA and ARRA for these purposes. We may also contact you to provide information about treatment options or alternatives or other health-related benefits and services that may be of interest to you. We will never sell or share your information for marketing purposes without your explicit written consent.
The privacy laws of a particular state or other federal laws might impose a more stringent privacy standard. If these more stringent laws apply and are not superseded by federal preemption rules under the Employee Retirement Income Security Act of 1974 (ERISA), the benefit plans will comply with the more stringent law.
Wichita Family Dental takes patient privacy seriously and implements the following safeguards:
Use of secure, encrypted electronic health record (EHR) systems.
Employee training on HIPAA compliance and patient confidentiality.
Regular review of privacy practices and security protocols to prevent unauthorized access.
If you have any questions, concerns, or complaints regarding your privacy or this Notice, you may contact:
Wichita Family Dental
9339 East 21st Street, North Wichita, KS, 67206
(316) 234-1296
We are here to address your concerns promptly. Filing a privacy complaint will not affect the quality of care you receive at Wichita Family Dental.
Complaint: You can file a complaint if you feel we have violated your rights, with the office at the address above, or with the Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave, SW, Room 509F HHH Bldg., Washington, D.C. 20201, calling 1-877-696-6775, or by visiting: www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.