Notice of Privacy Practice and Consent

Smile Dental Studio Glenview, Dr. Maja Simic, and Associates; believe our patients have the right to privacy and that their personal financial and health information should be kept confidential. Our belief in your right to privacy is nothing new.
However, new laws now require that we notify you about our privacy in writing.

How do we use your personal health information?
We will use your personal health information to provide, coordinate, or manage your dental treatment and any related services. This may include providing necessary information to pharmacy personnel, laboratory technicians, or to third parties health care providers. For example, we might need to disclose information, as necessary, to a physician or dental specialist to whom you have been referred to ensure that they have the necessary information to diagnose or treat you. Personal information may be given to your insurance company if necessary to facilitate payment of your claims. On occasion, your personal information may be used for/in supporting the practices of business operations. These activities include, but are not limited to, employee review activities, training of dental students, licensing, and conducting or arranging for other business activities. We may also call you by name in the reception area when we are ready to bring you back. We may use or disclose your protected health information, as necessary to contact you to remind you of your appointment or discuss any questions we may have regarding your account. We may also use or disclose your personal information in the following situations without your authorization as required by law: Public health issues/communicable diseases, abuse or neglect, Food and Drug Administration requirements, legal proceedings, law enforcement, coroners request, research, criminal activity, national security, and workers compensation.

What are your rights?
 You have the right to inspect and copy your personal information.
 You have the right to request a restriction of your personal information.
This means you may ask us not to use or disclose any of your personal information for the purposes of treatment, payment, or operations.
You may also request that any part of your information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested, in writing, and to whom you want the restriction to apply.
Your dentist is not required to agree to a restriction that you may request if your dentist believes it is in your best interest to permit the use and disclosure of such information, it will not be restricted. 
You have the right to use another Health Care Professional.
You have the right to request/receive confidential communications from us by alternative means or at an alternative location.
You have the right to have your dentist amend your personal health information.
You have the right to receive an accounting of certain disclosures we have made, if any, of your personal health information.
We have the right to change the terms of this notice and will inform you by mail of any changes.
You then have the right to object or withdraw as provided in this notice.

Complaints
You may complain to us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You can be assured there will be no ill-will following a complaint by you. We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected personal health information.