How We Collect
Information About You
The staff of the Center for TMJ & Sleep Disorders. collects data through a variety of means including but not necessarily limited to letters, phone calls, emails, voicemails, and from the submission of insurance claims that are necessary to process applications or other requests for assistance through our organization.
What We Do Not Do with Your Information:
Information about your financial situation and medical conditions and care that you provide to us in writing, via email, on the phone (including information left on voicemails), contained in or attached to applications, or directly or indirectly given to us, is held in strictest confidence.
We do not give out, exchange, barter, rent, sell, lend, or disseminate any information about patients who receive our services that are considered patient confidential, restricted by law, or specifically restricted by a patient/client in a signed HIPAA consent form.
How We Do Use Your Information:
Information is only used as is reasonably necessary to provide you with health or counseling services which may require communication between our office and other health care providers, medical product or service providers, pharmacies, insurance companies, and other providers necessary to verify your medical information is accurate and determine the type of medical supplies or health care services you need. This is including, but not limited to, or to obtain or purchase any type of medical supplies, devices, medications, or insurance.
If you wish to receive care through us and provide information with the intent or purpose of fraud or that results in either an actual crime of fraud for any reason including willful or un-willful acts of negligence whether intended or not, or in any way demonstrates or indicates attempted fraud, your non-medical information can be given to legal authorities including police, investigators, courts, and/or attorneys or other legal professionals, as well as any other information as permitted by law.
Information We Do Not Collect:
Limited Right to Use Non-Identifying Personal Information from Biographies, Letters, Notes, and Other Sources:
Any pictures, stories, letters, biographies, correspondence, or thank you notes sent to us become the exclusive property of the Center for TMJ & Sleep Disorders, LLC. We reserve the right to use non-identifying information about our clients (those who receive services or goods from or through us) for fundraising and promotional purposes that are directly related to our mission.
Patients will not be compensated for use of this information and no identifying information (photos, addresses, phone numbers, contact information, last names or uniquely identifiable names) will be used without the client’s express advance permission.
You may specifically request that NO information be used whatsoever for promotional purposes, but you must identify any requested restrictions in writing. We respect your right to privacy and assure you no identifying information or photos that you send to us will ever be publicly used without your direct or indirect consent. Our office recommends communication with your dental and health care providers to obtain the maximum results for treatment.
Patients understand that they have certain rights to privacy regarding their protected health information. They understand this information can and will be used to:
Conduct, plan, and direct their treatment and follow up among the multiple healthcare providers who may be involved in that treatment directly and indirectly.
Obtain payment from third-party payers (insurance).
Conduct normal healthcare operations at any time at the address below to obtain a current copy of the Notice of Privacy Practices.
Patients understand that they have been informed of our Notice of Privacy Practices containing a more complete description of the uses and disclosures of their health information. Patients are given the right to review such Notice of Privacy Practices prior to signing our HIPAA consent. Patients understand that this organization has the right to change its Notice of Privacy Practices from time to time and that they may contact this organization at any time at the address below to obtain a current copy of the Notice of Privacy Practices.
Patients understand that they may request in writing that they restrict how their private information is used or disclosed to carry out treatment, payment, or health care operations. Patients also understand they are not required to agree to my requested restrictions, but if they do agree then they are bound to abide by such restrictions.
Patients understand that they may revoke their consent in writing at any time, except to the extent that they have taken action relying on this consent.