NOTICE OF PRIVACY POLICIES FOR

Dr. Alan P. Chun, D.D.S., M.D., Inc.

A Professional Corporation

Oral & Maxillofacial Surgery 9301 Fircrest Lane, Suite 2

San Ramon, CA 94583

Telephone (925) 833-8516

FAX (925) 833-8347

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

PLEASE REVIEW IT CAREFULLY.

Introduction

We are committed to treating and using protected health information about you responsibly. This notice of Health Information Practice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective 4-14-03 and applies to all protected health information as defined by the federal regulations.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

Each time you visit our office a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care of treatment. This information, often referred to as your health or medical record, serves as a:

Basis for planning your care and treatment
Means of communication among the many health professionals who contribute to your care
Legal document describing the care you received
Means by which you or a third-party payer can verify that services billed were actually provided
A tool in educating health professionals
A source of data for medical research
A source of information for public health officials charged with improving the health of this state and the nation
A source of data for planning and marketing
A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosures to others.

Your Health Information Rights

Although your health record is the physical property of Dr. Alan P. Chun, the information belongs to you. You have the right to:

Obtain a paper copy of this notice of information practices on request
Inspect and receive a copy of your health record as provided for in 45 CFR 164.524
Amend your health record as provided in 45 CFR 164.528
Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528
Request communications of your health information by alternative means or at alternative locations
Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522
Revoke your authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities

Our office is required to:

Maintain the privacy of your health information
Provide you with this notice as to our duties and privacy practices with respect to information we collect and maintain about you
Abide by the terms of this notice
Notify you if we are unable to agree to a requested restriction, and
Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us, or if you agree, we will email the revised to you.

We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we receive a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem

If you have questions and would like additional information you may contact the practice’s Privacy Officer: Stephanie Ortega at (510) 889-9701 or (925) 833-8516.

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or with the Office of Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington D.C. 20201

Examples of Disclosures for Treatment, Payment, and Health Operations

We will use your health information for treatment

For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your physician or subsequent health care provider with copies of various reports that should assist him or her in your treatment. This is to include all health care providers in our practice and those assisting in coverage of our practice.

We will use your health information for payment.

For Example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations

For Example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.

This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. We may leave a message on your answering machine or on voicemail as a means of communication. We may mail you a postcard or written notice as a means of communication. We may email you or our transcriptionists as a means of communication.

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Food and Drug Administrations (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

To receive a physical copy of our privacy policy, please contact the front office.

Other Patient Information Pages

We have consolidated all of the most important information that you will need before, during, and after time here as a patient.

First Visit

Once you or your dentist has determined that you need to see Dr. Chun, the first thing you need to do is call our office to schedule an appointment. When you call our office our receptionist, Stephanie, will likely be the one to assist you. She will ask you to bring three things: referral slip, x-rays, list of medications, and insurance information. Read more >>

Scheduling

Dr. Alan P. Chun, DDS, MD, Inc. is open Monday through Thursday from 8 a.m. until 5 p.m. and Friday from 8 a.m. until 2 p.m. We will schedule your appointment as promptly as possible. If you have pain or an emergency situation, every attempt will be made to see you that day. Read more >>

Financial Information & Policy

For your convenience, we accept, cash, personal checks, and most credit cards. Payment is due at time of service. We deliver the finest care at the most reasonable cost to our patients. Therefore, payment is due at the time service is rendered. If you have questions regarding your account, please contact us or call our office at 925-833-8516. Read more >>

Insurance

At Eastbay OMS we make every effort to provide you with the finest care and most convenient financial options. We work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. Remember to please bring your insurance information with you to the consultation so that we can expedite reimbursement. Read more >>

Frequently Asked Questions

Compilation of all of the questions we get asked most frequently by patients. Read more >>