Notice of Privacy Practices












    This notice describes how health information about you and your child(ren)

     may be used and disclosed and how you can get access to this information. 


    Our Commitment to Privacy


    You have entrusted the practice of Thomas D. Jusino D.D.S., M.S. with the

    responsibility of providing orthodontic care of you and your family.  We are

    dedicated to maintaining your trust.  We know that the privacy of your

    personal medical information is important to you.  That is why we take our

    responsibility to protect the privacy of your personal medical information

    very seriously.


   Uses and Disclosures of Health Information:


    We use and disclose health information about you for treatment, payment and

    healthcare operations.  For example:




   Obtaining past treatment information and medical/dental history about you or

   your child(ren) and recording it in a health record.  During the course of

   treatment, the Doctor may determine the need to consult with another

   specialist, referring doctor or dentist, or primary care provider.




   We may use and disclose your health information to obtain payment for

   services we provide to you or your child(ren).


   Required by law:


   We may disclose your health information when we are required to do so by law.


   Appointment Reminders:


   We may use or disclose your health information to provide you with

   appointment reminders (such as voicemail messages, postcards or letters).


   Your Health Information Rights:


You have the right to:


   Ask for restrictions on the ways we use and give out information.  However,

   we are not required to do so in every case.


   Request a paper copy of the Notice of Privacy Practices for Protected Health

   Information.  Add information to your health record.




   If you believe your privacy rights have been violated, you may contact the

   Privacy Officer at our office.  You may also submit a written complaint to the

   U.S. Department of Health and Human Services.  We will provide you with the

   address to file your complaint upon request.


   We support your right to the privacy of your health information.  We will not

   retaliate in any way if you choose to file a complaint with us or with the

   U.S. Department of Health and Human Services.


Call today for your FREE EXAM (248) 476-3000