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
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.
We may use or disclose your health
information to provide you with
reminders (such as voicemail messages, postcards or letters).
Your Health Information Rights:
You have the right to:
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
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