How our office collects, uses and discloses patient's personal information
- To deliver save and efficient patient care and ensure continuous high quality service
- To assess your health needs and provide health care
- To advise you of treatment options
- To establish and maintain communication with you by phone or mail
- To offer and provide dental care to you
- To communicate with other treating health-care providers, including specialists and general dentists
- To allow us to efficiently follow-up for treatment, care and billing
- For teaching and demonstration purposes on an anonymous basis
- To complete and submit dental claims for third party adjudication and payment
- To comply with legal and regulatory requirements., including the delivery of patients’ charts and records to any and all regulatory bodies when required
- To comply with agreement/undertakings entered into voluntarily by all dentists with all governing bodies, including allowing access to the records for regulatory and monitoring purposes
- To permit a third party to evaluate the dental practice for an audit or evaluation
- To deliver your charts and records to the patient’s insurance carrier if required
- To prepare materials for the Health Professions Appeal and Review Board (HPARB)
- To invoice for goods and services
- To process credit card payments
- To collect unpaid accounts
- To comply generally with the law
Our office will not under and conditions supply your insurer with your confidential medical history. In the event this kind of a request is made, we will forward the information directly to you for review, and for your specific consent.
When unusual requests are received, we will contact you for permission to release such information. We may also advise you if such a release is inappropriate.
You may withdraw your consent for use or disclosure of our personal information, and we will explain the ramifications of that decision, and the process.
I have reviewed the above information that explains how your office will use my personal information, and steps your office is taking to protect my information.
I know that your office has a Privacy Code, and I can ask to see the Code at any time.
I agree that Dr. Paolasini and associates can collect and use and disclose personal information about myself.
In addition, I hereby authorize the release of information contained in claims to be submitted electronically to my insuring company and the sending of pre-determinations to my insuring company to determine coverage where required.
I agree that Dr. Paolasini and associates can collect, use and disclose personal information about the person listed on this document as set out above in the information about the office’s privacy policies.