Patient Privacy

Understanding Your Health Information

Each time you visit Capitol Square Dental for care, a record of your visit is made. This record usually contains identification and financial information as well as symptoms, diagnoses, test results, a description of an oral examination and a treatment plan. This record is often referred to as your “medical record,” or “health information,” and includes information contained in paper as well as electronic records.

Our Duty to Protect Your Health Information

Under the Health Insurance Portability and Accountability Act of 1996 (a Federal law also known as “HIPAA”) Capitol Square Dental providers are required to keep your health information confidential, and to provide you with this notice of our legal duties and privacy practices. This notice describes how Capitol Square Dental providers use and disclose your health information.

Capitol Square Dental may change the terms of this notice if their privacy practices change or as federal or state requirements change. Each notice will have an effective date listed on the page. Capitol Square Dental providers reserve the right to make the amended notice effective for any health information Capitol Square Dental providers have at the time the change is made, as well as for future health information.

How Capitol Square Dental Providers May Use and Disclose Your Health Information

Capitol Square Dental providers use and disclose your health information for many different reasons, most of which are necessary to provide you with quality health care services. Federal and state laws do not require Capitol Square Dental providers to get your permission to perform many routine functions, especially those activities necessary to treat you, create and deliver bills for your treatment and other routine activities necessary to perform efficiently. Federal and state law also permits Capitol Square Dental to share this information with third parties that assist us in the performance of these routine functions. For some activities, however, federal and/or state law requires Capitol Square Dental providers to obtain written authorization.

Uses and disclosures of your health information for the purpose of providing you with medical care

Providing you with treatment, collecting payment, and conducting health operations are necessary activities for delivering health care. State and federal law permits Capitol Square Dental providers to use and disclose your health information for these purposes. The following are some examples of what constitutes treatment, payment, and health care operations:

  • A provider treating you for a jaw injury may need to know your medical condition and speak to your primary care physician. Lab work and x-rays may be sent out for viewing and reading.
    Capitol Square Dental providers may disclose your health information by phone, letter, fax, or online to people not affiliated with Center for Oral and Maxillofacial
  • Surgery who are involved in your medical care, such as your primary care physician, dentist or home health agency.
  • Capitol Square Dental may need to give your health insurance plan information about your surgery to receive payment.
  • Capitol Square Dental may also tell your health insurance plan about treatment to obtain approval or to determine whether your plan will pay for the treatment.
  • Capitol Square Dental may bill the person in your family who is responsible for payment or who pays for your health insurance.
  • Your health information may be used to review the performance and competence of the oral surgeon, dentist, surgical staff member and others involved in your care.
  • Capitol Square Dental providers may use your health information for administrative activities, or for accreditation, certification or licensing purposes.
  • Other uses and disclosures of your information that do not require your authorization

There are some instances, usually those in the “interest of the public,” when Capitol Square Dental providers are permitted or required by law to use and disclose your information without your authorization.

  1. Disclosure required by law
    Capitol Square Dental providers will disclose medical information about you when required to do so by federal or state laws.
  2. Public health activities
    Capitol Square Dental providers may disclose medical information about you for public health purposes. For example: Reporting certain conditions such as cancer and communicable diseases for purposes of monitoring, preventing and controlling disease, or reporting reactions to medications or problems with health products and notifying people of health product recalls.
  3. Health oversight activities
    Capitol Square Dental providers may disclose health information to agencies that monitor our compliance with state and federal laws.
  4. Judicial and administrative proceedings
    If you are involved in a lawsuit or a dispute, Capitol Square Dental may disclose medical information about you in response to court orders.
  5. Law enforcement
    Capitol Square Dental may disclose health information about you to law enforcement officials in response to a court order or other similar process allowed by law.
  6. Appointment reminders and additional communications
    Capitol Square Dental may use your information to call you or send you a letter reminding you of an upcoming appointment. Capitol Square Dental providers may use your health information to send you the results of tests or to give you other health communications.
  7. Serious threat to health or safety
    Capitol Square Dental may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of others.
  8. Specific government functions
    If you are a member of the Armed Forces, Capitol Square Dental providers may disclose your health information, under certain circumstances, to military authorities to assist with the military missions.
  9. Workers' compensation
    Capitol Square Dental providers may release your health information to workers' compensation or similar programs that provide benefits for your work-related injuries or illness.

Uses and disclosures of your health information that you may refuse

Capitol Square Dental may use or disclose your health information without your authorization unless you refuse or object.

  1. Information disclosed to family members, close friends, or others
    To coordinate your care and explain your condition and treatment plan, Capitol Square Dental may disclose health information about you to your family or close personal friends. You have the right to object to these kinds of disclosures. In an emergency, Capitol Square Dental providers will exercise their professional judgment to determine if family or friends should receive information about you.
  2. Notification
    Unless you object, Capitol Square Dental providers may use your health information to notify, or assist in notifying members of your family, close personal friends or any other people responsible for your care about your condition.

Uses and disclosures of your health information requiring your authorization

If Capitol Square Dental providers need to use or disclose your health information for any purpose not listed above, they must first obtain your written authorization. Even if you authorize Capitol Square Dental providers to use or disclose your information for a particular purpose, you may revoke your authorization.

Your rights as a patient of Capitol Square Dental

As a patient of Capitol Square Dental, you have the following rights with regard to your health information:

  • Right to inspect and copy your medical and billing records
  • Right to add information to correct your medical and billing records
  • Right to an accounting of disclosures
  • Right to a paper copy of this notice
  • Right to request restrictions on uses and disclosures of your health information

Contact and Compliant Information

If you have any questions, concerns, comments or complaints regarding the information in this notice, please contact:

Name of Contact Person: Dr. Scott Sanderson D.D.S.
Telephone: (608) 256-1300
Address: 1 South Pinckney St
Madison, WI
53703

We support your right to protect the privacy of your protected health information. We will not retaliate in anyway if you choose to file a complaint with us or with the U.S. Department of Health and Human Services