Notice of Privacy Practices

About this notice

This notice describes how Molnar & Lee Oral Facial Surgery and Dental Implant Center ("we," "us," or "our") — Dr. Lee and our staff — may use and share your health information, your rights, and our responsibilities. It applies to the health information we create or receive while caring for you, including records kept in our practice-management and patient-portal systems.

Your rights

When it comes to your health information, you have the right to:

• Get a copy of your health and billing records, on paper or electronically. Ask us in writing. We will usually provide a copy or a summary within 30 days, and we may charge a reasonable, cost-based fee.
• Ask us to correct your records if you think they are incorrect or incomplete. Ask us in writing. We may say "no," but we will tell you why in writing within 60 days.
• Ask us to contact you in a specific way — for example, at a different phone number or mailing address. We will say "yes" to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree, and we may say "no" if it would affect your care. If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations, and we will say "yes" unless a law requires us to share it.
• Get a list of those we have shared your information with during the six years before you ask, and why. The list will not include disclosures for treatment, payment, or health care operations, or certain others (such as any you asked us to make). We provide one list a year free and may charge a reasonable, cost-based fee for another within 12 months.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will confirm the person has this authority before we act.
• File a complaint if you believe your privacy rights have been violated (see "Questions and complaints" below).

To use any of these rights, contact us using the information at the end of this notice.

Your choices

For certain health information, you can tell us your choices about what we share. You have both the right and the choice to tell us whether to:

• Share information with your family, close friends, or others involved in your care or in paying for your care.
• Share information in a disaster relief situation.

If you are not able to tell us your preference — for example, if you are unconscious or still recovering from sedation — we may share your information if we believe it is in your best interest, such as updating the person who will drive you home. We may also share information when needed to lessen a serious and imminent threat to health or safety.

We never share your information for marketing purposes, never sell it, and never share psychotherapy notes (in most cases) unless you give us written permission.

How we typically use or share your health information

• To treat you. We use your health information and share it with other professionals who are treating you — for example, sending a report to your dentist or physician, or sending a prescription to your pharmacy.
• To bill for your services. We use and share your information to bill and get payment from health and dental plans or other payers.
• To run our practice. We use and share your information to operate our office, improve your care, train staff, and contact you when necessary.
• To remind you of appointments and follow up on your care, by phone, voicemail, mail, email, or — if you have agreed to receive them — text messages.
• With our business associates. Companies that perform services for us, such as our practice-management and billing systems, may receive your information to do that work. They are required by contract to protect it.

Other ways we may use or share your health information

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

• Public health and safety: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.
• Research: under the conditions the law allows.
• As required by law, including sharing with the U.S. Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
• Organ and tissue donation: responding to requests from organ procurement organizations.
• Medical examiners and funeral directors, when an individual dies.
• Workers' compensation, law enforcement, and other government requests: for workers' compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
• Lawsuits and legal actions: in response to a court or administrative order, or in response to a subpoena.

Where other laws give certain information more protection than HIPAA does — for example, some HIV test results, mental health records, and substance use disorder treatment records — we follow the stricter law.

We will not use or share your information other than as described in this notice unless you give us written permission. If you do, you may change your mind at any time by telling us in writing; this will not undo anything we already did with your permission.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all the information we have about you. The new notice will be available on request, in our office, and on this website.

Questions and complaints

If you have questions about this notice or our privacy practices, contact our Privacy Officer using the information below.

If you believe your privacy rights have been violated, you can file a complaint with us using the information below, or with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

Contact us

Privacy Officer
Molnar & Lee Oral Facial Surgery and Dental Implant Center
2191 Park Avenue West
Ontario, OH 44906
Phone: (419) 529-9494
Fax: (419) 529-9391
Email: office@molnarleeoralsurgery.com