Dr. Ashraf W. Sedhom
Board Certified Oral and Maxillofacial Surgeon
Oral Surgery Centers
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Dr. Ashraf W. Sedhom Board Certified Oral and Maxillofacial Surgeon Oral Surgery Centers
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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Uses and Disclosures Treatment Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, the results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment to you or who may be consulted by our staff members. Payment Your health information may be used to seek payment from your insurance company, from other sources of coverage such as an automobile insurer, or from check and credit card companies that you may use to pay for services. For example, your insurance company may request and receive information on the dates and type of services provided as well as the medical condition being treated. Health Care Operations Your health information may be used as necessary to support the day-to-day activities and management of THE CENTER FOR ORAL & RECONSTRUCTIVE SURGERY & IMPLANTOLOGY and/or SANTA FE ORAL SURGERY CENTER. For example, information on the services you received may be used to support budgeting and financial reporting, and to evaluate and promote quality. Law Enforcement Your health information may be disclosed to facilitate law enforcement agency investigations, and to comply with government mandated reporting, audits and inspections. Public Health Reporting Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department. Other Uses and Disclosures Require Your Authorization Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing use or disclosure of your information, you may submit a written revocation. However, your decision to revoke the authorization will not undo any use or disclosure of information that occurred before you notified us of your decision.
Additional Uses of Information Appointment reminders Your health information will be used by our staff to send you appointment reminders. Information About Your Treatment Your health information may be used to send you information regarding the treatment and management of your medical condition. We may also send you information describing other health-related goods and services that may be of interest to you. Individual Rights You have certain rights under the Federal Privacy Standards. These include:
SURGERY CENTER Duties We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice. Right to Revise Privacy Practices As permitted by law, we reserve the right to amend or modify our privacy policies and practices. Changes that do occur in our policies and practices may be the result of changes in federal or state laws and regulations. If changes are made, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain. Request to Inspect Protected Health Information As permitted by federal regulation, we require that requests to inspect or copy your protected health information be submitted in writing. You may contact Yasser Sedhom to request access to your records. Complaints If you would like to submit a comment or complaint about our privacy practices, or believe that your privacy rights have been violated, you may do so by sending a letter outlining your concerns to: SANTA FE ORAL SURGERY CENTER Attn: Yasser Sedhom (Privacy Official) 2210 S. Federal Blvd., Suite 1 Denver, CO 80219 You will not be penalized or otherwise retaliated against for filing a complaint. Contact Person The name and address of the person you can contact for further information concerning our privacy practices is Yasser Sedhom at SANTA FE ORAL SURGERY CENTER 2210 S. Federal Blvd., Suite 1 Denver, CO 80219 Or THE CENTER FOR ORAL & RECONSTRUCTIVE SURGERY & IMPLANTOLOGY 11246 E. Mississippi Ave. Aurora, Colorado 80012
Effective Date This notice is effective as of January 01, 2003 Revised June 24, 2003 |
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Send mail to mailto:ysedhom@yahoo.com
with questions or comments about this web site.
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