Our Office

Privacy Statement

The following is how medical information about you may be used and disclosed, and how you can access this information.

Treatment:

Your health information may be used by University Dental Associates staff members or disclosed or other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, a doctor may use the information in your medical records to determine which treatment option (for instance, which drug or procedure) best addresses your health needs.

Payment:

Your health information may be used to seek payment from your health plan or from other sources of coverage.

Health Care Operations:

Your health information may be used as necessary to support day-to-day activities and management of University Dental Associates, Inc. For example, information may be used to support budgeting and financial reporting and activities to evaluate and promote quality.

Law Enforcement:

Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting.

Public Health Reporting:

As required by law, we may disclose your health information to public health authorities for purposes related to: Preventing or controlling disease, injury, or disability; reporting child abuse or neglect; reporting domestic violence; reporting problems with products and reactions to medications to the Food and Drug administration; and reporting disease or infection exposure.

Other Uses and Disclosures Require Your Authorization:

Disclosures of your health information or its use for reasons other than those listed above requires your specific written authorization. If you change your mind after authorizing, you must submit a written revocation of the authorization. However, your revocation will nor affect or undo any use or disclosure that occurred before you revoked the authorization.

Additional Uses of Information:

Your health information may be used by our staff to send appointment reminders.

Individual Rights:

You have certain rights under federal privacy standards, which include:

  • The right to request restrictions on the use and disclosure of your health information.
  • The right to receive confidential communications concerning your medical condition & treatment.
  • The right to request and obtain a copy of your health information.
  • The right to request to amend or submit correction to your health information.
  • The right to receive an accounting of how and to whom your health information has been disclosed.
  • The right to receive a printed copy of this summary and University Dental Associates, Inc.’s notice of privacy practices, which provides a more complete description of information uses and disclosures.

University Dental Associates, Inc.’s Duties:

We are required to maintain the privacy of your health information and to provide you with our notice of privacy practices. We reserve the right to amend or modify out privacy policies and practices. Upon request, we will provide you with the most recently revised notice at any office visit. The revised policies and practices will be applied to all protected health information we maintain.

You may generally inspect your health information. As permitted by federal regulation, we require that such a request be submitted in writing to University Dental Associates, Inc., Attn: Executive Director. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny your request.

Comment/Complaints:

If you would like to submit a comment or complaint about our privacy practices, you will not be penalized or otherwise retaliated against for doing so. You may request a copy of our complaint form, which should be submitted to:

University Dental Associates, Inc.
Attn: Executive Director
210A Squire Hall
Buffalo, NY, 14214

For further information concerning our privacy policies, please contact the University Dental Associates, Inc. Executive Director at the above address.

The effective date of this notice is: April 1, 2013.