Archibald Dental Office
Hak-Cheon Kim, DDS
Creating Beautiful Smiles
Call: (909)923-6622


 Archibald Dental Office

Notice of Privacy Practices 

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. 

Dear Patient, 

Archibald Dental Office has always strived to keep your health information secure and confidential. As of April 14, 2003, the HIPAA law (Health Insurance Portability and Accountability Act) will be implemented. It requires us to inform you about our privacy practices, our legal duties, and your rights in regards to your health information. 

The ever-growing use of computer technology and its use in the healthcare industry has motivated the Federal government to legally enforce the importance of health information privacy. The government has sought to standardize and protect the privacy of the electronic exchange of your health information as used within our computers but also with the phones, faxes, copy machines, sign-in sheets, the handling of a patient’s chart, treatment, billing and record storage and any outside communications such as consultations with a specialist. 

To ensure that reasonable safeguards are in place to protect the privacy of all patients health information, a privacy officer is appointed within our practice. This person is responsible for “ownership” of the privacy practices and will be the person for patients with questions or complaints.


How Your Health Information May Be Used 

To Provide Treatment,

We may use and disclose information about your health information for treatment purposes to a dentist physician, dental laboratory or other health care provider. This may also include referring dentist, hygienist, dental assistant, and business office staff.

To Obtain Payment

We may include your health information with an invoice used to collect payment for treatment you receive in our office. We may do this with insurance forms filed for you in the mail or sent electronically. We may also do this with collection agencies. We will make every attempt to only work with companies with a similar commitment to the security of your health information.

To Conduct Health Care Options

Your health care information may be used during performance evaluations of our staff. Some of our best teaching opportunities use clinical situations experienced by patients receiving care at our office. As a result, health information may be included in training programs for interns, associates, business and clinical employees. It is also possible that health information will be disclosed during audits by insurance companies or government appointed agencies as part of their quality assurance and compliance reviews. Your health information may be reviewed during the routine processes of certification, licensing, or credential activities.

Patient Reminders

We may use or disclose your health information to remind you of a scheduled appointment or that it is time for you to contact us and make an appointment. This may include postcards, letters, and telephone reminders. Additionally, we may contact you to follow up on your care and inform you of treatment options or services that may be of interest to you or your family.

Family, Friends, and Caregivers

We may share your health information with those you tell us will be helping you with your home hygience, treatment, medications, or payment. This will only be done with your permission first. In an emergency, we will use our best judgement when sharing your health information to a family member or another person responsible for your care.

Abuse or Neglect

We are compelled by our ethical judgment to notify authorities if we believe a patient is a victim of abuse, neglect or domestic violence. We may also disclose information when we believe we are specifically required or authorized by law or with the patient’s agreement.

Public Health, National Security, and Law Enforcement

We may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:

Ø  As required by law

Ø  For public health activities, including disease and vital statistic reporting, FDA oversight, and to employers regarding work-related illness or injury

Ø  To report adult abuse, neglect, or domestic violence

Ø  To health oversight agencies

Ø  To respond to court and administrative orders and other lawful processes

Ø  To coroners, medical examiners, organ procurement organizations, and funeral directors

Ø  To avert a serious threat to health or safety

Ø  To the military and to federal officials for lawful intelligence, counterintelligence, and national security activities

Ø  To correctional institutions regarding inmates

Ø  As authorized by state worker’s compensation law 

Patient’s Rights

You have the right to request restrictions on certain uses and disclosures of your health information. 

You have the right to request that we communicate with you in a certain way. You may request that we only communicate your health information privately with no other family members present or through mailed communications that are sealed. 

You have the right to read, review, and copy your health information. This includes your complete chart, x-rays, and billing records. We may also charge you a reasonable fee for copies. 

You have the right to ask us to update or modify your records if you believe your health information records are incorrect or incomplete. 

You have the right to ask us for a description of how and where your health information was used by our office for any reason other than for treatment, payment, or health operations. We may need to charge you a reasonable fee for your request. 

You have the right to obtain a copy of this Notice of Privacy Practices directly from our office at any time. 

You have the right to express complaints to us, our privacy officer, or to the Secretary of Health and Human Services if you believe your privacy rights have been compromised.