Notice of Privacy Practices
This notice describes how medical and dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our commitment to your privacy
Cosmo Dental Clinic is required by law to maintain the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach of your unsecured health information occurs.
How we may use and disclose your health information
Treatment
We may use and share your information to provide dental care — for example, with a dental specialist, laboratory or pharmacy involved in your treatment.
Payment
We may use and share your information to bill and get payment from you, your dental insurance plan or another payer.
Health care operations
We may use your information to run our practice, improve the quality of care and train staff.
Appointment reminders
We may contact you by phone, text, mail or email to remind you about appointments or tell you about treatment options.
Other uses allowed or required by law
- When required by federal, state or local law
- For public health and safety, such as reporting abuse or preventing a serious threat
- For health oversight activities and government audits
- In response to a court order, subpoena or other lawful process
- To law enforcement officials, medical examiners or funeral directors, as permitted by law
- For workers’ compensation claims
- For specialized government functions, such as military or national security
People involved in your care
Unless you object, we may share information with a family member, friend or other person you identify who is involved in your care or payment for care.
Uses that need your written permission
We will not use or share your information for marketing, sell your information, or use it in other ways not described in this notice without your written authorization. You may cancel an authorization at any time in writing.
Your rights
- Get a copy of your records. You can ask to see or get a copy (paper or electronic) of your dental record. We may charge a reasonable, cost-based fee.
- Ask us to correct your record if you believe it is incorrect or incomplete.
- Request confidential communications, such as contacting you at a different phone number or address.
- Ask us to limit what we use or share. We are not required to agree, except that if you pay for a service in full out of pocket, you can ask us not to share that information with your health plan.
- Get a list of disclosures we have made of your information, with certain exceptions.
- Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
- Choose someone to act for you, such as a legal guardian or someone with medical power of attorney.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr/complaints (opens in a new tab). We will not retaliate against you for filing a complaint.
Changes to this notice
We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available in our office and on this website.
Contact our Privacy Officer
Privacy Officer, Cosmo Dental Clinic
159 E North Ave, Northlake, IL 60164
Phone: (708) 345-6313
Email: b.abozor@cosmodentalmail.com