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Bret A. Bologna DDS, P.C.

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.

THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information.  We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.  We must follow the privacy practices that are described in this Notice while it is in effect.  This Notice takes effect (4/14/2003), and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law.  We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes.  Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.

You may request a copy of Notice at any time.  For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION

We use and disclose health information about you for treatment, payment, and healthcare operations.  For example:

Treatment:  We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.

Payment:  We may use and disclose your health information to obtain payment for services we provide to you.

Healthcare Operations:  We may use and disclose your health information in connection with our healthcare operations.  Healthcare operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditations, certification, licensing or credentialing activities.

Your Authorization:  In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose.  If you give us an authorization, you may revoke it in writing at any time.  Your revocations ill not affect any use or disclosures permitted by your authorization while it was in effect.  Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

To Your Family and Friends:  We must disclose your health information to you, as described in the Patient Rights section of this Notice.  We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.

Persons Involved In Care:  We may use or disclose health information to notify, or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death.  If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures.  In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare.  We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

Marketing Health-Related Services:  We will not use your health information for marketing communications without your written authorization.

Required by Law:  We may use or disclose your health information when we are required to do so by law.

Abuse or Neglect:  We may disclose your health information to appropriate authorities if we reasonable believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes.  We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

National Security:  We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances.  We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.  We may disclose to correctional institution or law enforcement official having lawful custody of protected health information of inmate or patient under certain circumstances.

Appointment Reminders:  We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).

PATIENT RIGHTS

Access:  You have the right to look at or get copies of your health information, with limited exceptions.  You may request that we provide copies in a format other than photocopies.  We will use the format you request unless we cannot practicably do so.  (You must make a request in writing to obtain access to your health information.  You may obtain a form to request access by using the contact information listed at the end of this Notice.  We will charge you a reasonable cost-based fee for expenses such as copies and staff time.  You may also request access by sending us a letter to the address at the end of this Notice.  If you request copies, we will charge you $6.00 for each page, including staff time to locate and copy your health information, and postage if you want the copies mailed to you.  If you request an alternate format, we will charge a cost-based fee for providing your health information in that format.  If you prefer, we will prepare a summary or an explanation of your health information for a fee.  Contact us using the information listed at the end of this Notice for a full explanation of our fee structure.)

Disclosure Accounting:  You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes, other than treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not before April 14, 2003.  If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.

Restriction:  You have the right to request that we place additional restrictions on our use or disclosure of your health information.  We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

Alternative Communication:  You have the right to request that we communicate with you about your health information by alternative means or to alternative locations.  (You must make your request in writing.)  Your request must specify the alternative means or location, and provide satisfactory explanation how payments will be handled under the alternative means or location you request.

Amendment:  You have the right to request that we amend your health information.  (Your request must be in writing, and it must explain why the information should be amended.)  We may deny your request under certain circumstances.

Electronic Notice:  If you receive this Notice on our Web site or by electronic mail (e-mail), you are entitled to receive this Notice in written form.

QUESTIONS AND COMPLAINTS

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us by using the contact information listed at the end of this Notice.  You also may submit a written complaint to the U.S. Department of Health and Human Services.  We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

We support your right to the privacy of your health information.  We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Contact Officer:  Claire Barenie

Telephone:  219-663-7193

Fax:  219-663-7833

Email: info@drbologna.com

Address:  Distinctive Dental Solutions, Bret A. Bologna DDS  11039 Broadway Ste A, Crown Point IN  46307

Privacy Statement

As of December 12, 2019, this privacy statement has been updated to include language that applies to citizens of the European Economic Area.

The purpose of this privacy statement is to provide transparency regarding the information we may collect about you via www.distinctivedds.com. Reading the entire statement carefully is recommended. We maintain compliance with privacy legislation requirements, including:

  • Disclosing the purpose of processing your personal data. This privacy statement is how we disclose this purpose.
  • Limiting personal data collection to only the information required for our purposes.
  • When consent is required to process your personal data, we will request your explicit consent before doing so.
  • Ensuring that proper security measures are observed to protect personal data by our employees and any parties that may process data on our behalf.
  • Acknowledging and respecting your right to access, correct, or delete your personal data when requested.

If you have any questions about the personal data we collect, please contact us.

  1. Data Used, Purpose, and Retention

1.1 Personal data is used for the following purpose:

Contact – Via telephone, email, mail and/or web-based forms

The data used for this purpose includes:

  • Name
  • Telephone number
  • Email address
  • Address and City

These data may be processed on the basis of:

Execution of an agreement

Retention

This data will be retained until the service is terminated.

1.2 Personal data is used for the following purpose:

Collecting and Processing Payments

The data used for this purpose includes:

  • Name
  • Telephone number
  • Email address
  • Address and City
  • Financial Data

These data may be processed on the basis of:

Execution of an agreement

Retention

This data will be retained until the service is terminated

1.3 Personal data is used for the following purpose:

New account registration

The data used for this purpose includes:

  • Email Address
  • Username, Password, and any other account-specific information

These data may be processed on the basis of:

Execution of an agreement

Retention

This data will be retained until the service is terminated.

1.4 Personal data is used for the following purpose:

Delivery of Newsletters

The data used for this purpose includes:

  • Email Address

These data may be processed on the basis of:

Expressed consent

Retention

This data will be retained until the service is terminated.

1.5 Personal data is used for the following purpose:

Support for products or services a customer has purchased or intends to purchase

The data used for this purpose includes:

  • Name
  • Address and City
  • Email Address
  • Username, Password, and any other account-specific information

These data may be processed on the basis of:

Execution of an agreement

Retention

This data will be retained until the service is terminated.

1.6 Personal data is used for the following purpose:

Website Performance Analysis

The data used for this purpose includes:

  • User behavior. This may include browsing and search history, geolocation data, and information relating to the use of a website, application, or advertisement.

These data may be processed on the basis of:

Execution of an agreement

Retention

This data will be retained for a period of 12 months after the service is terminated.

  1. Sharing of Personal Data

2.1 Your personal data is not shared with any third parties

2.2 When required by law or court order, we may disclose personal information to law enforcement agencies as permitted and/or required by law for the purpose of providing information or as part of an investigation.

  1. Use of Cookies

3.1 Cookies are used on our website. Cookies are small files associated with webpages and stored on your hard drive by your browser when you interact with the page. The information in that file may be recalled by our servers or the servers of relevant third parties upon future visits.

For more information on how we use cookies, please click here: www.distinctivedds.com/cookie-policy-us/

  1. Do Not Track Signals

 

4.1 Use of the Do Not Track (DNT) header field is supported by our website. When DNT is activated, your preferences are communicated to us and your browsing behavior will not be tracked.

  1. Security

5.1 Maintaining the security of your personal data is a top priority for us, and to that end we take all steps necessary to limit opportunities for abuse of, or unauthorized access to, your personal data. This includes restricting access of your data to necessary persons only and regularly reviewing our security measures.

  1. Third Party Websites

6.1 Third party websites connected to our site by links are not covered by this privacy statement. It is not possible for us to guarantee or fully disclose how these third parties may use or collect your personal data. It is recommended that you read the privacy statements of these websites before using them.

  1. Amendment

7.1 We reserve the right to amend this privacy statement at our discretion and as required by changes in law. Regularly reviewing this privacy statement is recommended in order to be aware of potential amendments. When appropriate or required, we will notify you of changes to this statement.

  1. Access to and Modification of Data

8.1 If you have questions about the personal data we have collected from you, please contact us using the information below. Please be sure to state your identity clearly when contacting us. When necessary or appropriate, and when allowed by law, we may require verification that you are the person making the request and that we are modifying or deleting the correct person’s information.

8.2 You have the right to know what personal information is being collected, why it is collected, what will happen to that information, and how long it may be retained. You have the right to know:

  • The category of personal information being collected.
  • The category of sources from which the information was collected.
  • The purpose for which the data was collected.
  • The categories of third parties who may have access to the data.
  • The specific personal information that has been collected.

8.3 You have the right to know if your personal information is being used by, disclosed to, or sold to third parties, and the identity of those third parties. If your information is being sold or disclosed to third parties, you have the right to request that they inform you of:

  • The category of any personal information being collected, sold and/or disclosed.
  • The category of third party to whom information is sold. The category of information sold must be disclosed for each third party to whom information is sold.

8.4 Exercising your privacy rights will not affect your right to equal service and prices. Consumers will not be discriminated against for exercising their privacy rights. Prohibited discrimination includes, but is not limited to:

  • Denying goods or services
  • Charging different prices or providing a different level of service or quality of goods than that received by other consumers, including through the use of discounts and benefits.
  • Implying or suggesting that the consumer will receive a different price, quality of goods, or level of service.

Charging different prices or rates, or providing a different level of service or quality of goods, is permitted if it can be shown that the value provided to the consumer is reasonably related to the consumer’s data.

8.5 You have the right to access your personal data that we collect, and request that your personal data be modified or deleted. When a valid request to delete data is received, the data will be deleted from our records and any service providers with access to that data will be directed to remove it from their records as well.

8.6 You have the right to correct, modify, supplement, or block your personal data. If consent was given to collect or use personal data, you may revoke that consent at any time. You also have the right to request a complete record of your personal data and transfer that record in whole to another controller.

8.7 Under certain circumstances, a business may not be required to comply with a consumer request to delete personal data if the data is deemed necessary to:

  • Complete a transaction, provide goods or services, or execute a contract between the business and consumer for which the information was collected.
  • Maintain security and protect against activity that may be deceptive, malicious, fraudulent, or illegal.
  • Detect, debug, or repair errors in intended functionality
  • Protect or exercise our right or another consumer’s right to free speech or any other right provided by law.
  • Ensure compliance with the California Electronic Communications Privacy Act pursuant to Chapter 3.6 (commencing with Section 1546) of Title 12 of Part 2 of the Penal Code.
  • Pursue historical, scientific, or statistical research that complies with all ethical and legal standards and which would be unsuccessful or severely impaired if the data is deleted, as long as informed consent was given to collect the data.
  • Satisfy reasonable expectations that the consumer may have based on their relationship with the business, as long as the use is internal and restricted to this purpose.
  • Meet legal obligations.
  • Complete any internal process or action related to the context in which the data was collected, given that the use of the data meets all other legal requirements.
  1. Disclosure and Selling of Your Data

9.1 We have not sold or disclosed your personal information to any third parties within the preceding 12 months.

  1. Complaints

10.1 If you have a complaint or dispute regarding the handling of your personal data, you have the right to submit a complaint to the appropriate Data Protection Authority for your country or region.

  1. Children

11.1 Our website is not intended or designed to attract children and we do not intentionally collect personal information from any user who is under the legal age of consent in the country where they reside. We request that users under the age of consent do not submit personal data to us in any form.

  1. Contact Information

Contact Officer:  Claire Barenie

Telephone:  219-663-7193

Fax:  219-663-7833

Email: info@drbologna.com

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