Patient Privacy Statement

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Your privacy is important to you. And it's just as important to us. We at Dr. Kvitko & Associates value the trust you place in our hands when you supply us with your nonpublic personal information. We want you to understand how we protect the confidentiality of that information as well as how and why we use and disclose it. This statement explains Dr. Kvitko & Associates' practices and procedures for protecting the security of your personal information both while you are a patient and thereafter.

How We Protect Your Information
We maintain physical, electronic, and procedural safeguards to guard your nonpublic personal information. We limit access to your nonpublic personal information to our staff, your insurance carrier, and on occasion other dental or medical professionals who need to know such information to provide services to you.

What Personal Information We Collect About You
We collect nonpublic personal information about you from the following sources: Information we receive from you on patient forms; Information we receive from other dental or medical facilities as permitted or required by law; Information we receive from dental or medical insurance carriers as permitted or required by law.

What Personal Information We Disclose About You
We do not disclose any nonpublic personal information about our patients or former patients to anyone, except as permitted or required by law.

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

Access to Your Health Information
You may request access to your health information in writing. If you request copies, we will charge you in accordance with state guidelines to locate and duplicate your health information, plus 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.

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

To Your Friends or Family
We may disclose your health information to a family member, friend or other person to the extent necessary to help with your dental care or with payment for your dental care, but only if you agree that we may do so. We will also use our professional judgment to make reasonable inferences of your best interest in allowing a person to pick up prescriptions, medical supplies, x-rays or other similar forms of health information.

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

Questions
Should you have any questions or need additional information, please do not hesitate to ask for our Privacy Compliance Officer, Nathan.