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Terms and Conditions

This privacy policy (“Privacy Policy”) sets out how this office uses and protects any information that you provide when you use the website. The office is committed to ensuring that your privacy is protected. You can be assured that information you provide on this website will only be used in accordance with this Privacy Policy. The office may change this Privacy Policy from time to time by updating the office website. You should check this website as often as possible to ensure that you are happy with any changes. This Privacy Policy is effective December 1st, 2021.

This office understands that your privacy is important. We've created this Privacy Policy to inform you about the ways we collect, use, disclose and otherwise treat your personal information. By visiting this office's site, you agree to the practices described here in our Privacy Policy.
 

WHAT PERSONAL INFORMATION DO WE GATHER ABOUT YOU?

  • Your contact information, such as your email, home address, ZIP code, phone number and email. Such items are collected when you sign up for our contests or promotions, or use our online appointment scheduling process.
  • Your name, date of birth, insurance information, appointment date and time and family member information.  Such items are collected when you use our online appointment scheduling process.
  • Your public information, such as comments or reviews that you post on our site. We also collect requests or questions that you publicly post.
  • Your demographic information, such as your postcode, preferences and interests.
  • Other information, such as your location, your IP address, the browser/device/hardware you are using, your GPS location and what pages you visit on our site. Such items are collected when you visit our website, affiliated websites, or any other digital property associated with us .

HOW DO WE USE YOUR INFORMATION?

  • To keep an internal record for our reporting and analysis purposes.
  • To provide you with relevant content, materials, offers, programs and to administer your participation in our contests or sweepstakes.
  • To respond to your requests or questions that you may provide via our social sites.
  • To improve our sites, products, services and other marketing purposes.
  • To protect the office, other patients and our assets and sites and for other security measures.
  • To remain in communication with you with any products or services you requested.
  • To schedule an appointment for you, and contact you via mobile phone text/SMS or e-mail to confirm your appointment.
  • From time to time, we may also use your information to contact you for market research purposes. We may contact you by email, phone or mail.
  • To target ads to you based on your past online activity.
  • We will never sell your information.
  • Any information collected is disclosed to you here and is used as permitted or required by law.

EMAILS ABOUT APPOINTMENTS, SPECIALTY TREATMENT, SPECIAL OFFERS AND PROMOTIONS AND HOW TO OPT-OUT

It is our intention to only send email communications that are useful to you and that you want to receive. When you provide us with your email address as part of the registration or appointment setting process, we will place you on a list of patients to receive informational and promotional emails. Each time you receive a non-transactional email, you will be provided the choice to "opt-out" of future emails by following the instructions provided in the email.

Information you receive by email will be an unsecure transmission meaning it is possible that information could potentially be exposed while in transmission from our office email server to your email server.  If this is not acceptable to you, you will be provided the choice to "opt-out" of future emails by following the instructions provided in the email.
 

SECURITY

We are committed to ensuring that your information is secure. In order to prevent unauthorized access or disclosure, we have put in place physical, electronic and managerial procedures to safeguard and secure the information we collect online.
 

HOW DO WE COLLECT INFORMATION ABOUT YOU?

  • When you sign up for things automatically like a contest or a promotion or when you register through www.smilegeneration.com.
  • When you schedule an appointment with us through our office website.
  • Through tracking tools, such as cookies, tags and other technologies.

Our partners, such as Smile Generation Financial, Smile Generation Dental Plan will provide us with information that you voluntarily give them. We may also use information associated with your social media account, e.g., your name, username, email address, gender, profile picture, etc. We may also collect information about your friends or family if you share any of our social content using web tools.
 

WHAT ARE COOKIES? HOW DO WE USE THEM?

A cookie is a small file that asks permission to be placed on your computer's hard drive. The cookie helps analyze web traffic or informs when you visit a particular site. Cookies allow web applications to respond to you as an individual. The web application can tailor its operations to your needs, likes and dislikes by gathering and remembering information about your preferences.

We transfer cookies to your device to provide you with personalized services and content and to identify which of our sites or pages are of most interest to you. We do, however, recommend that you leave these cookies on as it allows us to provide you with the best patient experience possible through reporting and analysis. By disabling cookies, you will also be prevented from experiencing the entire site as was intended, and we will not be able to personalize our services to you. To disable cookies, please visit your browser's settings.

Third-party vendors, including Google, use cookies to serve ads to you based on your past visits to our website. You can opt out of Google’s use of cookies by visiting Google’s Ads Settings.

Overall, cookies help us provide you with a better website experience, by enabling us to monitor which pages you find useful and which you do not. A cookie in no way gives us access to your computer or any information about you, other than the data you choose to share with us.
 

LINKS TO OTHER WEBSITES

This website may contain links to enable you to visit other websites of interest easily. However, once you have used these links to leave our site, you should note that we do not have any control over other websites. Therefore, we cannot be responsible for the protection and privacy of any information that you provide whilst visiting such sites, and such sites are not governed by this privacy statement. You should exercise caution and look at the privacy statement applicable to the website in question.
 

HOW DO THIRD PARTIES COLLECT AND USE YOUR INFORMATION?

  • Third-party vendors, including Google, show our ads on sites across the internet.
  • Please be aware that third parties may use cookies, web beacons, and similar technologies to collect or receive information from our website and use that information to provide measurement services and target ads.
  • Additionally, please be aware that Facebook may also use cookies, web beacons, and similar technologies to collect or receive information from our website and use that information to provide measurement services and target ads.
  • Using the tools on this page, you can opt out from receiving interest-based advertising from some or all of our participating companies, as well as:
  • Find out which participating companies have currently enabled customized ads for your browser;
  • See all the participating companies on this site and learn more about their advertising and privacy practices;
  • Check whether you've already opted out from participating companies;
  • Opt out of browser-enabled interest-based advertising by some or all participating companies, using opt-out cookies to store your preferences in your browser; or
  • Use the "Choose All Companies" feature to opt out from all currently participating companies in one step.

Opting out, or choosing to have data about you removed from marketing data products, will reduce the amount of unsolicited telemarketing, direct-mail and/or email offers you receive from companies with whom you have not done business. It may also reduce the relevance of offers you receive from companies with whom you have done business since our clients use these products to better understand what offers may be of interest to you. You should also be aware that your choice to opt-out will only impact marketers using our marketing data products. Therefore, we suggest you also consider opting-out directly from any company that sends you unwanted solicitations or use the Direct Marketing Association's Commitment to Consumer Choice services which applies to all DMA member companies and can be accessed at www.dmachoice.org.
 

WHAT CHOICES DO I HAVE? CAN I CONTROL MY PRIVACY?

If you wish to inquire about how we are using your personal information and for requests to opt-out, write our Privacy Contact (see below). If you live in California, you have the right to ask us one time each year if we have shared personal information with any third parties. Please specify "California Privacy Rights" in the letter.

  • To delete your cookies, please visit your browser's settings.
  • To turn off push notifications or your GPS locator on your phone, please visit your device settings.
  • To opt-out of email communications sent to you, please refer to the unsubscribe instructions listed on the bottom of the emails we send to you.
  • Please note, that law may require us to comply by disclosing any information that we collect about you.

WHAT IS OUR POLICY TOWARD CHILDREN?

We do not knowingly collect personally identifiable information from children under the age of 13 without expressed permission from a parent or guardian. If you feel the privacy of your child has been compromised by our site, please advise the Privacy Contact.
 

TRADEMARK

The contents of this website are protected by United States and International copyright and trademark law. Any unauthorized use or reproduction of this website is prohibited and may subject a violator to civil and criminal penalties. All rights reserved.
 

HOW DO I REACH THE PRIVACY CONTACT?

Any questions or comments that relate to this Privacy Policy may be directed to our Privacy Contact, Pacific Dental Services, LLC at 17000 Red Hill Avenue, Irvine, California 92614. (714) 845-8500.
 

PRIVACY POLICY REVISIONS

Our Privacy Policy may change from time to time. Any updates will be posted here on the office website. Please check our site regularly for updates.


CALIFORNIA CONSUMER PRIVACY ACT 

Learn more about new data privacy rights for California Residents.

The terms, conditions, and guidelines associated with the use of the services (the "Services") provided by Our Office are set forth in this Terms of Service Agreement ("TOS"). Please read this TOS carefully before you use the Services. By using the Services you ("you" or "your," as appropriate) agree to abide by the terms, conditions, and guidelines set forth in this TOS.

Please note that Our Office may update or change this TOS from time to time without notice. USE OF THE SERVICES AFTER SUCH CHANGES HAVE TAKEN EFFECT CONSTITUTES ACCEPTANCE OF ALL CHANGES.

Please also note that if Our Office determines at any time that you have abused or violated any of these terms, conditions and guidelines, Our Office reserves the right to terminate the Site and Services immediately without notice.

Links to Third-Party Sites
Some of the links on the Site will allow you to leave the Site. Third-party sites to which the Site may link ("Third-Party Linked Sites") are not in any way under Our Office's control, and Our Office DOES NOT ASSUME ANY RESPONSIBILITY OR LIABILITY FOR ANY INFORMATION, CONTENT, COMMUNICATIONS, SERVICES, GOODS OR OTHER MATERIALS AVAILABLE ON SUCH THIRD-PARTY LINKED SITES OR FOR ANY CHANGES OR UPDATES TO SUCH SITES. Absent express language to the contrary, Our Office does not intend links contained on the Site to be referrals to, or endorsements of, the Third-Party Linked Sites or the entities that operate them, and such links are provided for convenience only.

Disclaimer of Warranties
IN USING THE SITE AND/OR ANY THIRD PARTY LINKED SITE YOU AGREE THAT ALL INFORMATION AND SERVICES IN SUCH SITES ARE PROVIDED "AS IS, AS AVAILABLE" WITHOUT WARRANTY, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, OR NON-INFRINGEMENT, OR WARRANTIES ARISING BY COURSE OF DEALING OR CUSTOM OF TRADE. YOU AGREE THAT YOU USE THE SITE AND/OR ANY THIRD PARTY LINKED SITE AT YOUR OWN RISK. YOU FURTHER AGREE THAT OUR OFFICE AND ANY OTHER PARTY INVOLVED IN CREATING AND DELIVERING THE CONTENTS OR SERVICES OF THE SITE AND/OR THIRD PARTY LINKED SITES HAVE NO LIABILITY FOR DIRECT, INDIRECT, INCIDENTAL, PUNITIVE, OR CONSEQUENTIAL DAMAGES WITH RESPECT TO THE INFORMATION, SERVICES OR CONTENT CONTAINED ON OR OTHERWISE ACCESSED THROUGH SUCH SITES. YOU ACCEPT THE FACT THAT OUR OFFICE IS ONLY PROVIDING YOU WITH ACCESS TO CONTENT AND SERVICES AND THAT IT DISCLAIMS ALL WARRANTIES RELATING TO AND ANY AND ALL LIABILITY ARISING FROM SUCH CONTENT OR SERVICES.

WE CANNOT AND DO NOT ASSUME ANY RESPONSIBILITY FOR YOUR ILLEGAL, UNAUTHORIZED, OR IMPROPER USE OF INFORMATION TRANSMITTED, MONITORED, STORED OR RECEIVED USING THE SITE OR THE SERVICES. Some jurisdictions do not permit the exclusion or limitation of implied warranties. Therefore, only if required by applicable law, some or all of the exclusions or limitations above may not apply to you.

General Disclaimer
THE SITE, ALL THIRD PARTY LINKED SITES, AND ALL SERVICES AND MATERIALS PROVIDED IN SUCH SITES, ARE PROVIDED TO YOU ON AN "AS IS, WITH ALL FAULTS" BASIS, AND YOUR USE OF SUCH SITES, SERVICES, AND MATERIALS IS AT YOUR OWN RISK. NEITHER Our Office NOR ITS AFFILIATES, PARTNERS, AGENTS, OR LICENSORS, IF ANY, MAKE ANY REPRESENTATION OR WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, OR NON-INFRINGEMENT, OR WARRANTIES ARISING BY COURSE OF DEALING OR CUSTOM OF TRADE. NEITHER OUR OFFICE NOR ITS AFFILIATES, PARTNERS, AGENTS, OR LICENSORS, IF ANY, MAKE ANY REPRESENTATION OR WARRANTY THAT ANY CONTENT IS ACCURATE, COMPLETE, APPROPRIATE, RELIABLE, OR TIMELY. NEITHER Our Office NOR ITS AFFILIATES, PARTNERS, AGENTS, OR LICENSORS, IF ANY, MAKE ANY REPRESENTATIONS OR WARRANTIES THAT YOUR ACCESS TO AND USE OF THE SITE (1) WILL BE UNINTERRUPTED OR ERROR-FREE, (2) IS FREE OF VIRUSES, UNAUTHORIZED CODE, OR OTHER HARMFUL COMPONENTS, (3) IS YEAR 2000 READY OR COMPLIANT, (4) IS SECURE, OR (5) WILL BE AVAILABLE AT ANY TIME OR FROM ANY LOCATION. NEITHER OUR OFFICE NOR ITS AFFILIATES, PARTNERS, AGENTS, OR LICENSERS, IF ANY, MAKES ANY WARRANTY OR REPRESENTATION REGARDING (1) THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE SERVICES OR THE SITE, (2) ANY GOODS OR SERVICES PURCHASED OR OBTAINED THROUGH THE SERVICES OR THE SITE, OR (3) THAT ANY DEFECTS IN THE SITE WILL BE CORRECTED. YOU ARE RESPONSIBLE FOR TAKING ALL PRECAUTIONS YOU BELIEVE NECESSARY OR ADVISABLE TO PROTECT YOU AGAINST ANY CLAIM, DAMAGE, LOSS OR HAZARD THAT MAY ARISE BY VIRTUE OF YOUR USE OF THE SITE. Some jurisdictions do not permit the exclusion or limitation of implied warranties. Therefore, only if required by applicable law, some or all of the exclusions or limitations above may not apply to you.

Limitation of Liability
IN NO EVENT WILL OUR OFFICE, ANY OF ITS PARTNERS, PROVIDERS, AFFILIATES, INCLUDING THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES OR REPRESENTATIVES (COLLECTIVELY THE "COVERED PARTIES"), BE LIABLE FOR ANY DAMAGES (INCLUDING WITHOUT LIMITATION, DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES OR DAMAGES RESULTING FROM LOST PROFITS, LOST DATA OR BUSINESS INTERRUPTION) ARISING OUT OF THE USE, INABILITY TO USE, OR THE RESULTS OF USE OF THE SITE, THE SERVICES AVAILABLE ON THE SITE, ANY WEB SITES LINKED TO SUCH SERVICES, THE MATERIALS OR INFORMATION CONTAINED AT ANY OR ALL SUCH SITES OR AT BULLETIN BOARDS AVAILABLE THROUGH SUCH SITES, OR THE CONTENT ANYWHERE ON THE INTERNET. THIS LIMITATION OF LIABILITY APPLIES TO ALL CLAIMS OR DAMAGES ARISING FROM THE CIRCUMSTANCES DESCRIBED IN THIS PARAGRAPH REGARDLESS OF WHETHER ANY SUCH CLAIM IS BASED ON WARRANTY, CONTRACT, INFRINGEMENT, DEFAMATION, MISAPPROPRIATION OR ANY OTHER TORT OR LEGAL THEORY AND REGARDLESS OF WHETHER Our Office HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Some jurisdictions do not permit the exclusion or limitation of liability. Therefore, only if required by applicable law, some or all of the exclusions or limitations above may not apply to you.

License to Our Office
By posting messages, uploading files, inputting data, or engaging in any other form of communication through the Services, you are granting Our Office and its affiliated entities a royalty-free, perpetual, non-exclusive, unrestricted, transferable, worldwide license to:

  • Use, copy, adapt, transmit, retransmit, distribute, creative derivative works of, and/or publicly or digitally perform or display any such communication.
  • Sublicense to third parties the unrestricted right to exercise any of the foregoing rights granted with respect to the communication.

The foregoing grants shall include the right to exploit any proprietary rights in such communication, including but not limited to rights under copyright, trademark, servicemark, patent laws or the intellectual property laws under any relevant jurisdiction.

Appointment Scheduling
By using our online appointment scheduling process, you understand and agree to the following:

  • The information you provide during the course of scheduling an appointment through our webpage will be saved to you or your family’s account with Our Office.
  • If you are under eighteen, you will need to call Our Office to schedule an appointment, rather than use the online scheduling process.
  • If you schedule an appointment for a minor (under eighteen years old), Our Office must validate your legal guardian or parental status at the time of the appointment.
  • To the extent you need to re-schedule or cancel your appointment, or you have a dental emergency, you will need to call Our Office directly. 
  • You agree to receive e-mail and text message confirmations of your scheduled appointment.

Prohibited Uses
The Services may include access to bulletin boards, which allow users to post messages and interact with other users. You understand that Our Office has no obligation to monitor the bulletin boards, the Site, or Third-Party Linked Sites. However, Our Office reserves the right at all times to disclose any information posted by you or any other user as necessary to satisfy any law, regulation or governmental request, or to edit, refuse to post or to remove any information or material, in whole or in part, that in Our Office's sole discretion is objectionable or in violation of these terms and conditions.

As a user of the site, you agree to use the Services only for lawful purposes. Use of the Services for transmission, distribution, retrieval or storage of any information, data, or other material in violation of any applicable law or regulation is prohibited. You also agree not to use the Services to:

  • Use or transmit any material protected by copyright, trademark, trade secret, patent, or other intellectual property right without proper authorization;
  • Harass others by spamming;
  • Threaten, harass, defame, embarrass or distress any other person or group;
  • Distribute computer viruses, worms, or any software intended to damage or alter a computer system without the owner's consent;
  • Use "auto-responders," "cancel-bots," or other similar mechanisms that generate excessive network traffic;
  • Post or send any unlawful, harmful, defamatory, pornographic, obscene, vulgar or otherwise objectionable material;
  • Post, send or relay any unsolicited advertising;
  • Post or send any chain letters or pyramid schemes;
  • Post or send any fraudulent or misleading offers of products, items, loans, or other services;
  • Post any misleading, inaccurate or fraudulent information;
  • Post any junk emails;
  • Post any duplicative or unsolicited messages;
  • Harvest or otherwise collect information about others, including email addresses, without their consent;
  • Create a false identity or forged email address or header or otherwise attempt to mislead others as to the identity of the sender or the origin of the message; or
  • Attempt to gain unauthorized access to other accounts, computer systems or networks connected to the service through login password mining or any other means.

Termination
Our Office may terminate the Services and access to this Site at any time without notice in its sole discretion. In the event of a termination, the disclaimers and limitations of liabilities set forth in this TOS shall survive. Users who violate this TOS may additionally incur criminal and/or civil liability. Our Office may refer violators to civil or criminal authorities for prosecution, and will cooperate fully with applicable government authorities in connection with its investigations of any suspected civil or criminal violations.

Trademarks
The trademarks appearing on the Site, including those of Our Office are the property of their respective owners. Our Office's trademarks may be used only with the express written permission of Our Office. The design and layout of the Site, and all other Web sites owned, operated, licensed, or controlled by Our Office or its subsidiaries, if any, are protected as trade dress and may not be copied or imitated in whole or in part. No logo, graphic, sound, image, or animation from the Site may be copied or re-transmitted unless expressly permitted by Our Office. Other product and company names mentioned herein may be the trademarks of their respective owners.

Copyright
All materials on the Site are copyrighted and are protected under state and federal law, as well as international treaties and the copyright laws of other countries. Our Office's materials may not be reproduced, copied, distributed, adapted, displayed, edited, published, transmitted, or downloaded in any way without Our Office's express written permission. All rights not expressly granted herein are reserved by Our Office.

General
You may create a bookmark in your browser to the home page of the Site. All rights not expressly granted in this Agreement are reserved to us. No other rights or licenses, whether express, implied, arising by estoppels, or otherwise are conveyed or intended by this Agreement.

Indemnity
You agree to indemnify, defend and hold harmless Our Office, its telecommunications providers and service providers and its subsidiaries, affiliates, officers, directors, employees, consultants and agents, if any, from any and all third-party claims, liability, damages and costs (including, but not limited to, attorneys' fees) due to or arising from (i) your use of the Services and/or the Site, (ii) any content you post, email, transmit, or relay by use of the Services or to Our Office, a Third-Party Linked Site, and/or the Site, (iii) your violation of the TOS, or (iv) your infringement of any intellectual property or other right of any person or entity.

Changes to the Site and the Service
Our Office reserves the right to change, suspend or discontinue any aspect of the Services or the Site at any time, including the availability of any of the Site features, delivery services, databases or content. Our Office may also impose limits on features or restrict access to parts of the Site.

General Terms
If any provision(s) of the TOS is found to be contrary to law, then such provision(s) shall be construed, as nearly as possible, to reflect the intentions of the parties with the other provisions remaining in full force and effect. Our Office's failure to exercise or enforce any right or provision of the TOS shall not constitute a waiver of such right or provision unless acknowledged and agreed to by Our Office in writing. The section titles of the TOS are solely used for the convenience of the parties and have no legal or contractual significance. The TOS constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes and replaces all prior or contemporaneous understandings or agreements, written or oral, regarding such subject matter. Any waiver of any provision of the TOS will be effective only if expressly made in writing and signed by Our Office.

 

JOINT NOTICE OF PRIVACY PRACTICES AND NOTICE OF ORGANIZED HEALTH CARE ARRANGEMENT

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT US AT ADMIN@CLOVEDDS.COM.

We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services or payment of health care services.

This Notice was published and became effective on April 1, 2020. We are required to abide by the terms of this Notice currently in effect. We may change the terms of this Notice at any time. The new Notice will be effective for all protected health information that we maintain at that time. You may obtain a copy of any revised Notice by accessing our website, calling our Privacy Contact and requesting that a revised copy be sent to you in the mail, or asking for one at the time of your next appointment.

Organized Health Care Arrangement: Clove Dental Inc (“Clove Dental”) provides business support services to a number of entities engaged in the practice of dentistry (“Dental Entities”). All of the Dental Entities are included in the Smile Generation website maintained by CD, and the dental office locations operated by the Dental Entities are listed at the following URL: http://www.clovedds.com/SiteMap.aspx, as updated from time to time. CD, its subsidiaries and the Dental Entities are participants in an Organized Health Care Arrangement for purposes of federal privacy requirements and, accordingly, they may share information about you with each other for treatment, payment and operations purposes as described in this Notice. As used in this Notice, the words “we,” “our” and “us” collectively refer to CD, its subsidiaries and the Dental Entities. This Notice applies to all Dental Entities that provide health care to you.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION

To Contact You: We may use your protected health information to contact you to remind you about appointments, inform you about treatment options, or advise you about other health-related benefits and services.

Treatment: We may use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes coordinating your health care with a third party, consulting with another health care provider, or referring you to another health care provider. For example, your dentist may need to know if you have other health problems that might complicate your treatment and therefore may request your medical record from another health care provider that has provided treatment to you. We may also share your health information with other providers outside of the Organized Health Care Arrangement described herein. The disclosure of your health information to others outside of the Organized Health Care Arrangement may be done electronically through a health information exchange such as Care Everywhere, that allows providers involved in your care to access some of your health information to coordinate services and treatment for you.

Payment: We may use and disclose your protected health information to obtain or provide payment for your dental services. This may include sharing information with the person or entity responsible for paying, such as your health insurer. Your insurance company or health plan may need your information for activities such as determining eligibility or coverage for insurance benefits and reviewing services provided to you. For example, we may give your insurance company information about your dental surgery so your insurance will pay for the care.

Operations: We may use or disclose your protected health information for our health care operations, such as to support our business activities and to ensure that quality dental care is provided. Some of these activities involve quality assessments, peer or employee review, training health care professionals, licensing and accreditation activities, data aggregation, compliance- or audit-related activities, and business planning and development. For example, we may use your information to evaluate the performance of our dentists and staff in providing care to you. We may also disclose your protected health information to another provider, health plan, or health care clearinghouse that has or has had a relationship with you for certain of its health care operations. 

Business Associates: We may disclose your protected health information to third parties that perform services, such as billing or legal services. We have written contracts with third parties requiring them to protect the privacy of your protected health information.

Treatment Alternatives and Health-Related Products and Services: We may use or disclose your protected health information to provide you with information about certain products or services including to describe our participation in a dentist network or health plan network, products or services we provide or include in a plan of benefits, and alternative treatments, therapies, dentists or settings of care.

Family and Friends: We may disclose your protected health information to individuals, such as family and friends, who are involved in your care or who help pay for your care. We may do this if you tell us we can do so, or if you know we are sharing your information with these people and you do not object. If you are unavailable or unable to tell us your preference, we may also disclose your information if, based on our professional judgment, we believe that disclosing the information is in your best interest and you would not object. For example, we may assume you agree to disclosure of your information to your spouse if your spouse comes with you into the exam room or allow your spouse to pick up prescriptions, dental supplies and X-rays.

If you are a minor, you also may have the right to block parental access to your health information in certain circumstances, if permitted by state law. You can contact your dental provider or our Privacy Officer at the number at the top of this Notice.

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION

We may use or disclose your protected health information without your authorization in certain other circumstances, such as when required by law or for public health and safety purposes. We will comply with the legal requirements and limitations applicable to these circumstances.

As Required by Law: We may use or disclose your protected health information when and as required by federal, state or local law.

Public Health Activities: We may disclose your protected health information to a public health authority for public health activities such as to prevent or control disease, injury or disability; to respond to or report suspected abuse or neglect, non-accidental physical injuries, reactions to medications, or problems with products; and to comply with medication or product recalls.

Health Oversight Activities: We may disclose your protected health information to health oversight agencies, such as government agencies that oversee the health care system, government programs, or compliance with civil rights laws, for oversight activities such as audits, investigations, inspections and licensing.

Lawsuits and Disputes: We may use or disclose your protected health information in response to a court or administrative order in an administrative or judicial proceeding, or in response to a subpoena, discovery request or other legal process.

Law Enforcement: We may use or disclose your protected health information for law enforcement purposes, so as to respond to legal processes, identify or locate a suspect, provide information about crime victims, report crimes occurring on our premises, and report suspected crimes in a medical emergency.

Coroners, Medical Examiners and Funeral Directors: We may disclose your protected health information to a coroner or medical examiner to identify a deceased person or determine the cause of death or for other lawful activities, or to a funeral director, as necessary to allow him/her to carry out his/her activities.

Organ and Tissue Donation: If you are an organ or tissue donor, we may disclose your protected health information to organizations that handle organ procurement or organ, eye or tissue donation or transplantation.

Research: We may use and disclose your protected health information in preparation for research or for research if and as approved by an institutional review board or privacy board.

Serious Threat to Health or Safety; Disaster Relief: We may disclose your protected health information to appropriate individuals or organization when and as necessary to prevent a serious threat to the health and safety of a person (including yourself) or of the public. We may also disclose your protected health information to identify, locate or notify your family members or persons responsible for you in a disaster.

Military and Veterans: We may disclose your protected health information as required by military command or another government authority if you are a member of the armed forces.

National Security; Intelligence Activities; Protective Service: We may disclose your protected health information to federal officials for intelligence, counterintelligence and other national security activities authorized by law, including activities related to the protection of the President, other authorized persons or foreign heads of state, or related to the conduct of special investigations.

Workers’ Compensation: We may disclose your protected health information for workers’ compensation or similar work-related injury programs, to the extent permitted or required by law.

Inmates: We may disclose your protected health information to a correctional institution (if you are an inmate) or a law enforcement official (if you are in that official’s custody) as necessary (i) for the institution to provide you with health care; (ii) to protect your or others’ health and safety; or (iii) for the safety and security of the correctional institution.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITH YOUR AUTHORIZATION

All uses and disclosures of your protected health information not covered by this Notice will be made only with your written authorization. For example, we will not sell your protected health information without your written authorization. Federal and state laws may provide additional protections or further limit how we may use or disclose your protected health information. We will comply with these laws and, when necessary, ask for your authorization to use or disclose your protected health information. Examples of protected health information that may be subject to special protections include psychotherapy notes, genetic information, mental health information, HIV/AIDS test results or information, reproductive health information, sexually transmitted or other communicable disease information, and alcohol or substance use disorder information.

You may revoke any authorization, at any time, by notifying, in writing, our Privacy Contact. If you revoke your authorization, we will no longer use or disclose your protected health information as allowed by the authorization, except to the extent we have already relied on the authorization.

YOUR RIGHTS WITH RESPECT TO PROTECTED HEALTH INFORMATION

You have the following rights with respect to your protected health information. You may exercise these rights by submitting a written request to our Privacy Contact. Please contact our Privacy Contact with any questions about these rights.

Right to Inspect and Copy. You may inspect and obtain a copy of your protected health information maintained in your dental chart, including clinical and billing records and any other records that we use to make decisions about you. We may charge you a fee to cover costs of copying, mailing and associated supplies.

We may refuse to allow you to inspect or copy certain records, such as information compiled for legal actions and proceedings. If we deny your request, you may have a right to have this decision reviewed.

Right to Request Restrictions. You may request that we not use or disclose any part of your protected health information for a particular treatment, payment or health care operations-related purpose. You may also request that any part of your protected health information not be disclosed to particular family members or friends who may be involved in your care.

We are not required to agree to a restriction that you may request, unless you request to restrict the disclosure of your protected health information to a health plan for payment or health care operations-related purposes and the protected health information relates only to a health care item or service for which you have paid in full and not through insurance. If we agree to the requested restriction, we may still use or disclose your protected health information as needed for emergency treatment.

Right to Request Confidential Communications. You may request that we communicate with you via alternative means or at an alternative location. For example, you may request that we contact you using your work phone number, rather than a home phone number. We will accommodate reasonable requests and will not require an explanation for the request, but we may require you to provide additional information to ensure we can contact you and arrange for billing and payment.

Right to Amend. You may request an amendment of your protected health information to correct an error or omission. In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and, if we do, we will provide you with a copy of any such rebuttal. 

Right to an Accounting of Disclosures. You may request an accounting of certain disclosures of your protected health information made within a period up to six years prior to your request. This accounting does not include disclosures made to you or with your authorization; for treatment, payment or health care operations; to family members or friends involved in your care or for notification purposes; and certain other disclosures. The right to receive this information is subject to certain exceptions, restrictions and limitations.

Right to Breach Notification. If we or one of our service providers improperly uses or discloses your protected health information in a way that compromises the privacy or security of that information (a “breach”), we will notify you as required by law.

Right to Paper Copy of This Notice. You may receive a paper copy of this Notice upon request, even if you have agreed to accept this Notice electronically.

QUESTIONS OR COMPLAINTS

We take our obligations to protect your privacy seriously. If you have any questions about this Notice, please contact our Privacy Contact. If you believe your privacy rights have been violated, you may submit a complaint to us via our Privacy Contact at the number at the top of this form or the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint. 

Source: HHS Office for Civil Rights

This Practice complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

This Practice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

This Practice:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    ○ Qualified sign language interpreters
    ○ Written information in other formats (large print, audio, accessible electronic formats)

• Provides free language services to people whose primary language is not English, such as:
    ○ Qualified interpreters
    ○ Information written in other languages

If you need these services, contact the Operations Manager at the practice.

If you believe that this practice has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

admin@clovedds.comYou can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Director of Compliance is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC 20201

Toll Free: 1-800-368-1019,
800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

 

Notice of Teledentistry

The teledentistry system allows a dentist to view your records through the internet. The dentist will then make recommendations about your treatment. The dentist may not see you in person.

 

1.  What is a teledentistry consultation?

Teledentistry means a real-time interaction between a patient and a dental health care provider located at a distant site.  It can also include the transmission of a patient’s health information from an originating site to the dental health care provider at a distant site. This information may be reviewed at a later time.  It is a way to provide care for people who do not or cannot go to a dentist’s office. Teledentistry uses electronic dental records such as electronic versions of X-rays, photographs, recordings of the condition of your teeth, health and other history information. The goal of the teledentistry is to have the dentist create recommendations for you for dental care.

 

2.  What happens during teledentistry consultation?

The Dentist or other licensed dental professionals authorized by and under the direction of the Dentist will examine your mouth and collect electronic dental records. That person will record what she/he sees. Your medical and dental history and personal health information may be discussed with other health professionals. These discussions will occur through phone calls or “store and forward” technology. A teledentistry consultation may require more than one visit.

 

3.  What are the risks, benefits and alternatives?

The benefits of teledentistry include having access to a dentist and additional dental information without having to travel to a dental office or clinic.  A potential risk of teledentistry is that a face-to-face consultation with a dentist may still be necessary after the teledentistry appointment. This could be because of your specific medical or dental condition or for other reasons. Recommendations will be made to you about your future dental care after the teledentistry consultation. These could include recommendations about whether or not to see a dentist in a dental office or dental clinic. A visit to a dental office may be needed in the future even if it is not recommended now. The recommendations may change if more information about your dental needs becomes known. The alternative to teledentistry consultation is a face-to-face visit with a dentist. The practice of dentistry is not an exact science. Therefore, any specific results cannot be guaranteed.

 

4.  Confidentiality.

Current federal and state laws about confidentiality apply to the information used or disclosed during your teledentistry consultation.  A separate document, which describes how your private information will be handled, is known as the “Notice of Privacy Practices” and can be found on the dental practice’s website.

 

5.  Rights.

You may choose not to participate in a teledentistry consultation at any time before and/or during the consultation. If you decide not to participate, it will not affect your right to future care or treatment. You have the option to seek dental consultation or treatment in a dental office at any time before or after the teledentistry consultation. If an injury occurs as a result of procedures provided hereunder, notify the Dentist.  He or she will make arrangements for appropriate treatment of the injury.