Notice of Privacy Practices
Effective Date: April 14th, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY
We provide this notice to comply with the Privacy Regulations issued by the Department of Health and Human Services in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
This NOTICE OF PRIVACY PRACTICES describes the privacy policies and procedures we adhere to and extends to all healthcare providers and dental office employees for:
Samuel W. Christensen, DDS
7545 Soquel Drive, Suite B, Aptos, CA 95003 831-688-7878
ABOUT YOUR PROTECTED HEALTH INFORMATION (PHI):
* PHI includes any individually identifiable health information transmitted or maintained by our office in any form or medium (electronically, on paper, or orally).
* PHI is protected by law and provides penalties for healthcare providers that misuse or disclose it to unauthorized persons.
* Employment records maintained by a covered entity in its capacity as an employer are excluded from the definition of PHI.
* The protection of your PHI is something our dental offices takes very seriously.
ABOUT THIS NOTICE OF PRIVACY PRACTICES:
We are required by law to:
* Give you a copy of this notice when you sign a patient consent form.
* Post the notice in a prominent place and on our website, if we have one.
* Make the notice available to our patients upon request.
* Provide you with a revised notice, if we make material changes to our notice, and will do at your next office visit after the changes to the notice have been made.
* Follow the policies and conditions of the notice that is currently in effect.
* Change our notice at any time.
*Make revisions and changes to our notice effectively for PHI already in our system as well as for PHI we obtain from our patients in subsequent visits.
ABOUT USES AND DISCLOSURES OF YOUR PHI:
We may use and disclose your PHI:
FOR TREATMENT: Means providing, coordinating, or managing healthcare and related services by one or more healthcare providers. For example, we may use PHI we receive from your previous dentist to help determine a treatment plan for your current care.
FOR PAYMENT: Means such activities as obtaining reimbursement for dental services, billing, or collections activities, and confirming insurance coverage. For example, we may use and disclose your PHI to obtain payment for dental services.
FOR HEALTHCARE OPERATIONS: Include the business aspects of running our practice, such as conducting quality assessment and improvement activities, employee training, auditing functions, cost management analysis, and customer service. For example, we might hire a dental consultant to review our scheduling procedures. We may disclose PHI for treatment and payment activities of another covered entity or a health care provider, and for certain health care operations of another covered entity.
WHEN REQUIRED BY FEDERAL, STATE, OR LOCAL LAW: When required by the U.S. Department of Health and Human Services as part of an investigation or determination of the facilities compliance with relevant laws.
TO YOUR FAMILY AND FRIENDS: If you agree, we may disclose your PHI to a family member, friend, or another person to the extent necessary to help your healthcare or with payment for your healthcare. For example, if another person was paying for your dental treatment, you might ask us to explain the treatment to that person.
PERSONS INVOLVED IN YOUR CARE: Unless you object, we may disclose to a member of the family, a close friend, or any other person you identify, your PHI as it relates to the person's involvement in your healthcare. If you are able to agree or object to disclosure, we may disclose such information as necessary if we determine that it is in your best interest based upon our professional judgement. We may use or disclose your PHI to assist in notifying a family member, personal representative, or any other person that is responsible for your care of your location, general condition, or death.
APPOINTMENT REMINDERS AND OTHER USES: Your PHI may be used to remind you by phone, computer, or mail of a dental appointment. For example, we may leave a message containing PHI on your answering machine. Or, we may include PHI on recall cards sent to your home or mail you information regarding alternative dental treatment options, or dental related services. We will send you recall notices.
MARKETING: We will not use or disclose your PHI for marketing communications without your written authorization.
EMERGENCY SITUATIONS: To assist in disaster relief efforts or during a medical emergency.
RESEARCH: To researchers when their research has been approved by an institutional review board that has reviewed the research proposal and protocols to ensure the privacy of your PHI.
PUBLIC HEALTH AGENCIES: To report disease, injury, vital events, and to conduct public health surveillance, investigation, and/or intervention. To a health oversight agency activities authorized by law including audits, investigations, inspections, licensure and/or accreditation or disciplinary actions, administrative and/or legal proceedings. To prevent or lessen a serious threat to health or safety of another person or the public and as authorized by laws relating to workers compensation or similar programs. To the coroner, medical examiner, or a funeral director, to an organ donations or procurement organization if you are an organ donor.
LAWSUITS, DISPUTES, INVESTIGATIONS, AND GOVERNMENT ACTIVITIES: We may disclose your PHI if required to do so by a court order, administrative order, subpoena or discovery request by you or another individual involved in the dispute and in the course of certain judicial or administrative proceedings and to federal officials for intelligence and national security activities authorized by law.
LAW ENFORCEMENT: To law enforcement agencies or for specialized governmental functions. For example, for the identification of victims of a crime, to identify or locate a suspect, material witness, missing person, or fugitive or in response to a court order, warrant, summons, or subpoena.
MILITARY: Our practice may disclose your PHI if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate authorities to do so.
INMATES: If you are an inmate of a correctional institution and if the institution is going to provide healthcare for you. Or, to protect the health and safety of the inmate or others or to protect the health and safety of the institution.
FOOD AND DRUG ADMINISTRATION (FDA): Covered entities may disclose PHI, without authorization, to a person subject to the jurisdiction of the FDA for public health purposes related to the quality, safety or effectiveness of FDA-regulated products or activities such as collecting or reporting adverse events, dangerous products, and defects or problems with FDA-regulated products.
ANY OTHER USES: Will be made only with your written permission.
As a Patient YOU have the right to:
* Obtain a copy of this Notice, even if you agreed to accept it electronically.
* Request that we communicate with you in a particular manner or at a certain location.
The Dental Board of California
Dental Materials Fact Sheet Adopted by the Board on October 17th, 2001
As required by Chapter 801, Statutes of 1992, the Dental Board of California has prepared this fact sheet to summarize information on the most frequently used restorative dental materials. Information on this fact sheet is intended to encourage discussion between the patient and dentist regarding the selection of dental materials best suited for the patient's dental needs. It is not intended to be a complete guide to dental materials science.
The most frequently used materials in restorative dentistry are amalgam, composite resin, glass ionomer cement, resin-ionomer cement, porcelain (ceramic), porcelain-fused-to-metal, gold alloys (noble), and nickel or cobalt-chrome (base-metal) alloyws. Each material has its own advantages and disadvantages, benefits and risks. These and other relevant factors are compared in the attached matrix titled "Comparisons of Restorative Dental Materials". A "Glossary of Terms" is also attached to assist the reader in understanding the terms used.
The statements made are supported by relevant, credible dental research published mainly between 1993-2001. In some cases, where contemporary research is sparse, we have indicated our best perceptions based upon information that predates 1993.
The reader should be aware that the outcome of dental treatment or durability of a restoration is not solely a function of the material from which the restoration was made. The durability of any restoration is influenced by the dentist's technique when placing the restoration, the ancillary materials used in the procedure, and the patient's cooperation during the procedure. Following restoration of the teeth, the longevity of the restoration will be strongly influenced by the patient's compliance with dental hygiene and home care, their diet, and chewing habits.
Both the public and the dental profession are concerned about the safety of dental treatment and any potential health risks that might be associated wiht the materials used to restore the teeth. All material commonly used (and listed in this fact sheet) have been shown -- through laboratory and clinical research, as well as through extensive clinical use -- to be safe and effective for the general population. The presence of these material in the teeth does not cause adverse health problems for the majority of the population.
There exists a diversity of various scientific opinions regarding the safety of mercury dental amalgams. The research literature in peer-reviewed scientific journals suggests that otherwise healthy women, children and diabetics are not at increased risk for exposure to mercury from dental amalgams. Although there are various opinions with regard to mercury risk in pregnancy, diabetes, and children, these opinions are not scientifically conclusive and therefore the dentist may way to discuss these opinions with their patients. There is no research evidence that suggests pregnant women, diabetics, and children are at increased health risk from dental amalgam fillings in their mouth.
A recent study reported in the JADA factors in a reduced tolerance (1/50th of the WHO safe limit) for exposure in calculating the amount of mercury that might be taken in from dental fillings. This level falls below the established safe limits for exposure to a low concentration of mercury or any other released component from a dental restorative material. Thus, while these sub-populations may be perceived to be at increased health risk from exposure to dental restorative materials, the scientific evidence does not support that claim. However, there are individuals who may be susceptible to sensitivity, allergic or adverse reactions to selected materials. As with all dental materials, the risks and benefits should be discussed with the patient, especially with those in susceptible populations.
There are differences between dental materials and the individual elements or components that compose these materials. For example, dental amalgam filling material is composed mainly of mercury (43-54%) and varying percentages of silver, tin, and copper (46-57%). It should be noted that elemental mercury is listed on the Proposition 65 list of known toxins and carcinogens.
Like all material in our environment, each of these elements by themselves is a toxic at some level of concentration if they are taken into the body. When they are mixed together, they react chemically to form a crystalline metal alloy. Small amounts of free mercury may be released from amalgam fillings over time and can be detected in bodily fluids and expired air. The important question is whether any free mercury is present in sufficient levels to pose a health risk.
Toxicity of any substance is related to does, and doses or mercury or any other element that may be released from dental amalgam fillings falls far below the established safe levels as stated in the 1999 US Health and Human Service Toxicological Profile for Mercury Update.
All dental restorative material (as well as all materials that we come in contact with in our daily life) have the potential to elicit allergic reactions on hypersensitive individuals. 1. These must be assessed on a case-by-case basis, and susceptible individuals should avoid contact with allergic materials. Documented reports of allergic reactions to dental amalgam exist (usually manifested by transient skin rashes on individuals who have come into contact with the material), but they are atypical.
Documented reports of toxicity to dental amalgams exist, but they are rare. There have been anecdotal reports of toxicity to dental amalgam and as with all dental material risks and benefits of dental amalgam should be discussed with the patient, especially with those in susceptible populations.
Composite resins are the preferred alternative to amalgam in many cases. They have a long history of biocompatibility and safety. Composite resins are composed of a variety of complex inorganic and organic compounds, any of which might provoke allergic response in susceptible individuals. Reports of such sensitivity are atypical. However, there are individuals who may be susceptible to sensitivity, allergic or adverse reactions to composite resin restorations. The risks and benefits of all dental materials should be discussed with the patient, especially with those in susceptible populations.
Other dental materials that have elicited significant concern among dentists are nickel-chromium-beryllium alloys used predominately for crowns and bridges. Approximately 10% of the female population are alleged to be allergic to nickel. 2. The Incidence of allergic response to dental restorations made from nickel alloys is suprisingly rare. However, when a patient has a positive history of confirmed nickel allergy, or when such hypersensitivity to dental restorations is suspected, alternative metal alloys may be used. Discussion with the patient of the risks and benefits of these materials is indicated.
1 -- Dental Amalgam: A scientific review and recommendation public health service strategy for research, educations, and regulation, Dept. of Health and Human Services, Public Health Service, January 1993.
2 -- Merck Index 1983. Tenth Edition, M. Narsha Windholz, (ed).
General Description: Brief statement of the composition and behavior of the dental material.
Principle Uses: The types of dental restorations that are made from this material.
Resistance to further decay: The general ability of the material to prevent decay around it.
Longevity/Durability: The probable average length of time before the material will have to be replaced. (This will depend upon many factors unrelated to the material such as biting habits of the patient, their diet, the strength of their bite, oral hygiene, etc.)
Conservation of Tooth Structure: A general measure of how much tooth needs to be removed in order to place and retain the material.
Surface Wear/Fracture Resistance: A general measure of how well the material holds up over time under the forces of biting, grinding, clenching, etc.
Marginal Integrity (Leakage): An indication of the ability of the material to seal the interface between the restoration and the tooth, thereby helping to prevent sensitivity and new decay.
Resistance to Occlusal Stress: The ability of the material to survive heavy biting forces over time.
Biocompatibility: The effect, if any, of the material on the general overall health of the patient.
Allergic or Adverse Reactions: Possible systemic or localized reactions of the skin, gums, and other tissues to the material.
Toxicity: An indication of the ability of the material to interfere with normal physiologic processes beyond the mouth.
Susceptibility to Sensitivity: An indication of the probability that the restored teeth may be sensitivity of stimuli (heat, cold, sweet, pressure) after the material is placed in them.
Esthetics: An indication of the degree to which the material resembles the natural teeth.
Frequency of Repair or Replacement: An indication of the expected longevity of the restoration made from this material.
Relative Cost: A qualitative indication of what one would pay for a restoration made from this material compared to all the rest.
Number of Visits Required: How many times a patient would usually have to go to the dentist's office in order to get a restoration made from this material.
Dental Amalgam: Filling material which is composed mainly of mercury (43-54%) and varying percentages of silver, tin, and copper (46-57%).