Required by: HIPAA (45 CFR § 164.520)
1. Who We Are
MK Smile Dental, operated by Dr. Mykola Krylyuk, D.M.D., is a dental practice located at 133 Main Street, South River, NJ 08882. We are committed to protecting the privacy of your Protected Health Information (PHI) as required by the Health Insurance Portability and Accountability Act (HIPAA).
2. How We May Use and Disclose Your Health Information
Treatment: We may use and share your PHI to provide, coordinate, and manage your dental care.
Payment: We may use and disclose your PHI to bill and receive payment for your dental services, including submitting claims to your insurance company.
Healthcare Operations: We may use your PHI for practice management activities such as quality assessment, staff training, and business planning.
Appointment Reminders: We may contact you to remind you of upcoming appointments.
Required by Law: We may disclose your PHI when required to do so by federal, state, or local law.
Public Health Activities: We may disclose your PHI to public health authorities for activities such as disease reporting, injury reporting, or FDA oversight.
Health Oversight: We may disclose your PHI to government agencies for oversight activities including audits, investigations, and inspections.
3. Uses and Disclosures Requiring Your Authorization
Other uses and disclosures of your PHI not described above will be made only with your written authorization, including:
- Most uses and disclosures of psychotherapy notes
- Uses and disclosures for marketing purposes
- Disclosures that constitute a sale of PHI
You may revoke your authorization at any time, in writing, except to the extent we have already acted upon it.
4. Your Rights Regarding Your Health Information
Right to Inspect and Copy: You have the right to inspect and copy your PHI maintained in our records.
Right to Amend: If you believe information in your record is incorrect or incomplete, you may request that we amend it.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI.
Right to Confidential Communications: You have the right to request that we communicate with you about your health information in a specific way or at a specific location.
Right to a Paper Copy: You have the right to receive a paper copy of this Notice of Privacy Practices.
Right to Be Notified of a Breach: You have the right to be notified in the event of a breach of your unsecured PHI.
5. Our Duties
We are required by law to:
- Maintain the privacy of your PHI
- Provide you with this Notice of Privacy Practices
- Follow the terms of this Notice currently in effect
- Notify you following a breach of your unsecured PHI
We reserve the right to change this Notice at any time. Any revised Notice will be effective for all PHI we maintain. A current copy will be available at our office and on our website.
6. Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights. To file a complaint with HHS, visit www.hhs.gov/ocr/privacy/hipaa/complaints/.
You will not be penalized or retaliated against for filing a complaint.
7. Contact Information
Privacy Officer / Contact: Dr. Mykola Krylyuk, D.M.D.
MK Smile Dental
133 Main Street, South River, NJ 08882
Phone: (732) 727-8100
Email: miksmiledental@gmail.com