We care about maintaining the confidentiality of your protected health information
The UCLA School of Dentistry is considered a component of the covered entity of the University of California under the federal Health Insurance Portability and Accountability Act of 1996. To read about our privacy practices and to learn about your rights with respect to your health information, please refer the information below.
UCLA School of Dentistry Privacy Practices
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandates significant changes in the legal and regulatory environments governing the provision of health benefits, the delivery and payment of healthcare services, and the security and confidentiality of individually identifiable, protected health information. For more information about HIPAA please refer to the United States Department of Health & Human Services HIPAA website at http://www.hhs.gov/ocr/hipaa/.
As required by HIPAA, the School of Dentistry will distribute a Notice of Privacy Practices to each new and continuing patient at his/her first visit on or after April 14, 2003. For your convenience, the UCLA School of Dentistry Notice of Privacy Practices may be downloaded from here: Notice of Privacy Practices in English and Notice of Privacy Practices in Spanish. Each patient who is given a copy of the Notice of Privacy Practices will also be asked to acknowledge receipt of such notice. A copy of the acknowledgement form may also be downloaded from here: Acknowledgement form in English and Acknowledgement form in Spanish .
As you will see in your review of our Notice of Privacy Practices, patients have a number of rights including the following:
1. Right to Inspect and Copy Records – To request a copy of your records or authorize the release of your information to another party, please complete the “Authorization for Release of Health Information” form.
2. Right to Request an Amendment or Addendum to Records – To request an amendment or addendum to your record, please complete the “Request to Amend Protected Health Information” form.
3. Right to an Accounting of Disclosures – To request an accounting of certain disclosures of your medical information, please complete the “Request for an Accounting of Disclosures” form.
4. Right to Request Restrictions – To request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or operations, please complete the “Request for Special Restriction of Use or Disclosure of Protected Health Information” form. If you subsequently wish to change such restrictions, please complete the “Termination of Special Restriction” form .
5. Right to Request Confidential Communications – To request that we communicate with you about medical matters in a certain way or at a certain location, please complete the “Request for Restriction on the Manner/Method of Confidential Communications” form.
For more information about any of the foregoing rights, please refer to our Notice of Privacy Practices or to the United States Department of Health & Human Services HIPAA website at http://www.hhs.gov/ocr/hipaa/.