Notice of Privacy Practices
How we may use and share your health information, and the rights you have over it.
Google Business ProfileGoogle Verified BusinessThis notice describes how medical information about you may be used and shared, and how you can get access to it. Please read it carefully.
Revive by MWS is the trading name of Shireen Dhanani DMD PA, a Florida professional association. Questions about this notice can go to our Privacy Officer at (352) 559-1901.
Our duties to you
The law requires us to keep your health information private and to give you this notice of our legal duties and privacy practices. We must follow the notice that is currently in effect.
If a breach occurs that may have put the privacy or security of your information at risk, we will tell you promptly. We will not use or share your information in ways this notice does not describe unless you give us written permission.
How we use and share your information
Treatment. We use your information to evaluate and care for you. We may share it with other clinicians involved in your care, such as a doctor who referred you or a laboratory that processes a test.
Payment. We use your information to bill for the care you receive and to collect payment for it.
Running the practice. We use your information to manage the clinic, review the quality of our care and train our staff. We share only what each task needs.
Reminders and related services. We may contact you about appointments, or tell you about treatment options and health services that may be relevant to you.
People involved in your care. We may share information with a family member or friend who helps with your care, if you agree or do not object. In an emergency, we use professional judgment about what is in your interest.
Service providers. Some companies help us run the practice, such as our records and scheduling vendors. They must sign an agreement to protect your information and may use it only for the work they do for us.
Other uses the law allows or requires
In some situations we may share your information without your written permission, usually only when certain conditions are met. These include:
- when federal, Florida or local law requires it
- for public health work, such as reporting disease, injury, problems with medical products, or suspected abuse, neglect or domestic violence
- to government health agencies for audits, inspections and licensing
- in response to a court or administrative order, or a subpoena, in a legal proceeding
- to law enforcement in limited situations
- to prevent a serious threat to someone's health or safety
- to medical examiners, funeral directors and organ or tissue donation organizations
- for workers' compensation claims
- for research that has been approved under privacy safeguards
- for special government functions, such as military, national security and protective services
Florida law and some federal laws give extra protection to certain records, such as mental health records, HIV test results and substance use treatment records. When a stricter law applies, we follow it.
Uses that need your written permission
We will ask for your written permission before we use or share psychotherapy notes in most cases, use your information for marketing, or sell your information. Any use not described in this notice also needs your permission.
You can take back your permission at any time by telling us in writing. That will not undo anything we already did while your permission was in place.
Your rights
A copy of your records. You can ask to see or get a paper or electronic copy of your health records. We will usually respond within 30 days and may charge a reasonable, cost-based fee.
Corrections. You can ask us to correct information you believe is wrong or incomplete. If we say no, we will explain why in writing.
Confidential communication. You can ask us to reach you in a specific way, such as a different phone number or mailing address. We will agree to reasonable requests.
Limits on what we use or share. You can ask us not to use or share certain information. We do not have to agree, but if you pay in full out of pocket for a service, you can ask us not to share it with a health plan, and we will agree unless the law requires otherwise.
A list of disclosures. You can ask for a list of the times we shared your information in the six years before your request, other than for treatment, payment, running the practice and a few other purposes. One list a year is provided without charge.
A copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.
Someone to act for you. If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your information.
Changes to this notice
We can change the terms of this notice, and the changes will apply to all the information we hold about you. The current notice is posted on this website and is available at the front desk.
Questions and complaints
If you believe your privacy rights have been violated, you can file a complaint with us by contacting our Privacy Officer. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
We will not retaliate against you in any way for filing a complaint.
Contact
Privacy Officer, Revive by MWS, 920 E. Dixie Ave. Suite A, Leesburg, FL 34748. Call (352) 559-1901 or email [email protected].
Effective date: [to be set by the practice at adoption].