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7311 NE 141st St., Ste. 1, Kirkland, WATue – Fri: 7:00 a.m. – 4:00 p.m.
HIPAA Disclosure

Statement of Privacy Practices

Statement of Privacy Practices

Mark J. Andrews, DDS Family and Cosmetic Dentistry | 7311 NE 141st St, Suite 1, Kirkland, WA 98034

Our office is dedicated to protecting the privacy rights of our patients and the confidential information entrusted to us. The commitment of each employee to ensure that your health information is never compromised is a principal concept of our practice. We may, from time to time, amend our privacy policies and practices but will always inform you of any changes that might affect your rights.

Protecting Your Personal Healthcare Information

We use and disclose the information we collect from you only as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and the state of Washington. This includes issues relating to your treatment, payment, and our health care operations. Your personal health information will never be otherwise given to anyone – even family members – without your written consent.

Collecting Protected Health Information (PHI)

We will only request personal information needed to provide our standard of quality health care, implement payment activities, conduct normal health practice operations, and comply with the law. This may include your name, address, telephone number(s), Social Security Number, employment data, medical history, health records, etc.

Disclosure of Your Protected Health Information

As stated above, we may disclose information as required by law. We will not use your information for marketing purposes without your written consent. We may use and/or disclose your health information to communicate reminders about your appointments including voicemail messages, answering machines, and postcards.

Your Rights as Our Patient

You have a right to request copies of your healthcare information, request copies in a variety of formats, and request a list of instances in which we have disclosed your protected information. All such requests must be in writing.

Patient Acknowledgement & Signature

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