Emily Stout DDS

Notice of Privacy Practices / HIPAA

Emily Stout DDS

805 Waterbury Park Drive
Elkhart, IN 46517
Phone: 574-293-9222

Effective Date: January 1 2025

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical and dental information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities.

Get an electronic or paper copy of your medical or dental record

You can ask to see or receive an electronic or paper copy of your medical or dental record and other health information we have about you. Ask us how to do this.

We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical or dental record

You can ask us to correct health information about you that you believe is incorrect or incomplete. Ask us how to do this.

We may say no to your request, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way, such as home phone, office phone, cell phone, or mail to a different address.

We will say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to every request, and we may say no if it could affect your care. If we agree to your request, we may still share the information if you need emergency treatment.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or health care operations. We will say yes unless a law requires us to share that information.

Get a list of those with whom we have shared information

You can ask for a list, also called an accounting, of the times we have shared your health information for six years before the date you ask, who we shared it with, and why.

We will include disclosures except for those about treatment, payment, health care operations, and certain other disclosures, such as disclosures you asked us to make. We will provide one accounting per year for free, but we may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

If someone has authority to act as your personal representative, such as through medical power of attorney or legal guardianship, that person may exercise your rights and make choices about your health information.

We will make sure the person has this authority before we take any action.

File a complaint if you believe your rights are violated

You can file a complaint if you believe we have violated your privacy rights by contacting Emily Stout DDS at:

Emily Stout DDS
805 Waterbury Park Drive
Elkhart, IN 46517
Phone: 574-293-9222

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201

You may also call 1-877-696-6775 or visit the HHS website for information about filing a HIPAA complaint.

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference about how we share your information in the situations below, please tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care
Share information with someone involved in payment for your care
Share information in a disaster relief situation

If you are unable to tell us your preference, such as if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we will not share your information unless you give us written permission:

Marketing purposes
Sale of your information
Most sharing of psychotherapy notes, if applicable

In the case of fundraising:

We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: We may share information with another dentist, physician, specialist, laboratory, pharmacy, or other health care provider involved in your care.

Run our organization

We can use and share your health information to run our dental practice, improve your care, and contact you when necessary.

Example: We may use health information about you to manage your treatment, schedule appointments, review the quality of care, train staff, or improve our services.

Bill for your services

We can use and share your health information to bill and receive payment from health plans or other entities.

Example: We may give information about your dental treatment to your dental or health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways, usually in ways that contribute to public health, safety, research, or compliance with the law. We must meet legal requirements before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations, such as:

Preventing disease
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research when permitted by law.

Comply with the law

We will share information about you if state or federal law requires it, including with the Department of Health and Human Services if it wants to confirm that we are complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations, if applicable.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions, such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena, when permitted or required by law.

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you give us written permission, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you.

The new notice will be available upon request, in our office, and on our website.