3755 S. Capital of Texas Highway, Suite 292 Austin, TX 78704
info@thielpediatricdentistry.com • phone: (512) 892-0013 • fax: (512) 893-3359
Notice of Privacy Practices
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health
information. We are also required to give you this Notice about our privacy practices, our legal
duty, and your rights concerning your health information. We must follow the privacy practices
that are described in this Notice while it is in effect. This Notice takes effect 04/01/08, and will
remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any
time, provided such changes are permitted by applicable law. We reserve the right to make
the changes in our privacy practices and the new terms of our Notice effective for all health
information that we maintain, including health information we created or received before we
made the changes. Before we make a signicant change in our privacy policy practices, we will
change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy
practices, or for additional copies of this Notice, please contact us using the information listed
at the end of this Notice.
Uses and Disclosures of Health Information
We use and disclose health information about you for treatment, payment , and healthcare
operations. For Example:
Treatment
We may use and disclose your health information to a physician or other healthcare provider
providing treatment to you.
Payment
We may use/disclose your health information to obtain payment for services we provide to you.
Healthcare Operations
We may use and disclose your health information in connection with our healthcare operations.
Healthcare operations include quality assessment and improvement activities, reviewing
the competence or qualications of healthcare professionals, evaluating practitioner and
provider performance, conducting training programs, accreditation, certication, licensing or
credentialing activities.
Your Authorization
In addition to our use of your health information for treatment, payment or healthcare
operations, you may give us written authorization to use your health information or to disclose
it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at
any time. Your revocation will not effect any use or disclosures permitted by your authorization
while it was in effect. Unless you give us a written authorization, we cannot use or disclose your
health information for any reason except those described in this Notice.