Our HIPAA Privacy Commitment at Lumiere Dental

Lumiere Dental HIPAA Policy

Effective Date: March 03, 2025

Introduction

Lumiere Dental (1959 W Division St, Chicago, IL) complies with the Health Insurance

Portability and Accountability Act (HIPAA) to protect patient health information (PHI).

This policy explains how we collect, use, safeguard, and disclose PHI while ensuring

patient rights.

Patient Rights

Patients have the right to:

• Access & request copies of their health records (paper or digital); fees may apply.

• Request corrections to inaccurate information.

• Restrict PHI disclosures, including to insurance for out-of-pocket services.

• Request confidential communication methods.

• Obtain a record of PHI disclosures.

• File a HIPAA complaint with Lumiere Dental or the U.S. Department of Health &

Human Services (HHS). Lumiere Dental will not retaliate against any patient for filing a

HIPAA complaint.

• Lumiere Dental may deny access to records in limited cases (e.g., when disclosure

could cause harm). Patients will receive an explanation and appeal options.

Use & Disclosure of PHI

Lumiere Dental may use PHI for:

• Treatment (e.g., consulting with healthcare providers).

• Payment & Insurance Processing (e.g., verifying benefits, claims processing).

• Healthcare Operations (e.g., quality assessment, staff training).

• Legal & Regulatory Compliance (e.g., subpoenas, public health reporting).

• Public Health & Safety (e.g., disease control reporting).

• With Patient Authorization: Any additional use requires written consent, which may be

revoked.

• Minimum Necessary Rule: Only the necessary PHI is shared for each purpose.

Authorization for Other Uses

Lumiere Dental does not share PHI for marketing, research, or non-treatment purposes

without written patient authorization. Authorization may be revoked at any time.

Safeguarding PHI

Lumiere Dental follows strict security protocols to protect PHI, including:

• Secure electronic record storage & restricted access.

• Staff HIPAA training upon hiring & annually thereafter.

• Confidential disposal of PHI (shredding paper records, secure deletion of digital files).

• PHI access monitoring & audits to prevent unauthorized use.

Email & Text Communication Risks:

Patients who choose to send sensitive information via email or text acknowledge the

associated security risks. By doing so, they waive any liability against Lumiere Dental

for unauthorized access, interception, or breaches outside our secure systems.

Patient Use of Media & Recordings

Patients may not record conversations, take photographs, or video record inside

Lumiere Dental without written consent. Unauthorized recordings may result in

dismissal from the practice and legal action if privacy violations occur.

Third-Party Vendors & PHI Compliance

Lumiere Dental works with HIPAA-compliant vendors (e.g., Dentrix Ascend). All vendors

sign a HIPAA Business Associate Agreement (BAA). We are not responsible for

breaches within third-party systems.

PHI Disposal Policy

Lumiere Dental ensures secure PHI disposal:

• Physical records are shredded before disposal.

• Digital PHI is permanently deleted when no longer required.

• Disposal is documented as part of compliance audits.

Financial Responsibility

• Patients must provide accurate insurance/payment information.

• Patients are responsible for denied insurance claims due to incorrect details.

• Payments through third-party vendors (e.g., CareCredit, credit card processors) are

subject to their security policies. Lumiere Dental is not responsible for security

breaches or unauthorized access within these external systems.

Disclosure to Family Members & Caregivers

Lumiere Dental does not disclose PHI to family members, spouses, or caregivers

without a signed Authorization Form, except in emergencies or when required by law.

Electronic PHI Transfers

Lumiere Dental may transfer PHI to referring providers or labs using secure methods. If

a patient requests an email or fax transfer of PHI, they must provide written consent

acknowledging the associated security risks.

HIPAA Training & Staff Compliance

• All employees with PHI access must complete HIPAA training upon hiring and

annually thereafter.

• Staff must sign a Confidentiality Agreement and acknowledge their HIPAA

responsibilities.

• Unauthorized PHI access may result in disciplinary action, including termination.

Breach Notification

If a breach of unsecured PHI occurs, Lumiere Dental will:

• Notify affected patients as required by the HIPAA Breach Notification Rule.

• Provide details on what happened, what was compromised, and steps to protect

patients.

• Report major breaches to the U.S. Department of Health & Human Services (HHS) if

required.

Policy Updates

This policy may be updated periodically. Changes will be posted in our office and on

our website. Continued use of our services constitutes acceptance of updates.

Patient Acknowledgment & Agreement

• Patients must sign an acknowledgment form confirming they have reviewed and

understand this HIPAA Policy.

• A copy of this policy is available upon request.

• Lumiere Dental reserves the right to terminate the patient-provider relationship if a

patient repeatedly violates privacy policies, refuses to comply with HIPAA

acknowledgment requirements, or engages in disruptive behavior.

Contact Us

Lumiere Dental

1959 W Division St, Chicago, IL 60622

Phone: (312) 471-6545

Email: admin@yourchicagodentist.com

For HIPAA-related concerns, you may also contact:

U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR)

Website: www.hhs.gov/ocr