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HIPAA Information | UCLA Dentistry
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</ul> </nav> </div> </div> <div id="content" class="container-md layout--section--width page-content col-lg-9 col-md-12"> <div class="mobile-ct-row"> <div data-drupal-messages-fallback class="hidden"></div> <div id="block-dentistry-breadcrumbs" data-quickedit-entity-id=""> <div class="block-content"> <nav class="container-fluid" role="navigation" aria-labelledby="system-breadcrumb"> <h2 id="system-breadcrumb" class="visually-hidden">Breadcrumb</h2> <ol class="row"> <li class="d-flex"> <a href="/">Home</a> </li> <li class="d-flex"> <a href="/patient-care">Patient Care</a> </li> <li class="d-flex"> <a href="/patient-care/patient-resources">Patient Resources</a> </li> </ol> </nav> </div> </div> <div id="block-dentistry-page-title" data-quickedit-entity-id=""> <div class="block-content"> <h1><span>HIPAA Information</span> </h1> </div> </div> </div> <div class="ct-content-wrap"> <div id="block-dentistry-content" data-quickedit-entity-id=""> <div class="block-content"> <article data-history-node-id="1314"> <div> <div class="layout--top-styling--minimal layout--bottom-styling--padding layout--section--width layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="block--basic" data-quickedit-entity-id=""> <div class="block-content"> <div class="field-body block-basic--field-body"><p><span><span><span><span><span><span>The UCLA School of Dentistry is considered a component of the covered entity of the University of California under the federal Health Insurance Portability and Accountability Act of 1996, which </span></span></span></span></span></span><span><span><span><span><span><span>mandated significant changes in the legal and regulatory environments governing the provision of health benefits, the delivery and payment of healthcare services, and the security and confidentiality of individually identifiable, protected health information. </span></span></span></span></span></span></p></div> <div class="field-field-b-basic-read-more block-basic--field-field-b-basic-read-more"> <div class="secondary-button-wrapper"><a href="https://www.hhs.gov/hipaa/index.html" target="_blank" aria-label="U.S. Department of Health & Human Services (HIPAA Information) - Opens link in a new window">U.S. Department of Health & Human Services (HIPAA Information)</a></div> </div> </div> </div> <div class="block--basic" data-quickedit-entity-id=""> <h2 class="block-title">Privacy Practices</h2> <div class="block-content"> <div class="field-body block-basic--field-body"><p><span>The UCLA School of Dentistry is fully committed to protecting patient health information and maintaining patient confidentiality. However, due to the semi-private layout of our clinical facilities where dental chairs units are separated by partitions, there is a risk of incidental disclosure of your patient information to other individuals who may be nearby. While the chance of incidental disclosure through overhead communications cannot be completely eliminated, the UCLA School of Dentistry has taken reasonable precautions to minimize and limit such incidental use and disclosure.</span></p><p><span>As required by HIPAA, the School of Dentistry will distribute a Notice of Privacy Practices to each new and continuing patient at his/her first visit on or after April 14, 2003. Each patient who is given a copy of the Notice of Privacy Practices will also be asked to acknowledge receipt of such notice.</span></p><p><span>For your convenience, you may download a Notice of Privacy Practices, here:</span></p></div> <div class="field-field-b-basic-downloads block-basic--field-field-b-basic-downloads"> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-07/Notice-of-Privacy_English_7-23-24.pdf" type="application/pdf" title="Notice-of-Privacy_English_7-23-24.pdf">Notice of Privacy Practices (English)</a></span> <span>(95.98 KB)</span> </div> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-07/Notice-of-Privacy_Spanish_7-23-24..pdf" type="application/pdf" title="Notice-of-Privacy_Spanish_7-23-24..pdf">Notice of Privacy Practices (Spanish)</a></span> <span>(225.22 KB)</span> </div> </div> </div> </div> <div class="block--basic" data-quickedit-entity-id=""> <div class="block-content"> <div class="field-body block-basic--field-body"><p><span><span><span><span><span><span>As you will see in your review of our Notice of Privacy Practices, patients have a number of rights including the following:</span></span></span></span></span></span></p> <p><strong><span><span><span><span>Right to Inspect and Copy Records</span></span></span></span></strong> (request a copy and release your information to another party with this form)</p></div> <div class="field-field-b-basic-downloads block-basic--field-field-b-basic-downloads"> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2021-02/release_0.pdf" type="application/pdf" title="release_0.pdf">Authorization for Release of Health Information</a></span> <span>(99.35 KB)</span> </div> </div> </div> </div> <div class="block--basic" data-quickedit-entity-id=""> <div class="block-content"> <div class="field-body block-basic--field-body"><p><span><strong>Right to Request an Amendment or Addendum to Records</strong> (request an amendment or addendum to your record)</span></p></div> <div class="field-field-b-basic-downloads block-basic--field-field-b-basic-downloads"> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-03/request-to-amend-protected-health-information_3-12-24.pdf" type="application/pdf" title="request-to-amend-protected-health-information_3-12-24.pdf">Request to Amend Protected Health Information</a></span> <span>(87.24 KB)</span> </div> </div> </div> </div> <div class="block--basic" data-quickedit-entity-id=""> <div class="block-content"> <div class="field-body block-basic--field-body"><p><span><strong>Right to an Accounting of Disclosures</strong> (request an accounting of certain disclosures of your medical information)</span></p></div> <div class="field-field-b-basic-downloads block-basic--field-field-b-basic-downloads"> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-03/request-for-accounting-of-disclosures_3-12-24.pdf" type="application/pdf" title="request-for-accounting-of-disclosures_3-12-24.pdf">Right to an Accounting of Disclosures</a></span> <span>(92.5 KB)</span> </div> </div> </div> </div> <div class="block--basic" data-quickedit-entity-id=""> <div class="block-content"> <div class="field-body block-basic--field-body"><p><strong>Right to Request Restrictions</strong> (request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or operations)</p></div> <div class="field-field-b-basic-downloads block-basic--field-field-b-basic-downloads"> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-03/special-restrictions-of-use-of-phi_3-12-24.pdf" type="application/pdf" title="special-restrictions-of-use-of-phi_3-12-24.pdf">Right to Request Restrictions</a></span> <span>(90.45 KB)</span> </div> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-03/termination-of-special-restriction_3-12-24.pdf" type="application/pdf" title="termination-of-special-restriction_3-12-24.pdf">Termination of Restrictions</a></span> <span>(82.89 KB)</span> </div> </div> </div> </div> <div class="block--basic" data-quickedit-entity-id=""> <div class="block-content"> <div class="field-body block-basic--field-body"><p><strong>Right to Request Confidential Communications</strong> (request that we communicate with you about medical matters in a certain way or at a certain location)</p></div> <div class="field-field-b-basic-downloads block-basic--field-field-b-basic-downloads"> <div><span class="file file--mime-application-pdf file--application-pdf"><a href="/sites/default/files/2024-03/request-for-restriction-manner-method-confidential-communications_3-12-24.pdf" type="application/pdf" title="request-for-restriction-manner-method-confidential-communications_3-12-24.pdf">Right to Request Confidential Communications</a></span> <span>(207.2 KB)</span> </div> </div> </div> </div> </div> </div> </div> </article> </div> </div> </div> </div> </div> </div> </div> <footer id="footer"> <div class="container-fluid footer-address"> <div class="container"> <div class="row h-100"> <div class="logo-address-wrapper col-md-7 col-xs-12 p-left-0"> <div class="school-logo"> <img src="/themes/dentistry/images/school-of-dentistry.svg" alt="school of dentistry" /> </div> <address class="address"> <p>Location:</p> <p>714 Tiverton</p> <p>Los Angeles, CA 90095</p> </address> <address class="address"> <p>Mailing Address:</p> <p>10833 Le Conte Avenue</p> <p>CHS - Box 951668</p> <p>Los Angeles, CA 90095-1668</p> <p>Campus Mailing Code: 166815</p> </address> <div class="icons social-icons-white"> <a href="https://www.facebook.com/UCLADentistry/" target="_blank" aria-label="Dentistry Facebook - 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