Dr. Thomas Walther

Chesterfield Dentist

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314-469-1950

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You are here: Home / Patient Resources / HIPAA and Patient Privacy Acknowledgement

HIPAA and Patient Privacy Acknowledgement

HIPAA and PHI Privacy

Please reference our HIPPA and Privacy details below.  If you have any questions or concerns, our staff is happy to help you.

By submitting your information to our office, you acknowledge that you understand and agree to the following:

 

HIPAA

NOTICE OF PRIVACY PRACTICES ACKNOWLEDGEMENT

I understand that, under the HEALTH INSURANCE PORTABILITY ACT OF 1996 (HIPAA), I have certain rights to privacy regarding my protected health information.  I understand that this information can and will be used to:

Conduct, plan and direct my treatment and follow-up among the multiple healthcare providers who may be involved in that treatment directly or indirectly.

Obtain payment from third-party payers.

Conduct normal healthcare operations such as quality assessments and dentist certifications.

I understand that I may request in writing that you restrict how my private information is used or disclosed to carry out treatment, payment or healthcare operations.  I also understand you are not required to agree to my requested restrictions, but if you do agree then you are bound to abide by such restrictions.

 

Protecting Your Privacy

We will NEVER sell or release your personal contact or demographic information.  The information given to our office by our patients is strictly used to provide dental treatment, receive reimbursement for treatment, and/or to coordinate treatment with a specialty dentist or office.  Your contact information will be used in order to send appointment or treatment related texts, emails or phone calls, and send information regarding our practice and your dental care.

If you do not wish to receive texts or emails, please notify our staff to have your contact information removed from our list.

Our most important goal is to provide our patients with the best quality dental experience available, and keeping open lines of communication with our patients is a key factor in making that possible.

Distinctive Dental Solutions


42 Four Seasons Shopping Center
Suite 128
Chesterfield, MO 63017
Phone: (314) 469-1950
Fax: (314) 205-8778
Email:thomaswaltherdds@gmail.com



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Distinctive Dental Solutions

42 Four Seasons Shopping Center
Suite 128
Chesterfield, MO 63017
Phone: (314) 469-1950
Fax: (314) 205-8778
Email:thomaswaltherdds@gmail.com

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