Emily Stout DDS · 805 Waterbury Park Drive, Elkhart, IN 46517 · 574-293-9222
Effective date: January 1, 2025
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. You can:
- Get a copy of your dental and health records — usually within 30 days of your request (a reasonable, cost-based fee may apply).
- Ask us to correct records you believe are incorrect or incomplete.
- Request confidential communications — for example, by a specific phone or address.
- Ask us to limit what we use or share. We aren't always required to agree, but if you pay out-of-pocket in full you can ask us not to share that information with your insurer.
- Get a list of those with whom we've shared your information (an "accounting of disclosures").
- Get a paper copy of this notice at any time.
- Choose someone to act for you — such as through a medical power of attorney.
- File a complaint if you believe your privacy rights were violated.
Your choices
For certain information, you can tell us your preferences. You have both the right and the choice to tell us to share information with family or friends involved in your care, with someone involved in paying for your care, or in a disaster-relief situation. We will never share your information for marketing, sell your information, or share psychotherapy notes without your written permission.
Our uses and disclosures
We typically use or share your health information to:
- Treat you — and coordinate with other providers involved in your care.
- Run our organization — schedule appointments, improve care, and contact you when necessary.
- Bill for your services — with your dental or health plan.
We're also allowed or required to share information in ways that contribute to public health and safety, research, and compliance with the law — including with health-oversight agencies, for workers' compensation, in response to lawsuits and legal actions, and with law enforcement when permitted or required.
Our responsibilities
We are required by law to maintain the privacy and security of your protected health information, to notify you promptly if a breach occurs, and to follow the duties described in this notice. We won't use or share your information other than as described here unless you tell us we can in writing — and you may change your mind at any time.
Changes to 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 on request, in our office, and on our website.
Questions or complaints
To ask a question or file a complaint, contact us at Emily Stout DDS, 805 Waterbury Park Drive, Elkhart, IN 46517 — 574-293-9222. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (200 Independence Avenue, S.W., Washington, D.C. 20201; 1-877-696-6775). We will not retaliate against you for filing a complaint.