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David Richardson, DDS
Proudly Serving Our Community Since 1985


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STATEMENT OF PRIVACY PRACTICES

Our office is dedicated to protect the privacy rights of our patients and the confidential information en-trusted to us. The commitment of each employee to ensure that your health information is never com-promised is a principle concept of our practice. We may, from time to time, amend our privacy policies and practices but will always inform you of any changes that might affect your rights.

Protecting Your Personal Healthcare Information

We use and disclose the information we collect from you only as allowed by the Health Insurance Porta-bility and Accountability Act and the state of Washington. This includes issues relating to your treatment, payment, and our dental care operations. Your personal health information will never be otherwise given to anyone – even family members – without your written consent. You, of course, may give written au-thorization for us to disclose your information to anyone you choose, for any purpose.

Our offices and electronic systems are secure from unauthorized access and our employees are trained to make certain that the confidentiality of your records is always protected. Our privacy policy and prac-tices apply to all former, current, and future patients, so you can be confident that your protected health information will never be improperly disclosed or released.

Collecting Protected Health Information

We will only request personal information needed to provide our standard of quality dental care, imple-ment payment activities, conduct normal dental practice operations, and comply with the law. This may include your name, address, telephone number(s), Social Security Number, employment data, medical history, health records, etc. While most of the information will be collected from you, we may obtain in-formation from third parties if it is deemed necessary. Regardless of the source, your personal infor-mation will always be protected to the full extent of the law.

Disclosure of your Protected Health Information

As stated above, we may disclose information as required by law. We are obligated to provide infor-mation to law enforcement and governmental officials under certain circumstances. We will not use your information for marketing purposes without your written consent.

We may use and/or disclose your health information to communicate reminders about your appointments including voicemail messages, answering machines, and postcards.

Patient Rights

You have a right to request copies of your healthcare information; to request copies in a variety of for-mats; and to request a list of instances in which we, or our business associates, have disclosed your pro-tected information for uses other than stated above. All such requests must be in writing. We may charge for your copies in an amount allowed by law. If you believe your rights have been violated, we urge you to notify us immediately. You can also notify the U.S. Department of Health and Human Ser-vices.

We thank you for being a patient at Kirkland Dentistry. Please let us know if you have any questions concerning your privacy rights and the protection of your personal health information.


Kirkland Dentistry | 11830 NE 128th Street, Suite 201, Kirkland, WA 98034
Phone: 425-823-6820 | Fax: 425-820-2427 | E-Mail: receptionist@kirklanddentistry.net
Business Hours: Monday: 8:30 a.m. - 5:00 p.m. | Tuesday - Thursday: 8:00 a.m. - 5:00 p.m.