Gurnee Dental Care
Gary C. Kaplan, D.D.S.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Effective date of this Notice: 02/05/2026
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; examining your teeth; prescribing medications and faxing them to be filled; referring you to another doctor or clinic for other health care or services; or getting copies of your health information from another professional that you may have seen before us.
Examples of how we use or disclose your health information for payment purposes are: asking you about your health or dental care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney).
"Health care operations" mean those administrative and managerial functions that we must do to run our office. Examples include: financial or billing audits; internal quality assurance; personnel decisions; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.
Special Protections for Substance Use Disorder (SUD) Records
- Heightened Confidentiality: We will not disclose records identifying you as having a substance use disorder in civil, criminal, administrative, or legislative proceedings without your specific written consent or a specialized court order.
- Single Consent for TPO: You may choose to provide a single, written "Global Consent" that allows us to use and disclose your SUD records for all future treatment, payment, and health care operations.
- Right to Revoke: You have the right to revoke this consent at any time in writing, except to the extent that we already acted based on your prior permission.
- Accounting of Disclosures: You have the right to request a list of certain disclosures of your SUD records made for treatment, payment, and health care operations for the three years prior to your request.
- Prohibition on Redisclosure: Anyone receiving your SUD records is generally prohibited from sharing that information further unless you provide express written consent or the law specifically permits it.
USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Such uses or disclosures include:
- when a state or federal law mandates that certain health information be reported for a specific purpose.
- for public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the federal Food and Drug Administration regarding drugs or medical devices.
- disclosures to government authorities about victims of suspected abuse, neglect or domestic violence.
- uses and disclosures for health oversight activities, such as licensing, audits, or investigations.
- disclosures for judicial and administrative proceedings.
- disclosures for law enforcement purposes.
- disclosure to medical examiners, funeral directors, or organ donation organizations.
- uses or disclosures for health-related research.
- uses or disclosures to prevent a serious threat to health or safety.
- uses or disclosures for specialized government functions.
- disclosures of de-identified information.
- disclosures relating to worker's compensation programs.
- disclosures of a "limited data set" for research, public health, or operations.
- incidental disclosures.
- disclosures to business associates.
Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your dental care.
NOTIFICATION OF DATA BREACHES
We are required by law to maintain the privacy and security of your protected health information. In the event of a breach, we will notify you promptly with details of what happened, what information was involved, and steps taken to mitigate and prevent future issues.
APPOINTMENT REMINDERS
We may call or write to remind you of scheduled appointments or that it is time to make a routine appointment. We may also notify you of other treatments or services available at our office.
TELEHEALTH / VIRTUAL VISITS AND ELECTRONIC COMMUNICATIONS
We may offer telehealth visits or communicate electronically via patient portals, video, email, or text. Vendors assisting in these services may have limited access to your information and are required to protect it.
You may request confidential communication methods. Electronic communications carry some risk, and by using unencrypted methods, you accept those risks.
OTHER USES AND DISCLOSURES
We will not make other uses or disclosures of your health information unless you sign a written authorization form. You may revoke authorization at any time in writing.
Uses and Disclosures Requiring Your Authorization
Most uses and disclosures for marketing purposes or sale of your information require written authorization. You may revoke authorization at any time.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
- Request restrictions on use and disclosure.
- Request confidential communications.
- Access or obtain copies of your records.
- Request amendments to your information.
- Request a list of disclosures.
- Request additional copies of this notice.
- Restrict disclosures for out-of-pocket payments.
OUR NOTICE OF PRIVACY PRACTICES
We must follow the terms of this Notice until it is changed. We reserve the right to update it and will make updated versions available in our office and online.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you.
FOR MORE INFORMATION
If you want more information about our privacy practices, contact us using the information below.
Contact Information
Contact Officer: Gary C. Kaplan, D.D.S.
Telephone: 847-548-3800
Fax: 847-548-3802
E-mail: Info@gurneedentalcare.com
Address: 34491 N. Old Walnut Circle, Suite F, Gurnee, IL 60031