Common use of DISCLOSURE AND CONFIDENTIALITY OF INFORMATION Clause in Contracts

DISCLOSURE AND CONFIDENTIALITY OF INFORMATION. All personal and medical records (including any personal or privileged information, medical records, patient charts, etc.) shall remain confidential. Such confidential information may be reviewed by CDN as required by its staff and Quality Assurance Committee. Such information may also be made available to the Department of Managed Health Care, the Dental Board and CDN’s legal representatives or other agencies as required by law. Written consent for release of patient information and records is required to be signed by the patient, along with the appropriate fee, as allowed by law, before any records will be released. CDN will respond to such a request within 30 days after receipt of the appropriate executed forms and fees. CDN subscribers and enrollees may request confidential communication by direct mail or through electronic communication. Mail requests to: California Dental Network, Inc 00000 Xxxx Xxxxx Xxxxx, Xxxxx 000 Xxxxxx Xxxxx, XX 00000 or Phone: (000) 000-0000: Toll-Free (000) 000-0000 CDN will implement confidential communications requests within 7 calendar days of receipt of an electronic or telephonic request or within 14 calendar days of receipt by first-class mail. CDN does not require a protected individual to obtain the primary subscriber or other enrollee’s authorization to receive sensitive services or to submit a claim for sensitive services if the protected individual has the right to consent to care. CDN does not disclose medical information related to sensitive health care services provided to a protected individual to the primary subscriber or any plan enrollees other than the protected individual receiving care, absent an express authorization of the protected individual. CDN permits and accommodates requests for confidential communications in the form and format requested by the protected individual, if readily producible in the requested form and format, or at alternative locations. The confidential request will be valid until the subscriber or enrollee submits a revocation of request or a new confidential communication request is submitted. The confidential communication request will apply to all communications that disclose medical information or provider name and address related to the receipt of medical services by the individual requesting the confidential communication. CDN’s confidentiality policy is available for review to all plan members upon request. A Plan Member may request to have an addendum of 250 or fewer words added to his or her medical records, in compliance with state law. This request should be made directly to the Participating Dentist who has custody of the records. Should the Participating Dentist deny Member the request to add an addendum, the Member should contact CDN for assistance. A STATEMENT DESCRIBING CDN’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST.