F O R . Y O U R . I N F O R M A T I O N
Information you should know as a patient in our office

PLEASE REVIEW THE FOLLOWING, FOR YOUR INFORMATION

You will be meeting with the doctor to discuss the possibility of some dental or oral surgery for an evaluation of a specific problem that you are having.
Please provide the doctor with a note or referral that your dentist or physician has given you.
The doctor will review your medical history with you in detail.  Please be aware of ALL medications that you are currently taking and ALL medications that may have caused an allergic reaction or adverse reaction.
The doctor will then discuss the reason for today’s visit and examine you.  If a problem is related to the teeth, jaws or tissue attached to the jaws (gums, palate, etc.) a recent panoramic x-ray of appropriate quality is needed to further your treatment.
The doctor will evaluate the problem and recommend treatment if needed.  The recommendation for treatment will emphasize safety and comfort for you.  Very often relaxing medications are given (if you are a candidate for them) before treatment to make your experience comfortable and relaxing.
The doctor will discuss benefits and possible risks of your proposed procedure.  If you will be having a tooth extracted there are four common areas that are discussed in all cases.  Mostly these possibilities are rare but some people have increased risk of one or more of these issues.  Your doctor will discuss them with you in detail.
For all tooth extractions, the following considerations can occur:

  1. Adjacent teeth, if present, can react to an extraction with soreness or pain that usually resolves.  RARELY an adjacent tooth with no fillings or cavities may require root canal treatment to calm it down.  Adjacent teeth with large fillings, crowns or cavities may be more likely to need root canal treatment after an adjacent tooth is extracted.  This is not very common if the adjacent tooth has had no symptoms, but it is possible.
  2. Caps, crowns and fillings as well as normal tooth or root structure of an adjacent tooth can sometimes come off, loosen or be chipped or damaged due to the very close positioning of teeth in some situations.  These may require repair by your dentist.  This is also not common, but possible with any tooth extractions.
  3. Upper back teeth often sit under the sinus of the upper jaw (a normal air space behind your cheek).  Sometimes an opening will occur in the sinus when an upper back tooth is removed that normally heals on its own in about eight weeks with proper home care.  If this is a possibility with your treatment, the doctor will inform you.  Usually patients that have this are asked not to blow their nose or smoke for six to eight weeks to allow natural healing.  Rarely, an opening in the sinus may not close and you may need a procedure to close it weeks or months later.  This additional procedure is not common but possible with any upper back tooth removal.
  4. Lower back teeth sit over the sensory (feeling) nerve of the lower jaw.  In some cases, a tooth root is close or in contact with that nerve and may bump or bruise it when it is removed.  This can in some cases produce a tingling or numbness to the lip, chin or tongue.  If this occurs, the healing process is usually slow and can take up to 12 to 18 months to improve.  Some improvement can be partial, or rarely, not at all, and a partial or complete permanent numbness can occur in rare cases.  The dental injection used for lower fillings, root canals or extractions has even been known to cause permanent numbness in about 1 in 100,000 dental injections.  This is of course very rare and can occur with any dental work.
  5. Lower back tooth extractions can very rarely result in a fracture or break of the jaw.  This is very rare but some thinner people with thin jaws may be at an increased risk of this occurring.  Also, teeth that are very low in placement in the bottom jaw may carry an increased possibility of this.  Your doctor will usually recommend avoiding very hard foods for months after tooth removal in cases like this to avoid any injury to the jaw and allow it to become very strong or stronger once again.

The doctor will discuss your treatment and your medical condition.  If you are taking any blood thinners like aspirin, Coumadin, warfarin, Plavix, pletal, or others, you must inform your doctor so that your treatment can proceed properly and safely.  The doctor must be told all medications that you are currently taking.
If you have taken Fosamax, Boniva, Actonel, Aredia or Zometa in the past or present you must inform the doctor as the drug manufacturers of the above medications have major warnings that must be discussed with the doctor.  (These medicines are used for osteoporosis, osteopenia and certain types of cancer including breast cancer and multiple myeloma.)
If you are or may be pregnant, you must inform the doctor.  Your doctor may wish to consult with your physician on certain medical issues that could influence your treatment.
The doctor will answer all of your questions and plans to maximize your comfort and safety in the treatment process.


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HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices describes how we may use and disclosed your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information.  “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information


Uses and Disclosures of PHI
Your PHI may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law.

Treatment:
  We will discuss and disclose your PHI to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with a third party.  For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you.  For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment:
  Your PHI will be used, as needed, to obtain payment for your health care services.  For example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations:
  We may use or disclose, as-needed, your PHI in order to support the business activities of our physician’s practices.  These activities include, but are not limited, quality assessment activities, employee review activities, training of dental students, licensing, and conduction or arranging for other business activities.  For example, we may disclosed your PHI to dental school students that see patients at our office.  In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician.  We may also call you by name in the waiting room when your physician is ready to see you.  We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.

We may use or disclose your PHI in the following situations without your authorization.  These situations include: as Required By Law, Public Health issues as are required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity: and National Security: Workers’ Compensation: Inmates: Required Uses and Disclosures.  Under the law we must make disclosures to you and when required by the secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity To Object Unless Required By Law.

You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physicians practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Rights
Following is a statement of your rights with respect to your PHI.

You have the right to inspect and copy your protected health information.
  Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.

You have the right to request a restriction of your protected health information.
  This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or health care operations.  You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices.  Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request, if physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted.  You then have the right to use another Health Care Professional. 

You have the right to request to receive confidential communications from us by alternative means or at an alternative location.  You have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice alternatively i.e. electronically. 

You may have the right to have your physician amend your protected health information. 
If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.


We reserve
the right to change the terms of this notice and will inform you by mail of any changes.  You then have the right to object or withdraw as provided in this notice.

Complaints

You may complain to us or to Secretary of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our privacy contact of your complaint.  We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on/or before April 14, 2003.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information.  If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.


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CHERRY HILL OFFICE

(856) 428 4445
17 West Ormond Avenue
Cherry Hill, NJ 08002

VINELAND OFFICE

(
856) 205 9922
83 South State Street
Vineland, NJ 08360

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