PATIENT INFORMATION

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• Privacy Policy

Privacy Policy

                              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
               
                Dr. Timothy Kindt is required by federal and state law to maintain the privacy of your health
                information.  We are also required to give you this Notice of privacy practices that are 
                described in the Notice while it is in effect.  This Notice takes effect April 1, 2003 and will
                remain in effect untill we replace it.

                We reserve the right to change our privacy practices and the terms of this Notice at any 
                time, provided such changes are permitted by applicable law.  Before we make a               
                            significant change in our privacy practices, we will change this Notice and make the new
                Notice available upon request. 

                You have the right to review our privacy practices; the right to access any health information
                or amendments made to it.  You may also have the right to an accounting of disclousures
                and restrict uses of the communicating health information.  If your have any questions
                concerning this Notice please call us at 480-981-0094
                   

                     Uses and Disclosures of Health Information

                We may use and disclose health information about you for treatment, payment, and
                            health care operations with a family member, your personal representative or
                            another person responsible for your care(which does include communication with
                            dental specialists or physician).

                            We may use of disclose your health information to obtain payment for services we 
                             provide for you.

                            We may use or disclose your health information when we are required to do so by law.

                            We may disclose your health information to provide you with appointment reminders(such
                            as voicemail and answering machine messages, postcards or letters).

                            In addition to our use of your health information for treatment, payment or healthcare
                            operations, you may give us written authorization to use your health information
                            or to disclose  it to anyone for any purposes. If you give us authorization,
                            you may revoke it in writing at any time.  Your revocation will not affect any use or
                            disclosures permitted by your authorization while it is in effect.  Unless you give us
                            written authorization, we cannot use or disclose your health information for any reason
                            except those described in this Notice.

                            I have read and understand Dr. Kindt's privacy practices.  I consent for Dr. Kindt to
                            disclose my protected information as described.  I acknowledge receipt of the
                            Notice of privacy practices



                            ________________________________                       ____________________
                            signature of Patient or Guardian                                                Date