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| Rights, Privacy and Responsibilities
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As a HUSKY Health recipient you have the
following rights:
- The right to be treated with respect and due consideration for your dignity
and privacy.
- The right to receive information on treatment options and alternatives in a
manner/language that you can understand.
- The right to participate in treatment decisions, including the right to
refuse treatment.
- The right to be free from any form of restraint or seclusion as a means of
coercion, discipline, retaliation or convenience.
- The right to receive a copy of your dental records including, if the HIPAA
privacy rule applies, the right to request that the records be amended or
corrected.
- The freedom to exercise the rights above without any adverse effect
on your treatment by the Department of Social Services, the CTDHP or our
dental providers.
Your
Privacy:
Protecting your privacy is very important to the
CTDHP. We have many procedures in place to be sure we protect (keep safe from
harm) the health information we have about you. Some examples of health
information we have about you are the following:
- Your name, address and telephone number
- Your Client identification number
- Your social security number
- Information we may receive from your dentist
The Connecticut
Department of Social Services (DSS) has created a Notice of Privacy Practices
that tells you how health information we have about you is shared for our normal
daily operations and when we are required by law to share it. It also tells you
what your privacy rights are. If you would like to see a copy of our (DSS) Privacy
Notice, please
click here. If you have questions about the Privacy Notice, please contact customer service at 1-855-CTDENTAL (1-855-283-3682).
The Connecticut Dental Health Partnership - your HUSKY Dental Plan
Authorization of Disclosure Information
The Connecticut Dental Health Partnership (CTDHP) takes your privacy seriously. If you wish for a family member, care manager, advocate or other person to speak with our team, and if you will allow us to share your protected health information with them, please complete and sign the forms on the links below. The forms must be signed by the HUSKY Health member on record and delivered to the CT Dental Health Partnership staff person you are directly working with - or:
Fax: 860-674-8174
Mail: PO BOX 486, Farmington, CT 06032-0486
AUTHORIZATION FOR USE AND DISCLOSURE (ct.gov)
AUTHORIZATION FOR USE AND DISCLOSURE (ct.gov) (Spanish)
Your protected health information is not shared without your permission.
In addition to the rights listed
above, you have certain responsibilities as a client:
- The responsibility to provide any information that the
CTDHP or our dental network providers require in order to care for
you.
- The responsibility to follow the plans and instructions for care that have
been agreed on with your providers.
- The responsibility to choose a Primary Care Dentist (PCD) at your Dental
Home.
- The responsibility to call your PCD before receiving care unless you have an
emergency.
- The responsibility to call your Dental Home in advance if you cannot keep
your appointments. If you miss an appointment, you need to call to reschedule.
- The responsibility to carry your Connect Card (grey card) to all of
your appointments.
- The responsibility to let CTDHP and DSS know about changes to your name,
home address, telephone number, marital status, number of dependents or if you
have obtained other insurance Coverage. If your address or contact info has
changed, please login here and update
it.
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