4105 Clock Tower Ave, Caldwell, ID 83607
Call Us Today (208)-455-0033

Patient Information

Patient Information

Your initial appointment will usually consist of an examination, x-rays and review of your treatment options. Most often treatment can be done or started the same day as the exam. However, a complex treatment plan or medical history may require a longer evaluation and a second appointment will be needed for treatment. If your first visit is scheduled for teeth cleaning you can expect an examination, x-rays and cleaning. Periodontal cleanings typically require more than one appointment.

Please assist us by providing the following information at your appointment:

  • A current list of medications.
  • Insurance card, if applicable. Please also have this information available when you schedule your appointment.
  • Photo ID

IMPORTANT: All patients under the age of 18 must be accompanied by a parent or legal guardian.

X-Rays: Although it is not required, if you’ve recently had x-rays taken at another office you may have them e-mailed to our office ctdental@cableone.net.

Payment is due at the time of service. We accept cash, all major credit cards and Care Credit.

A 10% cash discount will be given if no insurance is being billed. Please note that cash discounts cannot be given when using Care Credit for payment. Also, cash discounts are not applied to preventive cleaning service or dental products.

If you are interested in financing your dental treatment please contact Care Credit. Call   800-365-8295 or visit their website at carecredit.com to obtain more information or apply for credit.

If you have insurance, we will bill your insurance company as a courtesy to you and we will collect what we estimate your portion to be at the time of service. However, if your insurance company does not pay for your services or as we have estimated, for whatever reason, the unpaid charges will be your responsibility.

We will send you a monthly statement. Most insurance companies respond within 4-6 weeks. Your prompt remittance is appreciated if you have a balance owing.

If you have questions regarding your account, please contact us at 208-455-0033.

We contract with most dental insurance companies. We will do our best to maximize your insurance benefits.

Please contact your insurance company to verify if Clock Tower Dental is in network with your insurance plan.

We are NOT accepting Medicaid at this time.

 

 

Darin R. Mooso DDS, P.C.
@ Clock Tower Dental

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.

OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you
this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy
practices that are described in this Notice while it is in effect. This Notice takes effect 04/14/2003, and will remain in effect until 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. We reserve the right to make the changes in our privacy and the new terms of our Notice effective for all health
information that we maintain, including health information we created or received before we made the changes. Before we make a
significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of the
Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for treatment, payment, and healthcare operation. For example:
Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
Payment: We may use and disclose your health information to obtain payment for services we provide to you.
Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare
operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare
professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or
credentialing activities.
Your Authorization: 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 purpose. If you give us an 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 was in
effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those
described in this Notice.
To Your Family and Friends: We must disclose your health information to you, as described in the Patient Rights section of this
Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your
healthcare or with payment for your healthcare, but only if you agree that we may do so.
Persons Involved in Care: We may use or disclose health information to notify, or assist in the notification of (including identifying or
location) a family member, your personal representative or another person responsible for your care, of your location, your general
condition, or death. If you are present, then prior to use of disclosure of your health information, we will provide you with an
opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health
information based on a determination using our professional judgment disclosing only health information that is directly relevant to the
person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make
reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar
forms of health information.
Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as
voicemail messages, postcards or letters).
Marketing Health-Related Services: We will not use your health information for marketing communications without your written
authorization.
Required by Law: We may use or disclose your health information when we are required to do so by law.

Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible
victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the
extent necessary to avert a serious threat to your health or safety or the health or safety of others.
National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain
circumstances. We may disclose to authorize federal official’s health information required for lawful intelligence, counterintelligence,
and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody of
protected health information of inmate or patient under certain circumstances.

PATIENTS RIGHTS
Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request that we provide
copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. (You must make a
request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information
listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time. You may also
request access by sending us a letter to the address at the end of this Notice. If you request copies, we will charge you $3.00 for each
page, $12.00 per hour for staff time to locate and copy your health information, and postage if you want the copies mailed to you. If you
request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will
prepare a summary or an explanation of your health information for a fee. Contact us using the information listed at the end of the Notice
for a full explanation of our fee structure).
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health
information for purposes, other that treatment, payment, healthcare operations and certain other activities, for the last 6 years, but not
before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based
fee for responding to these additional requests.
Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. We
are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (Except in an emergency).
Alternative Communication: You have the right to request that we communicate with you about your health information by alternative
means or to alternative locations. (You must make your request in writing). Your request must specify the alternative means or
location, and provide satisfactory explanation how payments will by handled under the alternative means or location you request.
Amendment: You have the right to request that we amend your health information. (Your request must be in writing, and it must
explain why the information should be amended). We may deny your request under certain circumstances.
Electronic Notice: If you receive this Notice by electronic mail (e-mail), you are entitled to receive this Notice in written form.

QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health
information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us
communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the
end of this Notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide
you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with
us or with the U.S. Department of Health and Human Services.
Darin R. Mooso DDS, P.C.
4105 Clock Tower Ave.
CALDWELL, ID 83607
Contact Officer: Jane Jakobson
Telephone: 208-455- 0033
Fax: 208-455- 8535