HIPAA Notice of Privacy Practices

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

Your Rights

You have the right to:

• Obtain a copy of your dental records, including electronic copies
• Request corrections to your records
• Request limits on how we use or share your information
• Request confidential communications
• Receive a list of certain disclosures
• Receive a paper copy of this Notice at any time
• File a complaint if you believe your privacy rights have been violated

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information (PHI). We must:

• Provide you with this Notice of Privacy Practices
• Follow the terms of this Notice currently in effect
• Notify you if a breach occurs that may have compromised your information

This Notice is effective January 1, 2026, and will remain in effect until replaced.

How We May Use and Disclose Your Health Information

Treatment

We may use and disclose your health information to provide, coordinate, or manage your dental care. This includes sharing information with dentists, hygienists, specialists, laboratories, or other health care providers involved in your treatment.

Payment

We may use and disclose your health information to bill and collect payment for services provided to you. This may include sharing information with dental benefit plans, insurance companies, or third-party payers to determine coverage, eligibility, or payment.
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Health Care Operations

We may use and disclose your health information for practice operations, including quality improvement, staff training, accreditation, licensing, audits, business management, and administrative activities necessary to operate our dental practice.
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Other Permitted Uses and Disclosures

Individuals Involved in Your Care or Payment

Unless you object, we may disclose relevant information to a family member, friend, or other person involved in your care or payment for your care. We may also disclose information to a legal representative authorized to act on your behalf.
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Public Health, Safety, and Legal Requirements

We may disclose your information when required by law, including for public health reporting, health oversight activities, abuse or neglect reporting, or law enforcement purposes.
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Disaster Relief

We may use or disclose your information to assist in disaster relief efforts so your condition or location may be communicated to family members or others involved in your care.
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Substance Use Disorder Information

(42 CFR Part 2 - Special Protections)
Some health information, including records related to the diagnosis, treatment, or referral for substance use disorder (SUD), is protected by federal law (42 CFR Part 2) and is subject to stricter privacy protections than other health information.

In most cases, we may not use or disclose substance use disorder information without your specific written authorization, even for treatment, payment, or health care operations, unless otherwise permitted or required by law.

We will not disclose substance use disorder information for marketing, law enforcement, or non-treatment purposes without your explicit authorization or as allowed by law.

You have the right to revoke an authorization for the disclosure of substance use disorder information at any time, except to the extent that action has already been taken based on your authorization.

Restrictions on Redisclosure of Substance Use Disorder Information

Federal law (42 CFR Part 2) prohibits the redisclosure of substance use disorder information.

Any person or organization that receives substance use disorder information from us may not redisclose that information unless:

• You provide specific written authorization, or
• The redisclosure is otherwise permitted by applicable law

This restriction applies even when the information has been disclosed once with authorization.