Effective Date: February 16, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
We are committed to protecting the privacy of your protected health information (PHI). PHI includes information
about your health condition, treatment, and payment that can identify you.
This Notice explains how we may use and disclose your health information, your rights regarding that information,
and our legal duties under the Health Insurance Portability and Accountability Act (HIPAA).
How We May Use and Disclose Your Health Information
Treatment
We may use and share your health information to provide, coordinate, or manage your dental care. Examples
include exams, cleanings, fillings, crowns, referrals, consultations, and coordination with specialists or dental laboratories.
Payment
We may use and disclose your health information to bill and collect payment for services provided. Examples
include submitting claims to your dental insurance plan, verifying coverage, billing statements, and collection activities.
Health Care Operations
We may use your health information for business operations necessary to run our practice. These activities include
quality improvement, staff training, auditing, compliance, customer service, and practice management.
Communication With You
We may contact you to remind you of appointments, confirm or reschedule visits, discuss treatment options, or
provide billing or insurance information.
Communication may occur by phone, voicemail, text message, email, or mail.
Text messages and emails may not be fully secure. By providing your contact information, you acknowledge and
accept this risk unless you request alternative communication methods in writing. You may request confidential
communications by alternative means or at alternative locations.
Other Uses and Disclosures Permitted or Required by Law
We may disclose your health information when required or permitted by law, including for public health activities,
health oversight activities, legal proceedings, law enforcement requests, medical examiners or coroners, organ and
tissue donation, workers’ compensation claims, military or national security activities, correctional institutions, or to
prevent a serious threat to health or safety.
Substance Use Disorder Information (42 CFR Part 2)
Certain health information related to substance use disorder diagnosis, treatment, or referral may be subject to
additional federal confidentiality protections under 42 CFR Part 2.
When applicable:
- This information will not be used or disclosed without your authorization, except as permitted or required by law.
- Recipients may not re-disclose this information unless allowed by federal law.
- This information may not be used against you in civil, criminal, administrative, or legislative proceedings without appropriate authorization or court order.
We are prohibited from discriminating against you based on substance use disorder information.
Marketing, Fundraising, and Sale of Information
We will not use or disclose your protected health information for marketing purposes, receive payment for
marketing communications, or sell your protected health information without your written authorization, except as permitted by law.
If we ever contact you about products or services related to your care, you may opt out of receiving those
communications at any time. We do not sell patient information.
Uses Requiring Your Written Authorization
Any use or disclosure not described in this Notice will be made only with your written authorization. You may revoke your authorization in writing at any time, except where action has already been taken based on your authorization.
Your Rights Regarding Your Health Information
You have the right to:
- Inspect and obtain a copy of your health records, including electronic copies.
- Receive access to your records generally within 30 days of your request.
- Request corrections or amendments to your records.
- Receive an accounting of certain disclosures.
- Request restrictions on certain uses or disclosures (we are not required to agree).
- Request that information not be disclosed to your insurance plan if you pay for the service in full out of pocket.
- Request confidential communications.
- Obtain a paper copy of this Notice at any time.
Requests must be submitted in writing.
Our Responsibilities
We are required by law to maintain the privacy of your protected health information, provide you with this Notice, and follow the terms of the Notice currently in effect.
We reserve the right to change this Notice and make the revised Notice effective for all health information we maintain. Updated versions will be available upon request and posted in our office.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S.
Department of Health & Human Services Office of Civil Rights. We will not retaliate against you for filing a complaint.
Office for Civil Rights
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 877-696-6775