HIPAA Notice of Privacy Practices

Your Rights

• Access your records. You can ask to inspect or receive a paper or electronic copy of the dental records and other health information we maintain about you. We generally respond within 30 days and may charge a reasonable, cost-based fee for copies.
• Request a correction. You can ask us to amend information you believe is inaccurate or incomplete. If we deny your request, we will explain our decision in writing within 60 days.
• Request confidential communications. You can ask us to contact you by a particular method or at a different address. We will accommodate reasonable requests.
• Request limits on use or disclosure. You can ask us to restrict the use or disclosure of your information for treatment, payment, or health care operations. We generally have discretion to decline. If you pay in full out of pocket for a service or item and ask us to withhold information about it from your health plan for payment or health care operations, we will honor your request unless disclosure is required by law.
• Request an accounting of disclosures. You can ask for a list of certain disclosures made in the six years before your request. The list excludes disclosures for treatment, payment, or health care operations and other disclosures exempt under HIPAA. The first accounting in a 12-month period is free. A reasonable, cost-based fee may apply to additional requests during that period.
• Get a paper copy of this notice. We will promptly provide one on request, even if you previously agreed to receive this notice electronically.
• Choose someone to act for you. A legally authorized representative, such as a guardian or someone with medical power of attorney, can exercise your rights on your behalf. We will verify their authority before acting on their request.
• File a complaint. If you believe your privacy rights were violated, you can complain to our practice or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your Choices

You can tell us whether we may share relevant information with family, friends, or others involved in your care or payment for your care. You can also tell us your preferences about sharing information for disaster relief.

If you cannot communicate your preferences, we may share relevant information if our professional judgment indicates that doing so is in your best interest. We may also share information as permitted by law to address a serious and imminent threat to health or safety.

We will obtain your written authorization for uses and disclosures outside those described in this notice. Most uses or disclosures for marketing, sales of protected health information, and most uses or disclosures of psychotherapy notes, if we maintain them, require written authorization. You can revoke your authorization in writing, except to the extent we have already acted on it. If we contact you for fundraising, you can opt out of future fundraising communications.

How We Use and Share Your Information

• Treatment. We may share dental X-rays or treatment notes with a specialist involved in your care.
• Payment. We may send procedure and billing information to your dental plan to obtain payment.
• Health care operations. We may use your health information to review the quality of care, train staff, and manage the practice.

Other Uses and Disclosures

We may use or disclose health information for the following purposes when applicable law permits or requires it and its conditions are met.

• Public health and safety, including reporting certain diseases, suspected abuse or neglect, or adverse reactions to medications.
• Health research that meets applicable privacy requirements.
• Compliance with federal or state law, including disclosures to HHS for compliance reviews and to authorized health oversight agencies.
• Workers’ compensation claims, qualifying law enforcement requests, and authorized government functions.
• Court or administrative orders and qualifying subpoenas or other lawful processes.
• Organ or tissue donation, or disclosures to a coroner, medical examiner, or funeral director when authorized by law.

Substance Use Disorder Patient Records

If we hold substance use disorder patient records protected by 42 CFR Part 2, we may not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying court order and a subpoena or other legal mandate compelling disclosure.

Our Responsibilities

• We are legally required to protect the privacy of your protected health information and provide this notice of our legal duties and privacy practices.
• We will notify you as required by law following a breach of unsecured protected health information.
• We will follow the terms of the notice currently in effect and provide a copy upon request.

Changes to This Notice

We reserve the right to revise this notice and apply the revised practices to health information we already maintain. The updated notice will be available on our website and at our office.

Contact Us or File a Complaint

For questions about this notice, to exercise your privacy rights, or to file a complaint with our practice, contact us and ask for the person responsible for HIPAA privacy.

You may also file a privacy complaint with the HHS Office for Civil Rights or call 1-800-368-1019.