NOTICE OF PRIVACY PRACTICES

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

 

OUR COMMITMENT TO YOUR PRIVACY

We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect.

The Health Insurance Portability & Accountability Act of 1996 ("HIPAA"), as amended by the Health Information Technology for Economic and Clinical Health Act ("HITECH Act"), requires that all medical records and other individually identifiable health information are kept properly confidential. Additionally, if we create, receive, maintain, or transmit records related to substance use disorder (SUD) diagnosis or treatment, those records are subject to heightened confidentiality protections under 42 CFR Part 2 ("Part 2").

This Notice takes effect February 16, 2026 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, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice 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 this Notice, please contact us using the information listed at the end of this Notice.

 

TYPES OF DENTAL SERVICES WE PROVIDE

Our practice provides dental services that may include general dentistry, periodontal care, orthodontic services, oral surgery, endodontic treatment, prosthodontic services, cosmetic dentistry, pediatric dentistry, preventive care, and pain management services.

We maintain both electronic health records (EHR) and paper records. Your protected health information may be stored, accessed, and transmitted in either format, with appropriate security measures in place for both.

 

SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS

What are Part 2 Records?

Part 2 records are records that relate to the identity, diagnosis, prognosis, or treatment of any patient in connection with substance use disorder services. If our practice creates or receives such records, they are subject to special confidentiality protections under federal law (42 CFR Part 2).

Enhanced Confidentiality Protections

Part 2 records receive stricter confidentiality protections than other health information protected under HIPAA. We cannot use or disclose Part 2 records without your written consent except in limited circumstances specifically permitted by law.

Prohibition on Criminal Use and Redisclosure

Part 2 records cannot be used to investigate or prosecute you for any crime. Federal law prohibits the use of Part 2 records in criminal, civil, or administrative proceedings against you without your specific written consent or a court order that meets strict legal requirements.

Anyone who receives Part 2 records from us with your consent is prohibited from further disclosing those records without your additional written consent, unless specifically permitted by Part 2 regulations. We include this prohibition statement on all disclosures of Part 2 records:

"This information has been disclosed to you from records protected by federal confidentiality rules (42 CFR Part 2). The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient."

 

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.

Treatment. We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you, or share your dental x-rays with an oral surgeon to whom we refer you.

Payment. We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your dental health plan containing certain health information.

Healthcare Operations. We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, conducting training programs, licensing activities, business planning and development, and general administrative activities including customer service and compliance programs.

Business Associates. We may share your health information with third-party service providers (called "business associates") who perform services on our behalf, such as billing companies, insurance verification services, IT support, or dental laboratories. We require these business associates to appropriately safeguard your health information through written agreements. For Part 2 records, business associates are considered "qualified service organizations" and must comply with Part 2 confidentiality requirements.

Individuals Involved in Your Care or Payment for Your Care. We may disclose your health information to your family or friends or any other individual identified by you when they participate in your care or in the payment for your care. Additionally, we may disclose information about you to a patient representative. If a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information. For Part 2 records, we require your specific written consent before making such disclosures.

Appointment Reminders and Health Communications. We may contact you to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services that may be of interest to you, including oral health education and preventive care recommendations.

Disaster Relief. We may use or disclose your health information to assist in disaster relief efforts.

Required by Law. We may use or disclose your health information when we are required to do so by law.

Public Health Activities. We may disclose your health information for public health activities, including disclosures to: â–ª Prevent or control disease, injury or disability; â–ª Report child abuse or neglect; â–ª Report reactions to medications or problems with products or devices; â–ª Notify a person of a recall, repair, or replacement of products or devices; â–ª Notify a person who may have been exposed to a disease or condition; or â–ª Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

National Security. We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials 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 the protected health information of an inmate or patient.

Secretary of HHS. We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA and Part 2.

Worker's Compensation. We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker's compensation or other similar programs established by law.

Law Enforcement. We may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order. Part 2 records are subject to strict limitations on disclosure to law enforcement and cannot be used to investigate or prosecute you for any crime without your consent or a qualifying court order.

Health Oversight Activities. We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested. Part 2 records may only be disclosed pursuant to a court order that meets specific Part 2 requirements, which are more stringent than standard HIPAA requirements.

Research. We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information. Part 2 records may be disclosed for research only when all patient-identifying information has been removed or when an independent review board has approved the research and specific Part 2 requirements are met.

Coroners, Medical Examiners, and Funeral Directors. We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to perform their duties.

Organ and Tissue Donation. If you are an organ donor, we may disclose your health information to organizations that handle organ procurement or transplantation.

To Avert a Serious Threat to Health or Safety. We may use and disclose your health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. Part 2 permits disclosure in medical emergencies when your prior consent cannot be obtained.

Fundraising. We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving the communications.

SUD Treatment Information (Part 2 Records). If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42 CFR Part 2 (a "Part 2 Program") through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your Part 2 Program record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.

Part 2 permits us to use or disclose Part 2 records without your consent only in these specific situations: â–ª Medical emergencies when your prior consent cannot be obtained â–ª Research activities when all patient-identifying information has been removed or when an independent review board has approved the research protocol â–ª Audits and evaluations by authorized personnel conducting oversight activities â–ª Court orders that meet specific Part 2 requirements â–ª Reports of crimes on program premises or against program personnel â–ª Child abuse or neglect reporting as required by state law â–ª Qualified Service Organization Agreements with entities that provide services to our program

In no event will we use or disclose your Part 2 Program record, or testimony that describes the information contained in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.

 

OTHER USES AND DISCLOSURES OF PHI

Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. We will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for in this Notice (or as otherwise permitted or required by law). For Part 2 records, we require your written consent for uses and disclosures for treatment, payment, and health care operations. You may revoke an authorization or consent in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already acted in reliance on the authorization.

 

YOUR HEALTH INFORMATION RIGHTS

Access. You have the right to look at or get copies of your health information, including Part 2 records, with limited exceptions. You must make the request in writing. You may obtain a form to request access by using the contact information listed at the end of this Notice. You may also request access by sending us a letter to the address at the end of this Notice. If you request information that we maintain on paper, we may provide photocopies. If you request information that we maintain electronically, you have the right to an electronic copy. We will use the form and format you request if readily producible. We will charge you a reasonable cost-based fee for the cost of supplies and labor of copying, and for postage if you want copies mailed to you. Contact us using the information listed at the end of this Notice for an explanation of our fee structure.

If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.

Disclosure Accounting. With the exception of certain disclosures, you have the right to receive an accounting of disclosures of your health information in accordance with applicable laws and regulations. For Part 2 records, the accounting will include disclosures made with your consent and disclosures made without your consent as permitted by Part 2. To request an accounting of disclosures of your health information, you must submit your request in writing to the Privacy Official. 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 the additional requests.

Right to Request a Restriction. You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official. Your written request must include (1) what information you want to limit, (2) whether you want to limit our use, disclosure or both, and (3) to whom you want the limits to apply. We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan), has paid our practice in full. For Part 2 records, you have the right to request restrictions on uses and disclosures made with your consent, and we will consider your request in accordance with Part 2 requirements.

Alternative Communication. You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request. We will accommodate all reasonable requests. However, if we are unable to contact you using the ways or locations you have requested, we may contact you using the information we have. This right is particularly important for Part 2 records, and we will work with you to ensure confidential communications.

Amendment. You have the right to request that we amend your health information, including Part 2 records. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances. If we agree to your request, we will amend your record(s) and notify you of such. If we deny your request for an amendment, we will provide you with a written explanation of why we denied it and explain your rights, including your right to submit a statement of disagreement.

Right to Notification of a Breach. You will receive notifications of breaches of your unsecured protected health information, including Part 2 records, as required by law.

Electronic Notice. You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our Web site or by electronic mail (e-mail).

Additional Rights for Part 2 Records. If we maintain Part 2 records about you, you have these additional rights: â–ª Right to written notice of our privacy practices regarding Part 2 records â–ª Right to provide or withhold consent for uses and disclosures of Part 2 records for treatment, payment, and health care operations â–ª Right to revoke your consent for use or disclosure of Part 2 records at any time in writing â–ª Right to file a complaint if you believe your Part 2 privacy rights have been violated

 

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 if 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 Office for Civil Rights. The HHS Office for Civil Rights enforces both HIPAA and Part 2 regulations. You may file a complaint regarding violations of either or both sets of regulations.

U.S. Department of Health & Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Phone: 1-877-696-6775 Website: hhs.gov/ocr/privacy/hipaa/complaints Email: OCRComplaint@hhs.gov

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. You will not be penalized or denied services for filing a complaint.