Notice of Privacy Policy
Effective Date: March 17, 2026
THIS NOTICE EXPLAINS HOW YOUR MEDICAL AND DENTAL INFORMATION MAY BE USED OR SHARED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE READ IT CAREFULLY.
Our Legal Responsibilities
Our practice is required by federal law to protect the privacy of your Protected Health Information (PHI). We must provide you with this Notice explaining our legal duties and privacy practices, and we must notify you if a breach occurs involving your unsecured PHI.
We are obligated to follow the privacy practices described in this Notice while it is in effect. We reserve the right to revise this Notice at any time, as permitted by law, and to apply revised terms to all PHI we maintain. If material changes are made, the updated Notice will be posted at our location and on our website, and copies will be available upon request.
You may request a copy of this Notice at any time. To obtain additional copies or learn more about our privacy practices, please use our contact form here: View Contact Form
How We May Use and Share Your Health Information
Your PHI may be used or disclosed for the purposes outlined below. Certain types of records, including HIV-related information, genetic information, substance use treatment records, and mental health information, may receive additional protection under federal or state law. Where applicable, we will follow those additional requirements.
Treatment
We may use and share your PHI to provide, coordinate, or manage your health care. For example, your information may be shared with a specialist or another provider involved in your care.
Payment
We may use and disclose your PHI to obtain payment for services provided to you. This may include submitting claims to insurance companies, verifying coverage, billing, and collections. For example, relevant information may be included in claims sent to your dental insurance provider.
Health Care Operations
We may use and disclose your PHI to support our business and clinical operations. This includes quality improvement efforts, staff training, licensing, accreditation, and administrative activities necessary to operate our practice.
Individuals Involved in Your Care or Payment
We may share relevant information with family members, friends, or others you identify as being involved in your care or payment. If a person has legal authority to make decisions on your behalf, we will treat that individual as your representative.
Disaster Relief
Your PHI may be disclosed to authorized organizations assisting with disaster relief efforts so that your condition, status, or location may be communicated to appropriate individuals.
When Required by Law
We will use or disclose your PHI when required by federal, state, or local law.
Public Health and Safety Activities
We may disclose your PHI for public health purposes, including:
- Preventing or controlling disease, injury, or disability
- Reporting suspected abuse, neglect, or domestic violence
- Reporting reactions to medications or issues with medical products
- Notifying individuals of recalls, repairs, or replacements
- Informing individuals of potential exposure to a disease
National Security, Military, and Correctional Institutions
Under certain circumstances, PHI may be disclosed to military authorities, national security officials, or correctional institutions when authorized or required by law.
Oversight and Compliance
We may disclose your PHI to the U.S. Department of Health and Human Services (HHS) or other authorized oversight agencies to verify compliance with HIPAA and other applicable laws.
Workers’ Compensation
We may disclose your PHI as necessary to comply with workers’ compensation or similar programs established by law.
Law Enforcement and Legal Proceedings
We may disclose your PHI for law enforcement purposes, in response to court orders, subpoenas, or other lawful processes, and as otherwise permitted by law.
Research
Your PHI may be used or disclosed for research purposes when approved by an authorized review board that ensures your privacy is protected.
Coroners, Medical Examiners, and Funeral Directors
We may share PHI with coroners, medical examiners, or funeral directors as required for identification or other lawful duties.
Fundraising Communications
We may contact you about practice-related programs or fundraising activities, where permitted by law. You may request to opt out of receiving these communications.
Substance Use Disorder Treatment Records (42 CFR Part 2)
If we receive records from a federally assisted substance use disorder treatment program under your general consent, we may use and disclose that information for treatment, payment, and health care operations. If received under specific consent, we will only use or disclose it as authorized.
Such records will not be used in legal or administrative proceedings against you without your written consent or a valid court order, as required by law.
Uses and Disclosures That Require Your Authorization
Your written authorization is required for:
- Most uses or disclosures of psychotherapy notes
- Marketing uses of PHI
- The sale of PHI
We will also obtain your authorization for uses not otherwise described in this Notice unless permitted or required by law. You may revoke your authorization at any time in writing, except where action has already been taken based on your authorization.
Your Rights Regarding Your Health Information
Right to Access
You may request to inspect or obtain copies of your PHI, with limited exceptions. Requests must be submitted in writing using our contact form. View Contact Form
Copies may be provided electronically if available. A reasonable, cost-based fee may apply for copying, supplies, or mailing.
If access is denied, you may request a review of the denial as permitted by law.
Right to an Accounting of Disclosures
You may request a record of certain disclosures of your PHI. Requests must be submitted in writing through our contact form. A fee may apply for multiple requests within a 12-month period.
Right to Request Restrictions
You may request limitations on how your PHI is used or shared. While we are not required to agree to all requests, we will comply when required by law, including when services are paid in full out-of-pocket and disclosure to a health plan is not required.
Right to Request Confidential Communications
You may request that we communicate with you through alternative methods or at different locations. We will accommodate reasonable requests when feasible.
Right to Request Amendments
You may request corrections to your PHI if you believe information is incomplete or inaccurate. Requests must be submitted in writing and include a reason. If denied, you will receive an explanation and information about your rights.
Right to Breach Notification
You will be notified as required by law if your unsecured PHI is compromised in a breach.
Right to a Paper Copy
You may request a paper copy of this Notice at any time, even if you have received it electronically.
Questions, Concerns, or Complaints
If you have questions about this Notice, wish to exercise your rights, or want to file a complaint, please contact us using our website contact form. View Contact Form
You may also file a complaint with the U.S. Department of Health and Human Services. Filing a complaint will not result in retaliation or affect your care in any way.