Notice of Privacy Practices

Effective Date: 01/07/2026
Publication Date: 01/07/2026

This notice describes how your medical and dental information may be used and disclosed, and how you can access this information. Please review it carefully.

Your Protected Health Information (PHI) is maintained by our practice as a written and/or electronic record of your visits and contacts for healthcare services. PHI includes personal and demographic information—such as your name, address, phone number, email, and insurance details—that may identify you and relates to your past, present, or future physical or mental health condition, as well as the dental care services provided to you.

Our dental practice is legally required to:

• Maintain the privacy and confidentiality of your PHI
• Follow the terms outlined in this Notice of Privacy Practices
• Use and disclose your information only as permitted or required by law

We reserve the right to update or change the terms of this notice at any time. Any revisions will apply to all PHI we already have on file. Upon your request, we will gladly provide a copy of the updated notice. The current version will always be posted visibly in our office and on our website.

Under federal and state privacy regulations, you have the following rights regarding your PHI:

• Right to Receive This Notice
  You have the right to obtain a copy of this Notice of Privacy Practices at any time.
• Right to Authorize Other Uses and Disclosures
  Any use or disclosure of your PHI not described in this notice requires your written authorization. This includes marketing purposes, psychotherapy notes, or the sale of PHI. You may revoke any authorization in writing at any time.
• Right to Request Confidential Communications
  You may ask us to contact you using alternative methods (phone, text, email) or at a different address. We will honor all reasonable requests submitted in writing.
• Right to Inspect and Copy Your Records
  You may review and obtain copies of your PHI. If records are kept electronically, you may request them in electronic format. A reasonable fee may apply for copies.
• Right to Request Restrictions
  You can request limitations on how we use or share your PHI for treatment, payment, or operations. We will consider all requests but may deny certain restrictions, except those that are paid fully out-of-pocket, which must be honored by law.
• Right to Request Amendments
  You may request corrections or amendments to your PHI if you believe information is incorrect or incomplete.
• Right to Disclosure Accounting
  You may request a report of certain disclosures of your PHI made outside our practice.
• Right to Breach Notification
  You will receive written notification if a breach of your unsecured PHI occurs.

We are permitted to use or disclose your PHI in the following ways:

Treatment

Your PHI may be used to provide, coordinate, and manage your dental care. This includes sharing information with specialists, laboratories, pharmacies, or other healthcare providers involved in your treatment.

Appointment Reminders and Health Information

We may contact you to:

• Remind you of upcoming appointments
• Provide test results
• Recommend treatment alternatives
• Inform you about health-related benefits or services

You have the right to opt out of receiving promotional communications.

Payment

We may use your PHI to obtain payment from insurance providers or confirm eligibility for benefits related to your dental services.

Healthcare Operations

Your PHI may be used for internal purposes such as:

• Quality improvement
• Audits
• Staff training
• Legal and administrative functions
• Business planning

Unless you object, we may share relevant PHI with family members or individuals you designate who are directly involved in your care. If you are unable to provide consent, we may disclose information if deemed in your best interest based on professional judgment.