HIPAA Notice of Privacy Practices
For Dental Practice Patients
Effective Date: February 16, 2026
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.
Your Information. Your Rights. Our Responsibilities.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an Electronic or Paper Copy of Your Medical Record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
- If we offer you a summary instead of a full copy, we will inform you that you have the right to obtain or direct copies of your protected health information to a third party.
Inspect Your Records In Person
- You may request to inspect your protected health information in person at our dental office.
- During an in-person inspection, you may take notes or photographs of your own health information. We will not impose unreasonable measures on your ability to do so.
Ask Us to Correct Your Medical Record
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request Confidential Communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask Us to Limit What We Use or Share
- You can ask us not to use or share certain health information for treatment, payment, or our operations.
- We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.
- We will say “yes” unless a law requires us to share that information.
Get a Copy of This Privacy Notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose Someone to Act for You
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a Complaint If You Feel Your Rights Are Violated
- You can complain if you feel we have violated your rights by contacting us using the information on the last page of this notice.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In These Cases, You Have Both the Right and Choice to Tell Us To:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In These Cases We Never Share Your Information Unless You Give Us Written Permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
Fundraising
We may contact you for fundraising efforts, but you can tell us not to contact you again. If we create or maintain substance use disorder records protected under 42 CFR Part 2, we will provide you with a clear and conspicuous opportunity to opt out of fundraising communications before using or disclosing such records for that purpose.
Special Protections for Certain Types of Information
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.
Substance Use Disorder (SUD) Treatment Information
Federal law (42 CFR Part 2) provides additional privacy protections for records relating to substance use disorder diagnosis, treatment, or referral created by federally assisted programs. Our dental practice may receive these records as part of your health history or through coordination of care with other providers.
If we receive information about you from a substance use disorder treatment program covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you gave that program for treatment, payment, and/or health care operations, we may use and share your record for those same purposes as explained in this Notice. If we receive your record with a specific consent that limits how it may be used, we will only use and share the information as expressly permitted in that consent.
Restrictions on Use in Legal Proceedings: Substance use disorder treatment records received from programs subject to 42 CFR Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order issued after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in 42 CFR Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.
Consent: With certain exceptions, substance use disorder records come with a patient consent form permitting the Part 2 Program to disclose the patient’s information. A patient may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes. This consent may be revoked at any time.
Notice Regarding Redisclosure
Information that we disclose pursuant to this Notice or with your authorization may be subject to redisclosure by the recipient and may no longer be protected by the HIPAA Privacy Rule. However, substance use disorder treatment records protected under 42 CFR Part 2 have additional restrictions on redisclosure. Any re-disclosure of Part 2 records must comply with the requirements of that regulation.
Our Uses and Disclosures
We typically use or share your health information in the following ways.
Treat You
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run Our Organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for Your Services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your dental insurance plan so it will pay for your services.
How Else Can We Use or Share Your Health Information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
Note: Where uses or disclosures described in this Notice are limited by other applicable laws that are more stringent than HIPAA, including but not limited to 42 CFR Part 2 (governing substance use disorder records) and applicable state laws, we will comply with the more restrictive requirements of those laws.
Help with Public Health and Safety Issues
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Do Research
We can use or share your information for health research.
Comply with the Law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to Organ and Tissue Donation Requests
We can share health information about you with organ procurement organizations.
Work with a Medical Examiner or Funeral Director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address Workers’ Compensation, Law Enforcement, and Other Government Requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to Lawsuits and Legal Actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
- For substance use disorder records protected under 42 CFR Part 2 that we create or maintain, we have a duty to provide you with adequate notice of how those records may be used and disclosed, and of your rights with respect to such records.
- We are also required to comply with all applicable federal nondiscrimination laws, including laws that address language access requirements.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Contact Information
This Notice of Privacy Practices applies to all the organizations on this site. For questions about this notice, to exercise any of your rights, or to file a complaint, please see the appropriate page for contact information.