HIPAA Notice of Privacy Practices

• Treatment: to provide, coordinate or manage your dental care, including sharing information with specialists, labs or other providers involved in your care.
• Payment: to bill and collect payment from you, your insurance company or another third party.
• Health care operations: to run our practice, including quality reviews, training, scheduling and appointment reminders.
• As required by law: when federal, state or local law requires it, including public health reporting, health oversight activities and responding to lawful court orders.

Other uses and disclosures, including most marketing uses and any sale of your PHI, will be made only with your written authorization. You may revoke an authorization in writing at any time, except where we have already acted on it.

• Get a copy of your dental and health records, in paper or electronic form.
• Ask us to correct information you believe is incorrect or incomplete.
• Request confidential communications, such as contacting you at a specific phone number or address.
• Ask us to limit what we use or share. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer.
• Get a list of certain disclosures we have made of your information.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone, such as a medical power of attorney or legal guardian, to act on your behalf.

• We are required by law to maintain the privacy and security of your protected health information.
• We will promptly notify you if a breach occurs that may have compromised the privacy or security of your information.
• We will not use or share your information other than as described here unless you tell us we can in writing.

Information you submit through our website contact form or Smile Guide assistant is used to respond to your inquiry and schedule your visit. Please do not send detailed medical history or other sensitive health information through the website. We will collect it securely at your appointment.

If you believe your privacy rights have been violated, you may file a complaint with our office by calling us, or with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

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 on request, in our office and on our website.