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.
Effective date of this Notice: 02/06/2026
We respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how we protect your health information and what rights you have regarding it.
The most common reason why we use or disclose your health information is for treatment, payment, or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; examining your teeth; prescribing medications and faxing them to be filled referring you to another doctor or clinic for other health care or services or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health or dental care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). "Health care operations" mean those administrative and managerial functions that we have to do in order to run our office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; personnel decisions participation in managed care plans; defense of legal matters business planning and outside storage of our records.
We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.
For patients receiving treatment for substance use disorders, federal law (42 CFR Part 2) provides additional privacy protections beyond standard health information.
In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office at all. Such uses or disclosures are:
Unless you object, we will also share relevant information about your care with your family or friends who are helping you with your dental care.
We are required by law to maintain the privacy and security of your protected health information. In the event of a breach—which is the unauthorized acquisition, access, use, or disclosure of your unsecured health information—we will notify you promptly. This notice will be provided in writing via first-class mail (or via email if you have previously agreed to electronic communications) and will include a description of what happened, the types of information involved, and the steps we are taking to investigate the breach, mitigate losses, and protect against further occurrences.
We may call or write to remind you of scheduled appointments, or that it is time to make a routine appointment. We may also call or write to notify you of other treatments or services available at our office that might help you. Unless you tell us otherwise, we will mail you an appointment reminder on a postcard,
and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.
From time to time, we may offer telehealth (virtual) visits or communicate with you electronically (for example, through a patient portal, secure video, email, or text) to provide care, answer questions, coordinate treatment, send reminders, or discuss billing matters. When we provide telehealth services, we may use technology vendors to help us deliver these services. These vendors may receive limited protected health information as needed to provide the service and are required to protect your information and may be required to sign a business associate agreement with us, as applicable. You may request that we communicate with you in a confidential way (for example, using a specific phone number, mailing address, email address, or through the patient portal). See the “Confidential Communications” right described in the Notice. Please tell us if you want to opt out of electronic communications or prefer a different method. Electronic communications can carry some risk of
interception or misdelivery. We use reasonable safeguards to protect your information, and we encourage you to use secure methods (such as the patient portal) when available. If you choose to communicate with us by unencrypted email or text, you are acknowledging and accepting those risks.
If you have questions about telehealth or electronic communications, contact the office contact person listed at the beginning of the Notice.
We will not make any other uses or disclosures of your health information unless you sign a written "authorization form." The content of an "authorization form" is determined by federal law. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it's your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form, or you can use one of ours. If we initiate the process and
ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign one, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the office contact person named at the beginning of this Notice.
Most uses and disclosures of your health information for marketing purposes, and disclosures that constitute a sale of your health information, require your written authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke such an authorization at any time in writing.
The law gives you many rights regarding your health information. You can:
By law, we must abide by the terms of this Notice of Privacy Practices until we choose to change it. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our office, have copies available in our office, and post it on our website.
If you think that we have not properly respected the privacy of your health information, you are free to complain to us or the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the office contact person at the address, fax or email shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.
If you want more information about our privacy practices, call or visit the office contact person at the address or phone number shown at the beginning of this Notice.