Notice of Privacy Practices

Any information that identifies you and relates to your health or dental care, or to payment for it: your chart, X-rays, treatment plans, insurance details, bills and appointment history.

• Treatment. To examine and treat you, and to share with other providers who treat you, such as a specialist we refer you to or a lab that makes your crown.
• Payment. To bill you, your insurer or another payer, and to check your benefits and get pre-treatment estimates.
• Health care operations. To run the practice: quality reviews, training, scheduling, and appointment reminders by phone, text or email.
• When the law requires it, including for public health reporting, health oversight, court orders, and reports of suspected abuse or neglect to the authorities.
• To prevent a serious threat to your health or safety or someone else's.
• To business associates who handle information for us, such as our practice software and billing services, under a written agreement that requires them to protect it.

Any use for marketing, any sale of your information, and any use or sharing not described in this notice. You can revoke an authorization in writing at any time, except for what was already done relying on it.

You can tell us not to share information with family members or friends involved in your care, and not to contact you for fundraising if we ever do any. If you are not present or cannot agree, we use professional judgment.

• See and get a copy of your dental record, on paper or electronically, usually within 30 days. We may charge a reasonable, cost-based fee.
• Ask us to correct your record if you think it is wrong or incomplete. If we say no, we tell you why in writing.
• Ask for confidential communication, such as calls on a different number or mail to a different address. We agree to reasonable requests.
• Ask us to limit what we use or share. We do not have to agree, except one case: if you pay for a service in full yourself, we will not share it with your health plan for payment or operations if you ask.
• Get a list of the times we shared your information in the past six years, other than for treatment, payment, operations and a few other cases.
• Get a paper copy of this notice at any time, even if you agreed to get it electronically.
• Be told of a breach that affects your unsecured information.
• Choose someone to act for you, such as a health care power of attorney or a child's parent.

The law requires us to keep your information private, to give you this notice, and to follow the notice currently in effect. We can change it; a new notice applies to all information we hold, and it is posted in the office and on this page, and you can ask for a copy.

If you think your privacy rights were violated, contact our privacy officer at (704) 555-0129 (demo number), or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.

This website is not a patient portal and holds no dental records. How the website itself handles visitor information is in the Privacy Policy.