Effective Date: January 20, 2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Legal Duty
We are required by law to maintain the privacy and security of your protected health information (“health information”). We are also required to provide you with this Notice explaining our legal duties, privacy practices, and your rights regarding your health information.
We must follow the privacy practices described in this Notice while it is in effect. This Notice applies to all health information we maintain, whether created or received before or after the effective date.
We may change the terms of this Notice at any time as permitted by law. Any revised Notice will apply to all health information we maintain and will be available in our office and on our website upon request.
Your Rights
You have the following rights regarding your health information.
Get an electronic or paper copy of your medical record
- You may ask to inspect or obtain an electronic or paper copy of your medical and billing records and other health information we maintain.
- You may request that we send your records to you or to a third party you choose, including by email or other electronic means.
- We will provide access or copies within 30 days of your request.
- We may charge a reasonable, cost-based fee as permitted by law.
Ask us to correct your medical record
- You may request correction of health information you believe is incorrect or incomplete.
- We may deny your request, but we will provide a written explanation within 60 days.
Request confidential communications
- You may request that we contact you in a specific way (for example, text message, email, home phone, or mail to a different address).
- We will accommodate all reasonable requests.
Ask us to limit what we use or share
- You may request limits on how we use or disclose your health information for treatment, payment, or health care operations.
- We are not required to agree to all requests.
- If you pay for a service out-of-pocket and in full, you may request that information not be shared with your health plan, and we will comply unless required by law.
Get a list of disclosures
- You may request an accounting of disclosures made in the six years prior to your request, excluding disclosures for treatment, payment, health care operations, and certain other permitted disclosures.
- One accounting per year is provided at no charge.
Get a copy of this Notice
- You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights after we verify their authority.
File a complaint
You may file a complaint with our practice using the contact information listed above.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
200 Independence Avenue, S.W., Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints
We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you have choices about what we share.
You may tell us whether to:
- Share information with family members, close friends, or others involved in your care or payment for care
- Share information in disaster relief situations
If you are unable to communicate your preference, we may share information if we believe it is in your best interest or to reduce a serious and imminent threat to health or safety.
We never share your information without your written authorization for:
- Marketing purposes
- Sale of your information
- Most psychotherapy notes
Our Uses and Disclosures
Treatment
We may use and share your health information to provide, coordinate, or manage your dental care.
Payment
We may use and share your health information to bill and collect payment from health plans or other entities.
Health Care Operations
We may use and share your health information to operate our practice, improve care, conduct quality assessment activities, manage administrative functions, and contact you when necessary.
Other Permitted or Required Disclosures
We may use or disclose your health information:
- For public health activities (such as preventing disease or reporting adverse events)
- For health research
- To comply with federal or state law
- To medical examiners, coroners, or funeral directors
- For workers’ compensation, law enforcement, or government oversight activities
- In response to court or administrative orders or lawful subpoenas
If another law provides greater privacy protection than HIPAA, we will follow the more restrictive law.
Confidentiality of Substance Use Disorder (SUD) Records
Certain health information related to substance use disorder diagnosis or treatment is subject to special federal confidentiality protections under 42 CFR Part 2.
If our practice receives substance use disorder treatment records about you:
- These records are subject to stricter limits on use and disclosure than other health information.
- Part 2 records generally may not be used or disclosed without your specific written consent or as otherwise permitted by law.
- Part 2 records generally may not be used in civil, criminal, administrative, or legislative proceedings against you without your written authorization or a qualifying court order.
- Any permitted disclosures will comply with both HIPAA and Part 2 requirements.
You may request additional information about these protections at any time.
Business Associates
We may disclose your health information to business associates that perform services on our behalf, such as billing, practice management, or information technology services. Business associates are required by contract to protect the privacy and security of your information and may only use or disclose it as permitted by law.
Electronic Communications
At your request, we may communicate with you via email, text message, patient portal, or other electronic means. These methods may involve some risk of unauthorized access. By choosing electronic communication, you acknowledge and accept these risks.
Our Responsibilities
We are required by law to maintain the privacy and security of your health information.
We will notify you without unreasonable delay if a breach occurs that may have compromised the privacy or security of your information.
We must follow the terms of this Notice and provide you with a copy.
We will not use or disclose your information other than as described unless you authorize us in writing.
Changes to This Notice
We may change the terms of this Notice at any time. Any changes will apply to all health information we maintain. The current Notice will be available in our office and on our website.
Acknowledgement of Receipt