Privacy Policy

Last Updated: May 13, 2025

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.

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.

1. Uses and Disclosures of Health Information

• Treatment, Payment, and Health Care Operations: The most common reasons why we use or disclose your health information are for treatment, payment or health care operations.
• Examples of how we use information for treatment purposes are: setting up appointments for you; examining your teeth; prescribing medications and faxing them to be filled; referring you to another doctor or clinic; or getting copies of your health information from another professional.
• Examples of how we use information for payment purposes are: asking about your health or dental care plans, or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts.
• "Health care operations" include administrative and managerial functions that we have to do in order to run our office, such as 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 special permission. If we need to disclose your health information outside our office for these reasons, we usually will not ask you for special written permission.2
• Uses and Disclosures Without Permission: In some limited situations, the law allows or requires us to use or disclose your health information without your permission.
• These situations may include: when a state or federal law mandates reporting for a specific purpose; for public health purposes, such as contagious disease reporting; notices to and from the FDA regarding drugs or medical devices; disclosures to authorities about suspected abuse, neglect or domestic violence; uses and disclosures for health oversight activities, such as licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws; disclosures for judicial and administrative proceedings, such as in response to subpoenas; disclosures for law enforcement purposes, such as to provide information about someone who is a victim of a crime; to provide information about a crime at our office; or to report a crime that happened somewhere else;3 disclosure to a medical examiner to identify a dead person or determine the cause of death; to funeral directors to aid in burial; or to organizations that handle organ or tissue donations; uses or disclosures for health-related research; uses and disclosures to prevent a serious threat to health or safety; uses or disclosures for specialized government functions, such as for the protection of the president or high-ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service; disclosures of deidentified information; disclosures relating to worker's compensation programs; disclosures of a "limited data set" for research, public health, or health care operations; incidental disclosures that are an unavoidable byproduct of permitted uses or disclosures; and disclosures to "business associates" who perform health care operations for us and who commit to respect the privacy of your health information.
• 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.

• Appointment Reminders: 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 post card, and/or leave you a reminder message on your home answering machine or with someone who answers your phone if you are not home.
• Other Uses and Disclosures: 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.

2. Your Rights Regarding Your Health Information

The law gives you many rights regarding your health information. You can:

• Ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the office contact person at the address, fax, or E Mail shown at the beginning of this Notice.

• Ask us to communicate with you in a confidential way, such as by phoning you at work rather than at home, by mailing health information to a different address, or by using email to your personal E Mail address. We will accommodate these requests if they are reasonable and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the office contact person at the address, fax or E mail shown at the beginning of this Notice.

• Ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or copying. For the most part, however, you will be able to review or have a copy of your health information within 30 days of asking us (or sixty days if the information is stored offsite). You may have to pay for photocopies in advance. If we deny your request, we will send you a written explanation, and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30-day extension of the time for us to give you access or photocopies if we send you a written notice of the extension. If you want to review or get photocopies of your health information, send a written request to the office contact person at the address, fax or E Mail shown at the beginning of this Notice.

• Ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons who we know got the wrong information, and others that you specify.