Notice of Privacy-Practices (Dental)

This notice describes how medical information about you may be used and disclosed and how you can get access to this information

The Health Insurance Portability & Accountability Act of 1996 (“HIPPA”) is a federal program that requires that all medical records and other individually identifiable information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. “HIPPA” provides penalties for covered entities that misuse personal health information.

As required by “HIPPA”, we may use and disclose your medical records only for each of the following purpose: treatment, payment and health care operations.

.Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include teeth cleaning.

.Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities and utilizing review. An example of this would be sending a bill for your visit to your insurance company for payment.

.Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis, and customer service. An example would be an internal quality assessment review.

We may also create and distribute the identified health information by removing all references to individually identifiable information.

We May contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected information, which you can exercise by presenting a written request to the Privacy Officer.

.The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

.The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.

.The right to inspect and copy your protected health information.

.The right to amend your protected health information.

.The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacies wit respect to protect health information.

You have recourse if you fee that your privacy protections have been violated. You have the right to file written complain with our office, or with the Department of health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filling a complaint.


For more information about HIPPA or to file a complaint


The U.S. Department of Health & Human Services

Office of Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

(202) 619-0257

Toll-Free: 1-877-696-6775

Contact Us