NOTICE OF PRIVACY PRACTICES

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: February 1, 2026

OUR LEGAL DUTY

We are required by law to:
• Maintain the privacy of your protected health information (PHI)
• Provide you with this Notice of our legal duties and privacy practices
• Follow the terms of this Notice currently in effect

Protected health information includes information that identifies you and relates to your dental or health condition, treatment, or payment for services.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

1. Treatment

We may use or disclose your health information to provide, coordinate, or manage your dental care.
Example: Sharing information with specialists, labs, or other healthcare providers involved in your care.

2. Payment

We may use or disclose your health information to obtain payment for services provided.
Example: Submitting claims to your dental or medical insurance plan.

3. Health Care Operations

We may use or disclose your health information for practice operations, including quality assessment, staff training, licensing, and administrative activities.

SUBSTANCE USE DISORDER (SUD) RECORDS — SPECIAL PRIVACY PROTECTIONS

Some health information related to substance use disorder (SUD) diagnosis, treatment, or referral may be protected by federal law (42 CFR Part 2) and receives additional confidentiality protections.

Important information about SUD records:

• We may not use or disclose SUD records for treatment, payment, or healthcare operations without your written consent, except as permitted by law.
  • These records will not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order.
  • If state or federal laws are more restrictive than HIPAA, those stricter laws will apply.

REDISCLOSURE NOTICE

If your health information is disclosed as permitted by law, the recipient may redisclose the information, and it may no longer be protected by HIPAA.

FUNDRAISING COMMUNICATIONS (If Applicable)

We will not use information protected under 42 CFR Part 2 for fundraising without giving you the opportunity to opt out of such communications.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the right to:
• Inspect and obtain a copy of your health records
• Request corrections to your health information
• Request restrictions on certain uses or disclosures
• Request confidential communications
• Receive a paper copy of this Notice at any time
• Be notified if your unsecured health information is breached

OTHER USES AND DISCLOSURES

Any uses or disclosures of your health information not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time in writing.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice and make the new Notice apply to all health information we maintain. The revised Notice will be available in our office and on our website.

COMPLAINTS

If you believe your privacy rights have been violated, you may 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
1-800-368-1019 | www.hhs.gov/ocr

We will not retaliate against you for filing a complaint.