Notice of Privacy Practices

Our duties

We are required by law to keep your protected health information private, to give you this notice of our legal duties and privacy practices, and to notify you if a breach occurs that may have compromised the privacy or security of your information.

We must follow the terms of the notice currently in effect. We may change this notice, and the changes will apply to all information we have about you. The current notice is always available at our front desks and on this page, and you may ask for a paper copy at any time.

How we may use and share your information

We may use and share your information without your written authorization for the following purposes.

• Treatment: to provide and coordinate your dental care, for example sharing X-rays with a specialist or a dental lab that makes your crown.
• Payment: to bill and collect payment from you, your dental insurance or a government program such as Medicaid or CHIP.
• Health care operations: to run our offices, for example reviewing the quality of care, training staff and sending appointment reminders.
• People involved in your care: we may share information with a family member, friend or caregiver involved in your care or payment, unless you tell us not to. If you cannot respond, we will use our professional judgment.
• Business associates: we may share information with companies that perform services for us, such as billing or software providers, who must protect it under a written agreement.

Other uses and disclosures allowed or required by law

We may also share your information when the law allows or requires it, including:

• When required by federal, state or local law.
• For public health activities, such as reporting disease, injury or adverse reactions to medications or products.
• To report suspected abuse, neglect or domestic violence to the proper authorities.
• For health oversight activities such as audits, investigations and licensing.
• In response to a court or administrative order, subpoena or other lawful process.
• To law enforcement officials when the law allows it.
• To coroners, medical examiners and funeral directors, and for organ and tissue donation.
• For research under strict privacy protections.
• To prevent a serious threat to your health or safety or that of others.
• For specialized government functions, such as military, veterans and national security purposes.
• For workers' compensation claims.

Uses that need your written authorization

We will not use or share your information for marketing, sell your information, or share psychotherapy notes without your written authorization. Any other use or disclosure not described in this notice requires your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Texas law

Texas law requires us to tell you that your protected health information may be subject to electronic disclosure. We will not disclose your information electronically to anyone for any purpose other than treatment, payment, health care operations, or as otherwise authorized or required by state or federal law, without your written authorization.

If we keep your records electronically and you ask for them in writing, we will provide an electronic copy within 15 business days, as Texas law requires.

Your rights

• Get a copy of your records: you may see or get a paper or electronic copy of your dental and billing records. Ask in writing. We may charge a reasonable, cost-based fee.
• Ask us to correct your records: if you think information is incorrect or incomplete, ask in writing. We may say no, but we will tell you why in writing within 60 days.
• Request confidential communications: you may ask us to contact you in a specific way, for example by cell phone only or by mail to a different address. We will agree to reasonable requests.
• Ask us to limit what we use or share: we are not required to agree, except that if you pay for a service in full out of pocket, you may ask us not to share that information with your health plan and we will agree unless the law requires us to share it.
• Get a list of disclosures: you may ask for a list of times we shared your information in the six years before your request, other than for treatment, payment, operations and certain other purposes. One list per year is free.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you: if you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights.

Questions and complaints

To use any of these rights or ask a question, contact the Privacy Officer at the office where you receive care, listed below.

If you believe your privacy rights were violated, you may file a complaint with us, or with the U.S. Department of Health and Human Services Office for Civil Rights by mail at 200 Independence Avenue, S.W., Washington, D.C. 20201, by phone at 1-877-696-6775, or online at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.