Notice of Privacy Practices for Designer Dental Services
Effective Date: February 16, 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.
We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect.
1. How We May Use And Disclose Health Information About You
We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example below:
- Treatment: We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you.
- Payment: We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. For example, we may send claims to your dental health plan containing certain health information.
- Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. Healthcare operations include quality assessment and improvement activities, conducting training programs, and licensing activities.
- Individuals Involved in Your Care or Payment for Your Care: We may disclose your health information to your family or friends or any other individual identified by you when they participate in your care or in the payment for your care. Additionally, we may disclose information about you to a patient representative.
- Disaster Relief: We may use or disclose your health information to assist in disaster relief efforts.
- Required by Law: We may use or disclose your health information when we are required to do so by law.
- Public Health Activities: We may disclose your health information for public health activities, including disclosures to prevent or control disease, report child abuse or neglect, report reactions to medications, notify a person of a product recall, or notify a person who may have been exposed to a disease.
- National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances, or to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities.
- Secretary of HHS: We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.
- Worker’s Compensation: We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation.
- Law Enforcement & Judicial Proceedings: We may disclose your PHI for law enforcement purposes as permitted by HIPAA, or in response to a subpoena, discovery request, or administrative order.
- Research, Coroners, and Funeral Directors: We may disclose your PHI to researchers when approved by an institutional review board, or to a coroner, medical examiner, or funeral director to enable them to perform their duties.
- Fundraising: We may contact you to provide you with information about our sponsored fundraising activities, as permitted by law. You may opt out of receiving these communications at any time.
- SUD Treatment Information: If we receive or maintain any information about you from a substance use disorder treatment program covered by 42 CFR Part 2, we will use and disclose it strictly within the boundary of your consent or as allowed by a specific court order.
2. Other Uses And Disclosures Of PHI
Your written authorization is required, with a few exceptions, for the following actions:
- Disclosure of psychotherapy notes
- Use or disclosure of PHI for marketing purposes.
- The sale of your PHI.
- Any other uses or disclosures not explicitly covered in this Notice.
You may revoke a written authorization at any time in writing. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already acted in reliance on the authorization.
3. Your Health Information Rights
You have the following rights regarding your protected health information:
- Access: Request to look at or get paper or electronic copies of your health information, with limited exceptions. We may charge a reasonable, cost-based fee for supplies, labor, and postage.
- Disclosure Accounting: Request an accounting of disclosures of your health information in accordance with applicable laws and regulations.
- Right to Request a Restriction: Request additional restrictions on our use or disclosure of your PHI. We are not required to agree unless the disclosure is to a health plan for payment or operations purposes, and the item or service has been paid for in full out-of-pocket.
- Alternative Communication: Request that we communicate with you about your health information by alternative means or at alternative locations. Your request must be made in writing.
- Amendment: Request that we amend your health information. Your request must be in writing and explain why the information should be amended.
- Right to Notification of a Breach: You have the right to receive timely notifications of breaches of your unsecured protected health information as required by law.
- Electronic Notice: You may receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically on our website or by email.
4. Changes To This Notice
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. When we make a significant change, we will update this Notice, post the new version clearly and prominently at our practice location, and update the version hosted on our website.
5. Questions And Complaints
If you want more information about our privacy practices, have questions, or believe your privacy rights have been violated, you can contact us directly or file a written complaint with the U.S. Department of Health and Human Services. We support your right to the privacy of your health information and will not retaliate against you in any way for filing a complaint.
6. Contact Our Privacy Official
If you have any questions about this Notice of Privacy Practices or wish to exercise any of your health information rights, please contact:
