Notice of Privacy Practices

Our Legal Duty

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.

This Notice takes effect 01/01/2026 and will remain in effect until we replace it.

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, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request. You may request a copy of our Notice at any time.

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. Some information, such as HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law.

• 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. For example, 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 are involved in your care or in the payment for your care.
• 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 preventing or controlling disease, reporting child abuse or neglect, and reporting reactions to medications.
• National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence 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: We may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
• Health Oversight Activities: We may disclose your PHI to an oversight agency for activities authorized by law such as audits and investigations.
• Judicial and Administrative Proceedings: If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order.
• Research: We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board.
• Coroners, Medical Examiners, and Funeral Directors: We may release your PHI to a coroner or medical examiner to identify a deceased person or determine the cause of death.
• Fundraising: We may contact you to provide you with information about our sponsored activities, including fundraising programs. You may opt out of receiving such communications.

Other Uses and Disclosures of PHI

Your authorization is required, with a few exceptions, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for the sale of PHI. You may revoke an authorization in writing at any time.

Your Health Information Rights

• Access: You have the right to look at or get copies of your health information, with limited exceptions. You must make the request in writing.
• Disclosure Accounting: You have the right to receive an accounting of disclosures of your health information in accordance with applicable laws.
• Right to Request a Restriction: You have the right to request additional restrictions on our use or disclosure of your PHI by submitting a written request to the Privacy Official.
• Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or at alternative locations.
• Amendment: You have the right to request that we amend your health information.
• Right to Notification of a Breach: You will receive 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 it electronically.

Questions and Complaints

If you want more information about our privacy practices or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights, you may complain to us or to the U.S. Department of Health and Human Services.

The downloadable PDF includes an acknowledgment section intended for in-office use. Online signatures are not required.