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. The privacy of your health information is important to us.

Our Legal Duty

We are required by applicable federal and state law to maintain the privacy of your protected health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your protected health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect August 19, 2026, and will remain in effect until we replace it. We are required to notify you if a breach occurs that may have compromised the privacy or security of your health information.

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. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and provide the new Notice at our practice location, and we will distribute it upon request.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

Your Authorization: We will not use or disclose your health information for any purpose not described in this Notice without your written authorization. This includes most uses for marketing and any disclosure that would be a sale of your information. You are never required to sign an authorization, and refusing will not affect your treatment or benefits. You may revoke an authorization in writing at any time, though revocation does not undo disclosures already made.

Uses and Disclosures of Health Information

We may use and disclose health information about you without authorization for the following purposes:

Treatment: We may use or disclose your health information to provide, coordinate, or manage your dental care and related services. For example, we may share your information with a physician or another healthcare provider involved in your care.

Payment: We may use and disclose your health information to obtain payment for services we provide. For example, we may send claims to your dental plan containing information necessary for payment.

Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations. These activities include quality assessment, reviewing provider performance, training programs, licensing, and accreditation.

To You or Your Personal Representative: We must provide your health information to you, as described in the Patient Rights section of this Notice. We will also provide your information to a person who is legally authorized to act as your personal representative, consistent with federal and state law. We may deny access to a personal representative in limited circumstances, such as if we reasonably believe that providing the information could cause harm.

Persons Involved in Care: We may use or disclose health information to notify, or assist in notifying, a family member, your personal representative, or another person responsible for your care, of your location, general condition, or death. If you are present, we will give you the opportunity to object to such disclosures. If you are incapacitated, absent, or in an emergency situation, we will use our professional judgment to determine whether disclosing information is in your best interest, and disclose only information directly relevant to that person’s involvement in your care.

Disaster Relief: We may disclose your health information to organizations involved in disaster relief efforts so that your family or others responsible for your care can be notified of your condition, status, and location.

Communications About Our Services: We may use your health information to send you communications about our own dental services, such as appointment reminders, new services we offer, or special events at our office. These communications may be sent by mail, email, text message (SMS), or phone. If we use a service bureau or vendor to help send these communications, they will be bound by a Business Associate Agreement to protect your information. We will not disclose your information to outside companies for their own marketing purposes.

Required by Law: We may use or disclose your health information when we are required to do so by law.

Public Health and Public Benefit: We may use or disclose your health information for public health and safety purposes as required or permitted by law. This includes reporting abuse, neglect, or domestic violence; reporting disease, injury, or vital statistics; reporting information to the Food and Drug Administration (FDA); alerting persons who may be at risk of contracting or spreading a disease; participating in health oversight activities; helping to avert a serious threat to health or safety; and complying with workers’ compensation or similar programs.

Decedents: We may disclose health information about a decedent as authorized or required by law.

Government, Law Enforcement, and Legal Proceedings: We may disclose your health information when required or permitted by law. This may include disclosures to military authorities for Armed Forces personnel, to authorized federal officials for national security or intelligence activities, or to correctional institutions or law enforcement officials who have lawful custody of an inmate or patient. We may also disclose your information in response to a court order, subpoena, or other lawful process in connection with judicial or administrative proceedings.

Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders such as voicemail messages, email messages, text messages (SMS), postcards, or letters. We may send these messages directly from our office systems and/or utilize a vendor who has signed a Business Associate Agreement with us and agrees to comply with all required HIPAA/HITECH rules to ensure the security and privacy of your information.

Patient Rights

Access: You have the right to look at or get copies of your health information, with limited exceptions. You may request copies in paper or electronic format, and we will honor your request unless it is not reasonably practical. All requests must be made in writing. You may obtain a request form or send a written letter using the contact information at the end of this Notice. We will provide access within 30 days of receipt of your request (with one possible 30-day extension, if needed, with notice to you). At your direction, we can send an electronic copy of your health information by email, or, if available, by another electronic method you choose, including to a third party you designate. We may charge a reasonable, cost-based fee for labor, supplies, or postage. If you prefer, we can prepare a summary or explanation of your health information for a fee. Contact us for a full explanation of our fee structure.

Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations, and certain other activities, for the last 6 years. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.

Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your health information. In most cases we are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in certain circumstances where disclosure is required or permitted, such as an emergency, for public health activities, or when disclosure is required by law). We must comply with a request to restrict the disclosure of protected health information to a health plan for purposes of carrying out payment or health care operations (as defined by HIPAA) if the protected health information pertains solely to a health care item or service for which we have been paid out of pocket in full.

Alternative Communication: You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. (You must make your request in writing.) Your request must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request.

Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.

Paper Copy of This 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 electronic mail.

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, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this Notice.

You may also file a written complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, or online through the OCR complaint portal at ocrportal.hhs.gov. Complaints must generally be filed within 180 days of when you knew or should have known of the violation.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Notice of Privacy Practices v5 — effective August 19, 2026.