HIPAA notice of privacy practices 

Get a copy of dental and claims records

• We will provide a copy or a summary of your dental and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• You can ask to see or get a copy of your dental and claims records and other information we have about you. Ask us how to do this.

Ask us to correct dental and claims records

• You can ask us to correct your dental and claims records if you think they are incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will consider all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain information for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say “no” if it would affect your care.
  

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
  

We can help manage the dental care treatment you receive.

We can use your health information and share it with professionals who are treating you.

Example: On our mobile dental clinic trucks, we use your information to provide high quality dental care. We may also share your information with another dentist who we are referring you to see.

We can run our organization.

We can use and disclose your information to run our organization and contact you when necessary.

Examples: (1) We use health information about you to develop better services for you. In some instances, we do this by requesting that you complete a survey. (2) We use health information about you to manage your treatment and services.
 

We help with public health and safety issues.

We can share health information about you for certain situations, such as:

• Preventing disease
• Helping with product recalls
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

We do research.

We can use or share your information for health research.

We comply with the law.

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. 

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing using an authorization form available on our website or by contacting us to request the form. If you tell us we can release information, you may change your mind at any time. Let us know in writing if you change your mind.
• To get a paper copy of this notice, download the ..pdf file.
• More information about your protected health information is available at the US Dept. of Health & Human Services webpage.