Because our patients are children, this Notice generally applies to your
child’s health information, and the rights described below are usually
exercised by a parent or legal guardian acting as the child’s personal
representative.

How We May Use and Disclose Health Information

For Treatment

We use your child’s health information to provide dental care, and we may
share it with other health professionals involved in your child’s care—for
example, sending records and X-rays to an orthodontist, oral surgeon, or
your child’s physician.

For Payment

We use and share health information to bill and collect payment—for
example, submitting claims to your dental insurance, confirming coverage
and benefits, or responding to your insurance company’s review of
services.

For Healthcare Operations

We use health information to run our practice, including quality review,
staff training, scheduling, and improving the care we provide.

Appointment Reminders and Communications

We may contact you by phone, text message, email, or mail to confirm
appointments, share forms, follow up after visits, tell you about treatment
options, or notify you of recalls that are due. You may ask us to use a
specific phone number, communication method, or address. See
Your Rights below.

Family and Friends Involved in Care

We may share relevant information with a family member or another person
you identify as involved in your child’s care, unless you tell us
otherwise.

As Required or Permitted by Law

We may use or disclose health information without your authorization for:

• Public-health activities
• Reporting suspected abuse or neglect
• Health-oversight audits and inspections
• Judicial and administrative proceedings
• Law-enforcement purposes
• Medical examiners or funeral directors
• Organ and tissue donation
• Research approved under specific safeguards
• Preventing a serious threat to health or safety
• Specialized government functions, including military and national
  security
• Workers’ compensation

Uses and Disclosures Requiring Your Written Authorization

We will not use or disclose your child’s health information for marketing,
and we will never sell health information, without your written
authorization.

Any use or disclosure not described in this Notice will be made only with
your written authorization. You may revoke an authorization at any time in
writing, except to the extent that we have already relied on it.

Your Rights

• See and get a copy of the record.
  You may inspect and receive a copy of your child’s dental record, on
  paper or electronically, within 30 days of a written request. A
  reasonable, cost-based fee may apply.
• Ask us to correct the record.
  If you believe information is incorrect or incomplete, you may request
  an amendment in writing. We may decline in certain cases, and we will
  tell you why in writing within 60 days.
• Request restrictions.
  You may ask us to limit how we use or share health information. We are
  not required to agree, except that if you pay for a service in full
  out-of-pocket, you may require us not to share information about that
  service with your dental insurance.
• Confidential communications.
  You may ask us to contact you in a specific way or at a specific number
  or address—for example, by text only or through a particular mobile
  number. We will accommodate reasonable requests.
• An accounting of disclosures.
  You may request a list of certain disclosures we have made of your
  child’s health information in the six years before your request. This
  does not include disclosures for treatment, payment, or operations, or
  disclosures you authorized.
• A paper copy of this Notice.
  You may request a paper copy at any time, even if you agreed to receive
  it electronically. It is also posted in our office and on our website.

Our Duties

We are required by law to:

• Keep your child’s health information private
• Give you this Notice of our legal duties and privacy practices
• Follow the Notice currently in effect
• Notify you if a breach occurs that may have compromised
  the privacy or security of your child’s information

We may update this Notice. The current version will always be posted in our
office and on our website, with its effective date displayed at the top.

Questions and Complaints

If you have questions about this Notice or believe your privacy rights have
been violated, contact our Privacy Official:

You may also file a complaint with the

U.S. Department of Health and Human Services, Office for Civil Rights
.

We will never retaliate against you for filing a complaint.