HIPAA Privacy Notice

Your Rights and Our Responsibilities Regarding Your Health Information.

Introduction

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. We are committed to protecting your health information and complying with the Health Insurance Portability and Accountability Act (HIPAA).

 

Our Legal Duty

We are required by law to maintain the privacy of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and abide by the terms of this notice while it is in effect.This notice takes effect on February 4, 2026 and will remain in effect unless we replace it. A copy of the current notice in effect will be available in our office and on our website. You may request a copy of the current notice at any time. We collect and maintain oral, written, and electronic information to administer our business and to provide products, services, and information of importance to our patients. We maintain physical, electronic, and procedural safeguards in the handling and maintenance of our patients' medical information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction and misuse.

 

How We May Use and Disclose Your Health Information

• Treatment: We may use and disclose your PHI to provide, coordinate, or manage your dental care and related services with other healthcare providers or your insurance plan subject to federal privacy laws, as long as the provider or insurance plan has a relationship with you.
• Payment: We may use and disclose your PHI to obtain payment for dental services provided to you, including billing and collection activities.
• Healthcare Operations: We may use and disclose your PHI for office management, quality assessment, training, licensing, and accreditation purposes.
• Appointment Reminders: We may use or disclose your PHI to send you reminders about your dental care, such as appointment reminders via email, telephone, and text. By providing your email address to us, you agree that you may receive reminders and data breach notifications via email as an alternative to US mail. It is the policy of our office to leave a message on any voicemail or answering machine that is attached to a number that you provide (home, cell, or work). If you prefer that we not leave a message, please let us know.
• Required by Law: We may disclose your PHI when required by federal, state, or local law.
  
• Public Health and Safety: We may disclose your PHI to prevent or control disease, injury, or disability; report child abuse or neglect; or notify authorities if we believe you are a victim of abuse, neglect, or domestic violence.
• Business Associates: We may disclose your medical information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
• Special protections for SUD records: Substance Use Disorder (SUD) treatment records have enhanced protections. They cannot be used in legal proceedings without your consent or a court order. If a use or disclosure of health information above in this notice is prohibited or materially limited by other laws that apply to us, we intend to meet the requirements of the more stringent law.
• Additional Restrictions on use and disclosure: Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. "Highly Confidential Information" may include confidential information under Federal laws governing reproductive rights, alcohol and drug abuse information and genetic information as well as state laws that protect the following types of information: HIV/AIDS, mental health, genetic tests (in accordance with GINA 2009), alcohol and drug abuse, sexually transmitted diseases and reproductive health information, and child or adult abuse or neglect, including sexual assault.
• Your Authorization: You (or your legal personal representative) may give us written authorization to use your PHI or to disclose it to anyone, including family and friends, for any purpose. Once you give us authorization to release your PHI, we cannot guarantee that the person to whom the information is provided will not disclose that information. You may revoke your written authorization at any time, except if we have already acted based on your authorization.

 

Your Rights Regarding Your Health Information

• Right to Request Amendment: You may request that we amend your PHI if you believe it is incorrect or incomplete by submitting the request in writing to our privacy officer. Your request does not guarantee the amendment, but does guarantee that it will be reviewed and considered.
• Right to an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your PHI.
• Right to Request Restrictions: You may request restrictions on how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to all requested restrictions.
• Right to Confidential Communications: You may request that we communicate with you in a specific way or at a specific location.
• Right to a Paper Copy of This Notice: You are entitled to receive a paper copy of this notice upon request.
• Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI.

 

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 law. The new notice will be effective for all PHI that we maintain. We will post a copy of our current notice in our office and make it available upon request.

 

Questions or Complaints

If you have questions about this notice or if you believe your privacy rights have been violated, please contact our Privacy Officer at the dental office. You may also file a written complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, Washington DC, 20201. You may contact the Office for Civil Rights' hotline at 1-800-368-1019. You will not be penalized for filing a complaint.

 

Contact Information

Dental Office Name: Lonnie Harrison, D.M.D
Privacy Officer: Karen Darus
Address: 80 Alton Hall Rd Cairo, GA 39828
Phone: 229-377-1350
Email: [email protected]