NOTICE OF PRIVACY PRACTICES
Office Contact: Tisha Johnston Practice Administrator
tjohnston@hannibaldentalgroup.com
Effective Date: 1/1/26

This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Legal Duty
We are required by law to maintain the privacy and security of your protected health information (PHI). 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.

How We May Use and Disclose Your Health Information
Treatment
We may use or disclose your PHI to provide, coordinate, or manage your dental care. This includes sharing information with dentists, hygienists, specialists, laboratories, or other healthcare providers involved in your treatment.
Payment
We may use or disclose your PHI to bill and collect payment for services. This may include disclosures to insurance companies, benefit plans, financing companies, or collection services.
Healthcare Operations
We may use or disclose your PHI for practice operations such as quality assessment, training, licensing, audits, business planning, and administrative activities.
Business Associates
We may share your PHI with business associates who perform services on our behalf (e.g., billing services, IT support). These entities are required by law to safeguard your information.
Appointment Reminders and Treatment Alternatives
We may contact you to remind you of appointments, recall visits, or provide information about treatment alternatives or health-related benefits.
As Required by Law
We will disclose PHI when required to do so by federal, state, or local law.
Public Health and Safety
We may disclose PHI for public health activities, to report abuse or neglect, to prevent or lessen a serious threat to health or safety, or for health oversight activities.
Individuals Involved in Your Care
We may share information with family members or others involved in your care or payment unless you object.

Substance Use Disorder Records – Federal Confidentiality Protections

Records relating to substance use disorder diagnosis, treatment, or referral for treatment are protected under federal law (42 CFR Part 2).

• Such records may not be disclosed without your written consent unless otherwise permitted by law.
• If you provide written consent for disclosure, you have the right to revoke that consent in writing at any time, except to the extent that action has already been taken based on the consent.
• Federal law prohibits recipients of substance use disorder records from making further disclosures unless expressly permitted by your consent or by law.
• Any unauthorized disclosure of such records may be reported to the U.S. Department of Health and Human Services, Office for Civil Rights.

Uses and Disclosures Requiring Your Written Authorization

We will not use or disclose your PHI for the following purposes without your written authorization:

• Marketing purposes (including promotional communications where we receive payment)
• Sale of PHI
• Most uses of psychotherapy notes (not typically applicable in dental settings)

You may revoke your authorization in writing at any time.

 

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You may request access to your dental records, in paper or electronic form. We may charge a reasonable, cost-based fee.

Right to Request an Amendment

You may request corrections to your PHI if you believe it is incorrect or incomplete.

Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your PHI.

Right to Request Restrictions

You may request restrictions on how we use or disclose your PHI. We are not required to agree, except:

• If you pay out-of-pocket in full for a service, you may request that information about that service not be shared with your health plan.

Right to Request Confidential Communications

You may request to receive communications in a specific way or at a specific location (e.g., work phone instead of home phone).

Right to a Paper Copy

You may request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

Right to Be Notified of a Breach

You will be notified following a breach of unsecured PHI.

Right to Complain

You may file a complaint if you believe your privacy rights have been violated. Filing a complaint will not affect your care.

You may also file a complaint with: Secretary of the U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 1-877-696-6775

 

Changes to This Notice

We reserve the right to change this Notice. Changes will apply to all PHI we maintain. The revised Notice will be available upon request and posted in our office.