Notice of Privacy Practices (HIPAA) - Crossroads Family Dentistry

At Crossroads Family Dentistry, protecting your personal health information is an important part of the care we provide. This Notice of Privacy Practices explains how your medical and dental information may be used and disclosed, how you can access your information, and your rights regarding your protected health information (PHI).
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Please review this notice carefully.
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Crossroads Family Dentistry is committed to maintaining the privacy and security of your protected health information. We are required by law to:

• Maintain the privacy of your health information
• Provide you with this Notice of Privacy Practices
• Follow the terms currently in effect
• Notify you if a breach occurs that may compromise the privacy or security of your information

Your information may include details related to your dental treatment, medical history, insurance information, payment records, x-rays, photographs, and other records created or received while providing your care.

We may use and disclose your protected health information for purposes related to treatment, payment, healthcare operations, and other situations permitted or required by law.

We may use and share your health information to provide, coordinate, or manage your dental care and treatment.
Examples include:

• Reviewing your dental and medical history
• Discussing treatment plans with specialists or referring providers
• Sending prescriptions to pharmacies
• Sharing information with laboratories or imaging providers
• Coordinating care with other healthcare professionals involved in your treatment

We may use and disclose your information to obtain payment for services we provide.
Examples include:

• Submitting claims to your dental insurance provider
• Verifying insurance eligibility and benefits
• Collecting unpaid balances
• Providing information required for claim approvals or reimbursements

We may use your information to support the day-to-day operations of our dental practice.
Examples include:

• Quality assessment and improvement activities
• Staff training and performance reviews
• Scheduling appointments and appointment reminders
• Business management and administrative activities
• Compliance and legal reviews

In certain situations, we may use or disclose your information without your written authorization when permitted or required by law.
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We may disclose information for public health purposes, including:

• Preventing or controlling disease
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Complying with health oversight agencies

We may disclose your information:

• In response to a court order or subpoena
• For law enforcement purposes when required by law
• To comply with government investigations or audits

We may disclose information related to workers’ compensation claims or similar programs.
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If necessary, we may share information to help prevent a serious threat to health or safety.
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Unless you object, we may share relevant information with family members, caregivers, or others involved in your care or payment for care.
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We may contact you regarding:

• Upcoming appointments
• Treatment recommendations
• Follow-up care
• Practice announcements or office updates

Communication may occur by phone call, voicemail, text message, email, or mail unless you request otherwise.
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Certain uses and disclosures of your protected health information require your written authorization.
We will obtain your written permission before:

• Using your information for marketing purposes where authorization is required
• Selling your protected health information
• Sharing psychotherapy notes, if applicable
• Using information for purposes not described in this notice

You may revoke your authorization at any time in writing, except to the extent action has already been taken based on your authorization.
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You have important rights concerning your protected health information.
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You have the right to inspect and request a copy of your health records, including electronic copies when available.
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Requests must be made in writing. We may charge a reasonable fee for copies as permitted by law.

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If you believe information in your records is incorrect or incomplete, you may request an amendment.
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Requests must be submitted in writing and include the reason for the requested correction.

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You may request limits on how we use or disclose your information for treatment, payment, or healthcare operations.
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While we are not required to agree to all requests, we will comply when legally required.

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If you pay in full out-of-pocket for a service, you may request that we not disclose information about that service to your health insurer.

You may request that we communicate with you in a specific way or at a specific location.
For example, you may request:

• Calls only to a mobile number
• Communication through email only
• Mail sent to a different address

We will accommodate reasonable requests.
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You may request a list of certain disclosures we have made of your protected health information.
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This list will not include disclosures made for treatment, payment, healthcare operations, or certain other permitted disclosures.
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You have the right to receive a paper copy of this notice at any time, even if you agreed to receive it electronically.
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Crossroads Family Dentistry reserves the right to change this Notice of Privacy Practices at any time. Updated notices will apply to all protected health information we maintain.
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The current version will always be available in our office and may also be posted on our website.
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If you believe your privacy rights have been violated, you may file a complaint with:

• Crossroads Family Dentistry
• The U.S. Department of Health and Human Services Office for Civil Rights

You will not be penalized or retaliated against for filing a complaint.
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If you have questions about this Notice of Privacy Practices or wish to exercise your rights, please contact:
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