HIPAA Notice of Privacy Practices

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This Notice describes how your medical and dental information may be used and disclosed and how you can access this information. Please review it carefully.

At Country Club Dental, we are committed to protecting your health information. This Notice of Privacy Practices (“Notice”) describes the ways we may use and disclose your Protected Health Information (PHI), and your rights regarding that information under the Health Insurance Portability and Accountability Act (HIPAA).

1. Your Health Information Rights
You have the right to:

• Inspect and receive a copy of your dental and health records
   
• Request an amendment to your records
   
• Receive an accounting of disclosures of your information
   
• Request restrictions on certain uses or disclosures
   
• Request confidential communications
   
• Receive a copy of this Notice
   
• File a complaint if you believe your rights have been violated
   

All requests must be made in writing to the contact information listed below.

2. How We May Use and Disclose Your Health Information

We may use or share your health information for the following reasons:

Treatment:
To provide, coordinate, or manage your dental care and related services. For example, we may consult with another dentist, physician, or lab.

Payment:
To bill and receive payment for services we provide. This may include sending information to your insurance company or a billing service.

Healthcare Operations:
For administrative, quality improvement, training, or audit purposes related to operating our dental practice.

3. Other Uses and Disclosures Without Your Authorization

We may also use or disclose your information without your written permission in the following situations:

• When required by law
   
• For public health activities (e.g., disease prevention, reporting adverse reactions)
   
• For abuse or neglect reporting
   
• For health oversight activities (e.g., audits, inspections)
   
• For legal or administrative proceedings if ordered by a court
   
• To coroners, medical examiners, and funeral directors as necessary
   
• For organ or tissue donation
   
• For workers’ compensation or similar programs
   
• For research (in limited cases, with safeguards)
   
• To prevent a serious threat to health or safety

4. Uses and Disclosures Requiring Your Written Authorization

Any other use or disclosure of your PHI not described in this Notice will be made only with your written authorization. This includes:

• Marketing communications not related to your treatment
   
• Sale of health information
   
• Most uses of psychotherapy notes (if applicable)
   

You may revoke your authorization at any time in writing.

5. Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your Protected Health Information
   
• Provide you with this Notice of our legal duties and privacy practices
   
• Follow the terms of this Notice
   
• Notify you promptly if a breach compromises the privacy or security of your PHI

6. Changes to This Notice

We reserve the right to revise this Notice at any time. Any changes will apply to information we already have and to future information. The revised Notice will be available upon request and posted on our website.

7. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

To file a complaint with our office, contact us at info@countryclub-dental.com