NOTICE OF PRIVACY PRACTICES

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 respect our legal obligation to keep health information that identifies you private. We are obligated by law to give you notice of our privacy practices. This Notice describes how Castle Hills Pediatric Dentistry protects your health information and what rights you have regarding it.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

The most common reason why we use or disclose your health information is for treatment, payment, or health care operations.

Examples of how we use or disclose information for treatment purposes are: setting up an appointment for your child; examining your child’s teeth; providing preventive and restorative dental care; recommending treatment options; prescribing medications when necessary; referring you to another healthcare provider or specialist for additional care; or obtaining copies of your health information from another healthcare professional that you may have seen before us.

Examples of how we use or disclose your health information for payment purposes are: asking about your dental insurance coverage or other sources of payment; verifying benefits; preparing and submitting insurance claims; sending bills; and collecting unpaid amounts.

“Health care operations” mean those administrative and managerial functions required to operate our dental office. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; staff training; business planning; compliance reviews; participation in managed care plans; defense of legal matters; and secure storage of patient records.

We routinely use your health information inside our office for these purposes without any special permission. If we need to disclose your health information outside of our office for these reasons, we usually will not ask you for special written permission.

Special Protections for Substance Use Disorder (SUD) Records

For patients receiving treatment for substance use disorders, federal law (42 CFR Part 2) provides additional privacy protections beyond standard health information.

Heightened Confidentiality: We will not disclose records identifying you as having a substance use disorder in civil, criminal, administrative, or legislative proceedings without your specific written consent or a specialized court order.

Single Consent for TPO: You may choose to provide a single, written “Global Consent” that allows us to use and disclose your SUD records for future treatment, payment, and health care operations.

Right to Revoke: You have the right to revoke this consent at any time in writing, except to the extent that we have already taken action based on your prior permission.

Accounting of Disclosures: You have the right to request a list of certain disclosures of your SUD records made for treatment, payment, and health care operations for the three years prior to your request.

Prohibition on Redisclosure: Anyone receiving your SUD records is generally prohibited from sharing that information further unless you provide express written consent or the law specifically permits it.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION

In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to our office; some may never come up.

Such uses or disclosures are:

• When a state or federal law requires certain health information to be reported for a specific purpose.
• For public health purposes, such as contagious disease reporting, investigation, or surveillance.
• Disclosures to governmental authorities about victims of suspected abuse, neglect, or domestic violence.
• Uses and disclosures for health oversight activities, such as professional licensing, audits, or investigations of possible healthcare law violations.
• Disclosures for judicial and administrative proceedings, such as in response to subpoenas or court orders.
• Disclosures for law enforcement purposes.
• Disclosure to a medical examiner to identify a deceased person or determine the cause of death.
• Uses or disclosures for approved health-related research.
• Uses and disclosures to prevent a serious threat to health or safety.
• Uses and disclosures for specialized government functions.
• Disclosures of de-identified information.
• Disclosures related to workers’ compensation programs.
• Disclosures of limited data sets for research, public health, or healthcare operations.
• Incidental disclosures that are an unavoidable result of permitted uses or disclosures.
• Disclosures to business associates who perform services for our office and agree to protect your health information.

Unless you object, we may also share relevant information about your child’s care with family members or friends who are involved in helping with your child’s dental care.

NOTIFICATION OF DATA BREACHES

We are required by law to maintain the privacy and security of your protected health information. In the event of a breach, which is the unauthorized acquisition, access, use, or disclosure of your unsecured health information, we will notify you promptly.

This notification will be provided in writing and will include a description of what happened, the types of information involved, and the steps we are taking to investigate the breach, reduce potential harm, and protect against future occurrences.

APPOINTMENT REMINDERS

We may call, text, email, or write to remind you of scheduled appointments or that it is time to schedule a routine dental visit. We may also contact you regarding treatments, services, or other information available at Castle Hills Pediatric Dentistry that may benefit your child.

Unless you tell us otherwise, we may leave reminder messages using the contact information you provide.

TELEHEALTH / VIRTUAL VISITS AND ELECTRONIC COMMUNICATIONS

From time to time, we may communicate with you electronically through methods such as patient portals, email, text messages, or other digital communication tools to provide care information, answer questions, coordinate treatment, send reminders, or discuss billing matters.

When we use technology vendors to support these services, they may receive limited protected health information as needed to provide the service. These vendors are required to protect your information and may be required to sign a business associate agreement with us.

You may request that we communicate with you through a specific phone number, email address, mailing address, or another preferred method. Please inform our office if you would like to change your communication preferences.

Electronic communications may carry some risks, including possible interception or misdelivery. We use reasonable safeguards to protect your information. If you choose to communicate with us through unencrypted email or text messages, you acknowledge and accept those risks.

OTHER USES AND DISCLOSURES

We will not make any other uses or disclosures of your health information unless you sign a written authorization form.

If we ask you to sign an authorization form, you do not have to sign it. If you do sign one, you may revoke it at any time in writing unless we have already acted based on your authorization.

Uses and Disclosures Requiring Your Authorization

Most uses and disclosures of your health information for marketing purposes, as well as disclosures that constitute the sale of your health information, require your written authorization.

Other uses and disclosures not described in this Notice will only be made with your written authorization.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

The law provides you with several rights regarding your health information. You may:

• Ask us to restrict certain uses and disclosures of your health information for treatment, payment, or healthcare operations.
• Request confidential communications, such as contacting you at a different phone number, address, or email.
• Ask to see or receive copies of your health information.
• Request amendments to your health information if you believe it is incorrect or incomplete.
• Request a list of certain disclosures made within the previous six years.
• Request additional paper copies of this Notice of Privacy Practices.
• Request restrictions on disclosures related to services paid fully out-of-pocket.

To make any of these requests, please submit a written request to Castle Hills Pediatric Dentistry.

OUR NOTICE OF PRIVACY PRACTICES

By law, Castle Hills Pediatric Dentistry must follow the terms of this Notice of Privacy Practices until we choose to change it.

We reserve the right to update this notice at any time as permitted by law. If we change this Notice, the updated privacy practices will apply to health information we already maintain as well as information created in the future.

Updated notices will be available in our office and posted on our website.

COMPLAINTS

If you believe that we have not properly respected the privacy of your health information, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights.

We will not retaliate against you for filing a complaint.

If you would like to submit a complaint to our office, please contact Castle Hills Pediatric Dentistry.

FOR MORE INFORMATION

If you would like more information about our privacy practices, please contact Castle Hills Pediatric Dentistry.

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