Notice of Privacy Practices

Our commitment to your privacy

Glynn Family Dentistry is required by law to protect the privacy of your health information, to give you this notice describing our privacy practices and your legal rights, and to follow the terms of the notice currently in effect.

"Protected health information," or PHI, means information that identifies you and relates to your dental or medical care, or to payment for that care. This includes your records, X-rays and images, treatment plans, and billing information.

How we may use and disclose your health information

Treatment

We use your health information to provide, coordinate, and manage your dental care. For example, we may share your records or X-rays with a specialist we refer you to, consult with your physician about a medical condition that affects your treatment, or send a prescription to your pharmacy. We may also share information with a dental laboratory fabricating a crown or appliance for you.

Payment

We use and disclose your health information to bill and collect payment for the care we provide. For example, we may send a claim to your dental plan that includes your diagnosis, the procedures performed, and the teeth or surfaces involved, and we may respond to a plan's request for records to support that claim.

Health care operations

We use your health information to run the practice and maintain quality of care. For example, we may review records to evaluate treatment outcomes, train staff, conduct compliance audits, or work with our attorneys, accountants, and consultants.

Appointment reminders and treatment information

We may contact you by phone, text message, email, or mail to remind you of an appointment, to let you know a recall or hygiene visit is due, or to tell you about treatment alternatives or other services that may benefit you. If you would like these communications sent a particular way, or not at all, tell us and we will accommodate reasonable requests.

Individuals involved in your care

Unless you object, we may share information relevant to your care with a family member, friend, or other person you identify as involved in your treatment or payment. For a minor patient, we generally communicate with the parent or legal guardian.

Uses and disclosures permitted or required without your authorization

The law permits or requires us to use or disclose your health information without your authorization in certain circumstances, including:

• As required by law — when a federal, state, or local law requires the disclosure.
• Public health activities — including reporting disease, injury, vital events, or adverse events involving products regulated by the FDA.
• Victims of abuse, neglect, or domestic violence — reports to authorities authorized to receive them.
• Health oversight — audits, investigations, licensure actions, and inspections by agencies such as the Iowa Dental Board.
• Judicial and administrative proceedings — in response to a court order, subpoena, or discovery request that meets legal requirements.
• Law enforcement — in limited circumstances defined by law, such as identifying a suspect or reporting a crime on our premises.
• Coroners, medical examiners, and funeral directors — to permit them to carry out their duties, including dental identification.
• Organ and tissue donation — to organizations that handle procurement or transplantation.
• Research — where an institutional review board has approved the use and privacy protections are in place.
• To avert a serious threat to your health or safety or that of another person.
• Specialized government functions — including military and veterans activities, national security, and protective services.
• Workers' compensation — as authorized by workers' compensation laws.
• Business associates — vendors who perform services for us, such as billing, software, or IT support. Each is required by written contract to safeguard your information.

Uses and disclosures that require your written authorization

Other uses and disclosures of your health information will be made only with your written authorization. This includes, in every case:

• Marketing — most uses and disclosures of your information for marketing purposes.
• Sale of your information — we do not and will not sell your health information.
• Psychotherapy notes — most uses and disclosures of these notes, in the rare case any exist.
• Photographs and images — any use of identifiable clinical photographs for advertising, our website, or social media.

You may revoke an authorization in writing at any time. A revocation stops future uses and disclosures but does not undo anything we already did in reliance on it.

Your rights

Right to inspect and copy

You may inspect and obtain a copy of your dental records and billing records. If you ask for an electronic copy of information we maintain electronically, we will provide it in the form and format you request if we can readily produce it. We may charge a reasonable, cost-based fee. We will respond within 30 days.

Right to request an amendment

If you believe information in your record is incorrect or incomplete, you may ask us in writing to amend it and explain why. We may deny the request in certain circumstances, and if we do, you may submit a statement of disagreement to be included in your record.

Right to request restrictions

You may ask us to limit how we use or disclose your information for treatment, payment, or health care operations, or to a person involved in your care. We are not generally required to agree, but if we do, we will honor the restriction except in an emergency.

One restriction we must honor: if you pay for a service in full, out of pocket, and ask us not to send information about that service to your health plan, we are required to agree — unless the law requires us to disclose it.

Right to confidential communications

You may ask us to contact you at a specific address or phone number, or by a specific method. We will accommodate reasonable requests and will not ask you why.

Right to an accounting of disclosures

You may request a list of certain disclosures we made of your health information. The list does not include disclosures for treatment, payment, or health care operations, disclosures you authorized, or several other categories defined by law. The first request in a 12-month period is free.

Right to a paper copy of this notice

You may request a paper copy of this notice at any time, even if you agreed to receive it electronically. Ask at the front desk and we will give you one.

Right to notification of a breach

We will notify you if a breach occurs that may have compromised the privacy or security of your health information.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We are required to abide by the terms of the notice currently in effect.
• We will not use or share your information other than as described here unless you tell us we may, in writing.

We reserve the right to change this notice, and to make the revised notice effective for information we already have as well as information we receive in the future. If we make a material change, we will post the current notice in the office and on this website, and we will provide a copy on request.

Questions and complaints

If you have a question about this notice, or if you believe your privacy rights have been violated, please contact our Privacy Officer. We would genuinely rather hear about a problem directly and fix it.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by mail at 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint.