Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES
Effective Date: February 16, 2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
OUR LEGAL DUTY
We are required by federal and Washington State law to maintain the privacy and security of your protected health information (“PHI”). We are required to provide you with this Notice describing our legal duties and privacy practices.
We must follow the privacy practices described in this Notice while it is in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by law. If we make material changes, we will update this Notice and make the revised version available in our office and on our website, if applicable.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Treatment
We may use and disclose your health information to provide, coordinate, or manage your dental care and related services with other healthcare providers.
Payment
We may use and disclose your health information to obtain payment for services provided to you.
Healthcare Operations
We may use and disclose your health information for practice operations, including quality assessment, quality improvement, staff training, licensing, accreditation, credentialing, and business management activities.
Business Associates
We may disclose your health information to third parties who perform services on our behalf. These parties are required by law and contract to safeguard your information.
Individuals Involved in Your Care
We may disclose relevant health information to a family member, friend, or other person involved in your care or payment for care, unless you object.
Appointment Reminders and Communications
We may use your information to contact you regarding appointments, treatment alternatives, or other health-related services.
Required by Law
We may use or disclose your health information when required by federal, Washington State, or local law.
Public Health and Safety
We may disclose your information to public health authorities or appropriate agencies as required by law.
Abuse, Neglect, or Domestic Violence
We may disclose health information to appropriate authorities if we reasonably believe you are a victim of abuse, neglect, or domestic violence.
Law Enforcement and National Security
We may disclose health information for certain law enforcement or national security purposes as permitted by law.
SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER (SUD) RECORDS
Certain records related to substance use disorder diagnosis, treatment, or referral for treatment may be protected under federal law (42 CFR Part 2).
If our practice receives Substance Use Disorder (SUD) records from a federally assisted substance use disorder program, we will maintain and protect those records in accordance with applicable federal and Washington State law.
How We May Use and Disclose SUD Records
We may use and disclose SUD records for purposes of treatment, payment, and healthcare operations as permitted under 42 CFR Part 2 and HIPAA.
Legal Proceeding Restrictions
SUD records may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the patient without the patient’s specific written consent or a court order that complies with 42 CFR Part 2.
Redisclosure Restrictions
Federal law prohibits the redisclosure of substance use disorder information unless expressly permitted by the patient’s written consent or as otherwise allowed by law.
Patient Rights Related to SUD Records
Patients have the right to:
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Request restrictions on certain uses and disclosures
• Request an accounting of disclosures
• Inspect and obtain a copy of their SUD records, subject to applicable limitations
We are required by law to maintain the privacy and security of SUD records.
YOUR RIGHTS
You have the following rights regarding your health information:
Right of Access
You have the right to inspect and obtain a copy of your health information. We may charge a reasonable, cost-based fee as permitted by law. We do not charge retrieval fees.
Right to Request Amendment
You have the right to request that we amend your health information. Requests must be in writing and explain the reason for the amendment.
Right to an Accounting of Disclosures
You have the right to receive an accounting of certain disclosures made during the previous six years.
Right to Request Restrictions
You may request restrictions on certain uses and disclosures. We are not required to agree, except when the request relates to disclosures to a health plan for services paid in full out-of-pocket.
Right to Confidential Communications
You may request that we communicate with you in a certain way or at a certain location.
Right to Breach Notification
You have the right to be notified if your unsecured protected health information is breached.
Right to a Paper Copy
You may request a paper copy of this Notice at any time.
QUESTIONS OR COMPLAINTS
