NOTICE OF PRIVACY PRACTICES

Effective Date: [02/08/2026]

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Your privacy is important to us. This Notice explains how we may use and disclose your protected health information (“PHI”) and describes your rights under federal and Georgia law.

OUR LEGAL DUTIES

We are required by federal law (HIPAA), 42 CFR Part 2 (where applicable) and Georgia 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 the Notice currently in effect
  • Notify you in the event of a breach of your unsecured protected health information

We reserve the right to change our privacy practices and the terms of this Notice at any time, as permitted by law. Any changes will apply to all health information we maintain. The current version of this Notice will be available in our office and on our website.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use and disclose your protected health information for the following purposes:

  1. Treatment: We may use and disclose your health information to provide, coordinate, or manage your dental care and related services. This may include sharing information with specialists, laboratories, pharmacies, or other healthcare providers involved in your treatment.
  1. Payment: We may use and disclose your health information to obtain payment for services provided to you. This may include disclosures to dental insurance companies, health plans, or other entities responsible for payment.
  1. Healthcare Operations: We may use and disclose your information for practice operations, including:
  • Quality assessment and improvement activities
  • Staff training and education
  • Licensing, credentialing, and accreditation
  • Business management and administrative activities
  1. Appointment Reminders and Communications: We may contact you regarding appointments, treatment, insurance, or billing matters by phone, voicemail, text message, email, patient portal, or mail. Electronic communications may not always be secure. By providing your contact information, you acknowledge and accept the potential privacy risks associated with electronic communications.
  1. Individuals Involved in Your Care: With your permission, or when you do not object, we may disclose relevant information to a family member, friend, or other person involved in your care or payment for your care. In emergency situations or if you are unable to respond, we may use professional judgment to determine whether disclosure is in your best interest.
  1. Required by Law: We may disclose your health information when required to do so by federal, state, or local law.
  1. Public Health and Safety: We may disclose your health information as permitted or required by law, including:
  • Reporting suspected child abuse or neglect
  • Reporting suspected abuse, neglect, or exploitation of elderly or disabled adults
  • Preventing or reducing a serious threat to health or safety
  • Complying with public health reporting requirements
  1. Law Enforcement, Military, and National Security: We may disclose health information to law enforcement officials, military authorities, authorized federal officials for national security purposes, or correctional institutions, as permitted by law.

SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)

Some health information may be subject to additional confidentiality protections under federal law governing substance use disorder (“SUD”) treatment records (42 CFR Part 2). If we receive or maintain records that are subject to Part 2:

  • Such records are protected by both HIPAA and Part 2.
  • We may use and disclose these records for treatment, payment, and healthcare operations in accordance with applicable law.
  • However, Part 2 records (and testimony about those records) may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order issued after notice and an opportunity for you to be heard.

We will comply with all applicable federal and state confidentiality requirements when handling such records.

USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

We will not use or disclose your protected health information without your written authorization for:

  • Marketing purposes
  • The sale of protected health information
  • Most uses and disclosures of psychotherapy notes (if applicable)

You may revoke your authorization in writing at any time, except to the extent we have already relied on it.

SPECIAL CONSIDERATIONS UNDER GEORGIA LAW

Minor Patients: In most cases, parents or legal guardians have the right to access a minor child’s dental records. In limited circumstances permitted by Georgia law, a minor may consent to certain care and access rights may be restricted accordingly.

Sensitive Health Information: Certain types of health information, such as HIV/AIDS-related information, may receive additional protections under Georgia law. We will comply with applicable federal and state requirements before making such disclosures.

YOUR RIGHTS

You have the following rights regarding your protected health information:

  1. Right to Access: You have the right to inspect and obtain a copy of your health information, with limited exceptions. Requests must be made in writing. We may charge a reasonable, cost-based fee as permitted by law.
  2. Right to Request an Amendment; If you believe your health information is incorrect or incomplete, you may request an amendment in writing. We may deny your request in certain circumstances but will provide a written explanation.
  3. Right to an Accounting of Disclosures: You have the right to receive a list of certain disclosures we have made of your health information for purposes other than treatment, payment, or healthcare operations for the previous six (6) years.
  4. Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to all requested restrictions. If you pay for a service in full out-of-pocket, you have the right to request that we not disclose information about that service to your health plan. We must agree to such a request unless disclosure is otherwise required by law.
  5. Right to Request Confidential Communications: You have the right to request that we communicate with you by alternative means or at alternative locations. Requests must be made in writing and must specify how or where you wish to be contacted.
  6. Right to a Paper Copy: You have the right to receive a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

RECORD RETENTION

We maintain patient records in accordance with applicable federal regulations and Georgia law. Records are retained for the time period required by law and are securely maintained and disposed of in accordance with applicable privacy and security standards.

COMPLAINTS

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

To file a complaint or obtain more information, please contact:

Privacy officer: Nicole Reynolds

912-352-2021

7001 Hodgson Memorial Drive, Suite 3
 Savannah, GA 31406

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.