HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

Ambar Dental is required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and follow the terms of the Notice currently in effect.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this Notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your protected health information without your specific authorization.

For Treatment

We may use and disclose your health information to provide, coordinate, or manage your dental care and any related services. This includes sharing information with other dental or healthcare providers involved in your treatment, such as specialists or laboratories.

For Payment

We may use and disclose your health information to obtain payment for the services we provide. This may include sharing information with your dental insurance carrier to determine eligibility, obtain prior authorization, or submit claims.

For Healthcare Operations

We may use and disclose your health information to support the business activities of our practice, including quality assessment, staff training, licensing, and general administrative activities.

Appointment Reminders

We may contact you by phone, text message, mail, or email to remind you of upcoming appointments or to inform you about treatment alternatives or other health-related benefits and services.

Individuals Involved in Your Care

Unless you object, we may share relevant portions of your health information with a family member, friend, or other person you identify as involved in your care or payment for your care.

As Required by Law

We will disclose your health information when required to do so by federal, state, or local law.

Public Health Activities

We may disclose your health information for public health activities, including preventing or controlling disease, reporting child abuse or neglect, reporting adverse reactions to medications or products, and notifying persons of recalls.

Law Enforcement and Legal Proceedings

We may disclose your health information in response to a court order, subpoena, warrant, summons, or similar legal process, and for law enforcement purposes as permitted or required by law.

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures of your protected health information not described in this Notice will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and any sale of your health information. You may revoke any authorization, in writing, at any time, except to the extent that we have already taken action in reliance on it.

Your Rights

Right to Inspect and Obtain Copies

You have the right to inspect and obtain a copy of the health information we maintain about you, with limited exceptions. We may charge a reasonable, cost-based fee for copies.

Right to Request Corrections

If you believe the health information we have about you is incorrect or incomplete, you may ask us to amend it. Your request must be in writing and provide a reason supporting your request. We may deny your request under certain circumstances.

Right to Receive an Accounting of Disclosures

You have the right to request a list of certain disclosures we have made of your health information for purposes other than treatment, payment, healthcare operations, or disclosures you authorized.

Right to Request Restrictions

You have the right to request a restriction on the health information we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to your request unless the disclosure is to a health plan for payment or operations and the information pertains to a service you paid for out of pocket in full.

Right to Confidential Communications

You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you may ask that we contact you only at home or only by mail. We will accommodate reasonable requests.

Right to Obtain a Paper Copy

You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to receive it electronically.

Electronic Communications and Online Forms

Email, text messages, and web forms are not fully secure methods of communication. Please do not submit detailed medical history, diagnoses, or other sensitive protected health information through our website or email. For urgent dental concerns or to discuss medical details, please call our office directly at (361) 480-0311.

Questions or Complaints

If you have questions about this Notice or believe your privacy rights have been violated, you may contact our Privacy Officer at:

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office and on our website. The Notice will contain the effective date in the lower right-hand corner of the first page.