Notice of Privacy Practices

Our duties

AZ Family Dentistry is required by law to maintain the privacy of your protected health information ("PHI"), to give you this notice of our legal duties and privacy practices, and to notify you if a breach of your unsecured PHI occurs. We must follow the terms of the notice currently in effect.

We reserve the right to change this notice and to make the new notice apply to all PHI we keep. The current notice is posted in our office and on this page, and you may ask for a copy at any visit.

How we may use and disclose your health information

Treatment: we may use and share your PHI to provide, coordinate, or manage your dental care — for example, with a specialist we refer you to, a dental laboratory, or your physician.

Payment: we may use and share your PHI to bill and collect payment from you, your insurance plan, or another party responsible for your care — for example, to confirm coverage or submit a claim.

Health care operations: we may use and share your PHI to run our practice, such as quality review, staff training, licensing, audits, and business planning.

Appointment reminders and health-related services: we may contact you by phone, text, email, or mail to remind you of appointments or to tell you about treatment options or services that may interest you.

Business associates: we may share PHI with companies that perform services for us, such as scheduling, patient forms, billing, or IT support. They must agree in writing to protect it.

Family and friends involved in your care: unless you object, we may share relevant PHI with a family member, friend, or other person you identify who is involved in your care or in paying for it.

Other uses and disclosures permitted by law

We may also use or share your PHI without your authorization when the law requires or permits it, including: as required by federal, state, or local law; for public health activities, such as reporting disease or adverse reactions; to report suspected abuse, neglect, or domestic violence; for health oversight activities, such as audits and inspections by the Arizona State Board of Dental Examiners; in response to a court order, subpoena, or other lawful process; to law enforcement in limited circumstances; to coroners, medical examiners, and funeral directors; for organ and tissue donation; to prevent a serious threat to health or safety; for specialized government functions, such as military or national security; and for workers' compensation claims.

Uses that require your written authorization

We will not use or share your PHI for marketing, sell your PHI, or use or share psychotherapy notes without your written authorization. Any other use or disclosure not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Your rights

Right to inspect and copy: you may ask to see or get a paper or electronic copy of your dental records and other PHI we keep. We may charge a reasonable, cost-based fee.

Right to amend: if you believe information in your record is incorrect or incomplete, you may ask us in writing to correct it. We may deny the request, and will tell you why in writing.

Right to an accounting of disclosures: you may ask for a list of the times we shared your PHI in the six years before your request, other than for treatment, payment, operations, and certain other disclosures.

Right to request restrictions: you may ask us to limit how we use or share your PHI for treatment, payment, or operations. We are not required to agree, except that we must agree not to share information with your health plan about a service you paid for in full out of pocket.

Right to confidential communications: you may ask us to contact you in a specific way or at a specific address, such as only by mobile phone. We will accommodate reasonable requests.

Right to a paper copy of this notice: you may ask for a paper copy at any time, even if you agreed to receive it electronically.

Right to choose someone to act for you: if you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights.

Questions and complaints

To exercise any of these rights, or if you have questions about this notice, contact our Privacy Officer using the details below.

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 Office for Civil Rights at hhs.gov/ocr/complaints, by calling 1-877-696-6775, or by writing to 200 Independence Avenue S.W., Washington, D.C. 20201. We will not retaliate against you for filing a complaint.

This website

How we handle information collected through this website is covered separately by our website Privacy Policy.