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HIPAA Policy

NOTICE OF PRIVACY PRACTICES

Smiths Grove Family Dentistry
Effective Date: February 16, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

OUR LEGAL DUTY

We are required by law to protect the privacy of your protected health information (“medical information”). We are also required to provide you with this notice about our privacy practices, our legal duties, and your rights concerning your medical information.

We must follow the privacy practices described in this notice while it is in effect. This notice takes effect on the date listed above and will remain in effect unless replaced.

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. Any changes may apply to all medical information we maintain, including information created or received before the change.

A current copy of this notice will always be available in our office and on our website. You may request a copy at any time.

We collect and maintain oral, written, and electronic information to provide services and administer our business. We maintain physical, electronic, and procedural safeguards to protect your information in accordance with state and federal standards.

USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION

Treatment

We may disclose your medical information to another healthcare provider for the purpose of evaluating, diagnosing, or treating you. For example, information may be shared with an oral surgeon to determine whether surgical intervention is necessary.

Payment

Your medical information may be used to obtain payment from your insurance company, a collection agency, or directly from you. Insurance providers may request information regarding services received in order to process claims.

Health Care Operations

We may use or disclose your medical information for health care operations, including:

  • Quality assessment and improvement activities
  • Provider performance reviews and credentialing
  • Audits, legal services, and fraud prevention
  • Business planning, management, customer service, and billing
  • De-identifying information and creating limited data sets

We may also share information with other providers or health plans involved in your care for quality assessment or fraud prevention activities.

Your Authorization

You may give written authorization for us to use or disclose your medical information for purposes not described in this notice. You may revoke authorization at any time in writing. Revocation will not affect actions already taken.

We will obtain authorization before using your information for marketing, fundraising, or commercial purposes. You may opt out of such communications at any time.

Family and Others Involved in Your Care

We may disclose relevant information to family members or others involved in your care or payment for care. You will have an opportunity to object unless emergency circumstances prevent it.

Health-Related Products and Services

We may contact you about treatment options, benefits, or health-related services.

Appointment Reminders

We may send appointment reminders by mail, email, telephone, or text message. By providing your email address, you agree to receive communications electronically. We may leave voicemail messages unless you instruct us otherwise.

Public Health and Legal Requirements

We may disclose medical information when required or permitted by law, including for:

  • Public health reporting
  • Preventing serious threats to health or safety
  • Health care oversight activities
  • Research
  • Court or legal proceedings
  • Law enforcement
  • Military or national security purposes
  • Workers compensation claims

Special Protections

Certain records such as Substance Use Disorder treatment records and other highly confidential information may receive additional legal protections.

Business Associates

We may disclose information to business associates who perform services on our behalf. They are required by contract to protect your information.

Data Breach Notification

We may use your contact information to notify you if your health information is involved in a breach.

YOUR RIGHTS

  1. You have the right to inspect and obtain a copy of your health records.
  2. You have the right to request an amendment to your health information.
  3. You have the right to request an accounting of certain disclosures.
  4. You have the right to receive a copy of this Notice of Privacy Practices.
  5. You may decline authorization for certain uses such as marketing.
  6. You have the right to request confidential communications.
  7. You have the right to request restrictions on disclosures.
  8. You may request amendments in writing to our Privacy Officer. Requests will be reviewed and responded to within 30 days.
  9. You may file a complaint if you believe your rights have been violated.

COMPLAINTS

If you believe your privacy rights have been violated, you may contact our Privacy Officer or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW, Room 509F
Washington, DC 20201
Phone: 1-800-368-1019

We will not retaliate against you for filing a complaint.

CONTACT INFORMATION

Privacy Officer: Amanda Walden
Phone: 270-563-4819
148 Vincent Street
Smiths Grove, Kentucky 42171