4470 Green Valley Road, Suite 161
Cibolo, TX 78108
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.
If you have any questions about this Notice, please contact our Privacy Officer or any staff member in our office.
Privacy Officer: Niraj Patel — 210-797-7740
External HIPAA Privacy & Security Resource: David Wornica, CHPSE — 469-342-8300 ext. 628
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, collect payment for your care, and manage clinic operations. It also explains your rights to access and control your PHI.
We are required by Federal law to abide by this Notice. We may change our Notice at any time, and the new Notice will apply to all PHI we maintain. You can get the latest Notice on our website, by calling our office to request a mailed copy, or at your next appointment.
By seeking care in our office, you imply consent for your doctor, our staff, and others involved in your care to use and disclose your PHI for treatment, payment, and health care operations. The examples below are illustrative, not exhaustive.
Treatment
We may use and disclose PHI to provide, coordinate, or manage your care. This can include sharing information with specialists, labs, or other providers at your dentist’s request. Our office may also use HIPAA-compliant artificial intelligence (AI) tools to support care—e.g., to review dental images and other data to assist diagnosis and treatment planning. AI supplements, not replaces, clinical judgment; licensed dentists review and approve all AI-assisted findings before use in your treatment.
Payment
We may use and disclose PHI as needed to obtain payment for services, including eligibility checks, coverage determinations, medical-necessity review, and utilization review. For example, we may share relevant PHI with your plan to get pre-approval for procedures.
Health Care Operations
We may use or disclose PHI for office operations such as quality assessment, employee reviews, and staff training. Examples include: sign-in sheets; calling your name in the reception area; appointment reminders; and recording communications to accurately capture responses. We may share PHI with Business Associates (e.g., billing, transcription) under agreements requiring them to safeguard your PHI. We may also provide information about treatment alternatives or health-related benefits/services (e.g., newsletters). You may opt out of such materials.
Other uses/disclosures not covered by this Notice or applicable law require your written, signed authorization (e.g., certain fundraising communications using your demographics and dates of service). You may revoke an authorization in writing, except to the extent we have already acted in reliance on it.
If you agree—or if you are unavailable and your provider determines it is in your best interest—we may disclose PHI relevant to your care to family members, close friends, or others you identify; assist in notifying those involved in your care of your location/general condition; and share limited PHI with disaster-relief entities to coordinate disclosures.
We may use or disclose PHI without your consent/authorization in the following situations, consistent with law and limited to what is relevant:
• Required by Law — We will comply with legal requirements and provide any required notices.
• Public Health — To public health authorities for disease/injury/disability control, including disclosures to collaborating foreign agencies.
• Communicable Diseases — To persons at risk or potentially exposed, as authorized by law.
• Health Oversight — To oversight agencies for audits, investigations, inspections, and similar activities.
• Abuse or Neglect — To appropriate authorities regarding suspected child abuse/neglect or if you may be a victim of abuse, neglect, or domestic violence, per applicable laws.
• Legal Proceedings — In response to court/administrative orders and, in certain conditions, subpoenas or lawful processes.
• Law Enforcement — For specific law-enforcement purposes (e.g., legal process; limited identification/location requests; crimes; suspected criminal death; crimes on our premises; medical emergencies off-premises where a crime likely occurred).
• Workers’ Compensation — As authorized for workers’ compensation or similar programs.
• Required Uses and Disclosures — To you, and to the U.S. Department of Health and Human Services when required to investigate or determine our HIPAA compliance.
Inspect and Copy
You may inspect and obtain copies of PHI in your designated record set (e.g., medical and billing records) for as long as we maintain it. Exceptions: psychotherapy notes; information compiled for or used in legal actions; PHI otherwise restricted by law. Some denials may be reviewable.
Request Restrictions
You may request restrictions on PHI uses/disclosures for treatment, payment, or operations, and on disclosures to family/friends involved in your care. Requests must be in writing and specify the restriction and to whom it applies. We are not required to agree; if we do, we will honor it except as needed for emergency treatment. Ask a staff member for the “Restriction of Consent” form and a copy for your records.
Confidential Communications
You may request to receive communications by alternative means or locations (e.g., different address). We will accommodate reasonable requests and may ask about payment handling or a specific contact method. No explanation for the request is required. Please submit in writing.
Amendments
You may request that we amend PHI in your designated record set. We may deny some requests; if denied, you may submit a statement of disagreement, and we may provide a rebuttal with a copy to you.
Accounting of Disclosures
You may request an accounting of certain disclosures of your PHI (excluding those for treatment, payment, operations; to you; to family/friends involved in care; under authorization; or for notification purposes), subject to exceptions, restrictions, and limits.
Paper Copy of This Notice
You may obtain a paper copy upon request, even if you agreed to receive it electronically.
If you believe your privacy rights have been violated, you may file a complaint with us, the Texas Attorney General’s Office, or the U.S. Secretary of Health and Human Services. To file with us, contact our Privacy Officer in writing at our office address. We will not retaliate for filing a complaint. Our website may provide additional details on the complaint process.
This Notice was published and becomes effective on December 10, 2024.