Notice of Privacy Practices

How We May Use and Disclose Your Health Information

Treatment

We may use and disclose your health information to provide, coordinate, or manage your dental treatment and related services.

Examples include:

• Scheduling appointments
• Examining and diagnosing dental conditions
• Prescribing medications
• Referring you to specialists
• Consulting with other healthcare providers
• Obtaining prior dental records

Payment

We may use and disclose your health information to obtain payment for services we provide.

Examples include:

• Submitting claims to insurance companies
• Verifying insurance benefits
• Billing and collections
• Processing payment arrangements

Healthcare Operations

We may use and disclose your information for practice operations necessary to run our office.

Examples include:

• Quality assessment and improvement activities
• Staff training
• Licensing and credentialing
• Business planning and administration
• Legal and auditing functions
• Record storage and management

Special Protections for Substance Use Disorder (SUD) Records

If applicable, records related to substance use disorder treatment are protected under federal law (42 CFR Part 2).

These protections include:

• Additional confidentiality safeguards
• Specific written consent requirements
• Right to revoke consent
• Accounting of certain disclosures
• Restrictions on redisclosure

Other Uses and Disclosures Permitted or Required by Law

We may disclose health information without your authorization when required or permitted by law, including:

• Public health reporting
• Abuse or neglect reporting
• Health oversight activities
• Judicial and administrative proceedings
• Law enforcement requests
• Coroners and medical examiners
• Approved research activities
• Preventing serious threats to health or safety
• Workers’ compensation claims
• Business associate operations

Appointment Reminders and Communications

We may contact you to:

• Remind you of appointments
• Inform you of treatment alternatives
• Provide follow-up care information
• Notify you of office-related services

We may communicate by phone, voicemail, email, text message, or patient portal.

You may request confidential communication methods at any time.

Telehealth and Electronic Communications

Glint Dental Studio may offer virtual consultations and electronic communications.

Electronic communication may involve secure technology vendors who are contractually required to protect your information.

By choosing unsecured email or text communication, you acknowledge and accept associated privacy risks.

Notification of Breaches

If a breach of your unsecured protected health information occurs, we will notify you as required by law.

The notification will include:

• What happened
• What information was involved
• Steps we are taking
• Recommendations for protecting yourself

Uses Requiring Your Written Authorization

We will obtain your written authorization before:

• Using your information for certain marketing purposes
• Selling your health information
• Any use not otherwise described in this notice

You may revoke your authorization at any time in writing, except where action has already been taken.

Your Rights Regarding Your Health Information

You have the right to:

Request Restrictions

Request limits on how we use or disclose your information.

Confidential Communications

Request contact through specific methods or locations.

Access Your Records

Inspect or request copies of your health information.

Request Amendments

Request corrections to inaccurate or incomplete records.

Receive an Accounting of Disclosures

Request a list of certain disclosures made within the previous six years.

Obtain a Paper Copy of This Notice

Receive a paper copy at any time.

Restrict Disclosure to Health Plans

If you pay out-of-pocket in full, you may request that information related to that service not be disclosed to your insurance provider.

Our Responsibilities

Glint Dental Studio is required to:

• Maintain the privacy of your health information
• Provide this notice
• Follow its terms
• Notify you of breaches
• Update this notice as required by law

We reserve the right to revise this notice. Updated versions will be posted in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Privacy Officer
Glint Dental Studio
1600 S. First St. Suite 160
Austin, TX 78704
Phone: (512) 653-4009
Email: [Privacy Officer Email]
You may also file a complaint with the
U.S. Department of Health and Human Services Office for Civil Rights
We will not retaliate against you for filing a complaint.

Contact Information

If you have questions regarding this Notice of Privacy Practices, please contact:

Privacy Officer
Glint Dental Studio
1600 S. First St. Suite 160
Austin, TX 78704
Phone: (512) 653-4009
Website: glintatx.com