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HIPAA Notice of Privacy Practices

This Notice of Privacy Practices describes how Dentistry at Bridlewood (“we,” “our,” “us”) may use and disclose your protected health information (PHI) to carry out treatment, payment, or healthcare operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights regarding your PHI and how you can exercise those rights.

Understanding Your Health Information

What is Protected Health Information (PHI)?

PHI includes any information about your health status, provision of healthcare, or payment for healthcare that can be linked to you. This includes medical records, treatment plans, and billing information.

Our Responsibilities
  • Confidentiality: We are required by law to maintain the privacy and security of your PHI.
  • Notice: We must provide you with this notice of our legal duties and privacy practices concerning your PHI.
  • Compliance: We will abide by the terms of this notice.
Uses and Disclosures of PHI For Treatment
We may use and share your PHI to provide, coordinate, or manage your dental care and related services. This may include communicating with other healthcare providers regarding your treatment.

For Payment
We may use and disclose your PHI to bill and collect payment for the services and treatments you receive from us. This may include disclosures to your health insurance plan to obtain prior authorization for services.
For Healthcare Operations
We may use and disclose your PHI for healthcare operations to improve our services, conduct quality assessments, and for other administrative purposes.
Other Permitted and Required Uses and Disclosures
We may use or disclose your PHI in the following situations without your authorization:
  • As required by law
  • For public health activities
  • For health oversight activities
  • For legal proceedings
  • To law enforcement
  • To avert a serious threat to health or safety
  • For workers’ compensation
Your Rights
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI. This may include medical and billing records but does not include psychotherapy notes.
Right to Amend
If you believe your PHI is incorrect or incomplete, you may request an amendment. We may deny your request if we believe the information is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures of your PHI we have made outside of treatment, payment, and healthcare operations.
Right to Request Restrictions
You have the right to request a restriction or limitation on the use or disclosure of your PHI. We are not required to agree to your request, but we will try to accommodate reasonable requests.
Right to Request Confidential Communications
You have the right to request that we communicate with you in a specific way or at a specific location. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice
You have the right to obtain a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
Changes to This Notice
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI we maintain. The current notice will be posted on our website and available at our office.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact:
You will not be penalized for filing a complaint.
Contact Us
If you have any questions about this notice or need further information, please contact:
Thank you for trusting Dentistry at Bridlewood with your dental care. Your privacy is a priority to us.