Notice of Privacy Practices

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. It applies to the protected health information ("PHI") maintained by Northern Smiles Dentistry & Orthodontics.

How we may use and disclose your health information

• Treatment. To provide, coordinate, and manage your dental care, including sharing information with other providers involved in your treatment.
• Payment. To bill and obtain payment from you, an insurance company, or another third party.
• Health care operations. For activities necessary to run our practice, such as quality assessment, staff training, and scheduling.
• As required by law. When federal, state, or local law requires it, including certain public-health and law-enforcement situations.

Other uses and disclosures — for example, most marketing or any sale of PHI — will be made only with your written authorization, which you may revoke at any time.

Your rights regarding your health information

• Access. Inspect and obtain a copy of your dental and billing records.
• Amendment. Request a correction to information you believe is incomplete or inaccurate.
• Accounting of disclosures. Request a list of certain disclosures we have made.
• Restrictions. Request limits on how we use or disclose your information.
• Confidential communications. Ask us to contact you a certain way or at a certain location.
• Paper copy. Receive a paper copy of this notice on request, even if you agreed to receive it electronically.

Our responsibilities

We are required by law to maintain the privacy of your PHI, to provide you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. We will notify you if a breach occurs that may have compromised the privacy or security of your information.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office using the contact information below, or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact

Privacy Officer, Northern Smiles Dentistry & Orthodontics
7501 N 16th St Suite 100, Phoenix, AZ 85020
Phone: (602) 944-9197
Email: northernsmiles@gmail.com

This page is a summary for your convenience. Our complete Notice of Privacy Practices is available at our office; please ask a team member for a copy.