This notice describes how health information about you may be used and disclosed and how you can access this information. Please review it carefully.

Your Rights

When it comes to your health information, you have certain rights. Depending on applicable law, you may have the right to:

• Inspect or obtain an electronic or paper copy of your health record and certain other health information maintained by the practice.

• Ask the practice to correct health information you believe is incorrect or incomplete.

• Request confidential communications and ask the practice to contact you in a specific way or at a specific location.

• Request restrictions on certain uses or disclosures of your health information.

• Request an accounting of certain disclosures of your health information.

• Obtain a paper copy of the practice’s Notice of Privacy Practices.

• Choose someone who is legally authorized to act on your behalf.

• File a complaint if you believe your privacy rights have been violated.

You may revoke certain authorizations to use or disclose your protected health information in writing, subject to applicable legal limitations.

Our Responsibilities

Clayton Dental Center is required to protect the privacy and security of protected health information and comply with applicable federal and state privacy laws.

• Maintain the privacy and security of protected health information.

• Notify affected individuals following certain breaches when required by law.

• Follow the duties and privacy practices described in its current Notice of Privacy Practices.

• Provide patients with a copy of the notice upon request.

• Use or disclose health information only as permitted or required by law or as authorized by the patient.

How Health Information May Be Used

Clayton Dental Center may use or disclose health information for purposes that include treatment, payment, healthcare operations, and other uses permitted or required by law.

Treatment

Health information may be used and shared with dentists, physicians, specialists, and other healthcare professionals involved in your treatment or coordination of care.

Payment

Health information may be used or shared to bill for services and obtain payment from insurance plans or other responsible parties.

Healthcare Operations

Health information may be used to operate the practice, coordinate care, improve services, and conduct other healthcare operations permitted by law.

Other Uses Permitted or Required by Law

Health information may also be used or disclosed when permitted or required by law for purposes that may include public health and safety activities, reporting certain adverse events, reporting suspected abuse or neglect, health oversight activities, workers’ compensation, certain law enforcement purposes, organ and tissue donation, medical examiners and funeral directors, certain government functions, lawsuits and legal proceedings, research when legally permitted, and preventing or reducing a serious threat to health or safety.

Your Choices

In certain situations, you may tell us your preferences regarding the sharing of your health information.

This may include sharing information with family members, close friends, or others involved in your care and sharing information during a disaster relief situation.

Certain uses of health information may require your written authorization, including specific marketing activities, the sale of protected health information, and most uses or disclosures of psychotherapy notes when applicable.

Filing a Privacy Complaint

If you believe your privacy rights have been violated, you may file a complaint with Clayton Dental Center’s designated Privacy Officer.

Clayton Dental Center, 660 Veterans Parkway, Clayton, NC 27520. Phone: 919-553-5652. Email: claytondentalcenter@outlook.com.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

Clayton Dental Center will not retaliate against you for filing a complaint.

Changes to This Notice

Clayton Dental Center reserves the right to change its Notice of Privacy Practices as permitted by law. Changes may apply to health information already maintained by the practice as well as information received in the future.

The current Notice of Privacy Practices will be available through the practice and on its website.