HIPAA Privacy Policy & Notice of Privacy Practices
Effective Date: March 18, 2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect February 16, 2026, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make new Notice provisions effective for all protected health information that we maintain. When we make a significant change in our privacy practices, we will change this Notice and post the new Notice clearly and prominently at our practice location, and we will provide copies of the new Notice upon request.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We may use and disclose your health information for different purposes, including treatment, payment, and health care operations. For each of these categories, we have provided a description and an example. Some information, such as HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.
Treatment
We may use and disclose your health information for your treatment. For example, we may disclose your health information to a specialist providing treatment to you.
Payment
We may use and disclose your health information to obtain reimbursement for the treatment and services you receive from us or another entity involved with your care. Payment activities include billing, collections, claims management, and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may send claims to your dental health plan containing certain health information.
Healthcare Operations
We may use and disclose your health information in connection with our healthcare operations. For example, healthcare operations include quality assessment and improvement activities, conducting training programs, and licensing activities.
Individuals Involved in Your Care or Payment for Your Care
We may disclose your health information to your family or friends or any other individual identified by you when they participate in your care or in the payment for your care. Additionally, we may disclose information about you to a patient representative. If a person has the authority by law to make health care decisions for you, we will treat that patient representative the same way we would treat you with respect to your health information.
Disaster Relief
We may use or disclose your health information to assist in disaster relief efforts.
Required by Law
We may use or disclose your health information when we are required to do so by law.
Public Health Activities
- Prevent or control disease, injury or disability;
- Report child abuse or neglect;
- Report reactions to medications or problems with products or devices;
- Notify a person of a recall, repair, or replacement of products or devices;
- Notify a person who may have been exposed to a disease or condition; or
- Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
National Security
We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement official having lawful custody the protected health information of an inmate or patient.
Secretary of HHS
We will disclose your health information to the Secretary of the U.S. Department of Health and Human Services when required to investigate or determine compliance with HIPAA.
Worker’s Compensation
We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Law Enforcement
We may disclose your PHI for law enforcement purposes as permitted by HIPAA, as required by law, or in response to a subpoena or court order.
Health Oversight Activities
We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings
If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process.
Research
We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board.
Coroners, Medical Examiners, and Funeral Directors
We may release your PHI to a coroner or medical examiner and to funeral directors as necessary.
Fundraising
We may contact you to provide information about our sponsored activities, including fundraising programs. You may opt out of receiving such communications.
UD Treatment Information
If we receive or maintain information from a substance use disorder treatment program covered by 42 CFR Part 2, we may use and disclose it as permitted by your consent and applicable law.
Other Uses and Disclosures of PHI
Your authorization is required, with limited exceptions, for certain disclosures such as psychotherapy notes, marketing, or sale of PHI. You may revoke authorization in writing at any time.
Your Health Information Rights
Access
You have the right to look at or get copies of your health information, with limited exceptions. Requests must be in writing.
Disclosure Accounting
You have the right to receive an accounting of disclosures of your health information.
Right to Request a Restriction
You have the right to request restrictions on the use or disclosure of your PHI.
Alternative Communication
You have the right to request communication by alternative means or locations.
Amendment
You have the right to request amendments to your health information.
Right to Notification of a Breach
You will be notified of breaches of unsecured protected health information as required by law.
Electronic Notice
You may request a paper copy of this Notice even if you agreed to receive it electronically.
Questions and Complaints
If you have questions or concerns, please contact us. You may also file a complaint with the U.S. Department of Health and Human Services.
We support your right to privacy and will not retaliate if you file a complaint.
Contact Information
- Our Privacy Official: Borden Family Dentistry
- Telephone: 574-936-8588
- Fax: (574)-936-8530
- Address: 315 E Jefferson St.
Plymouth, IN 46563 - E-mail: bordenfamilydentistry@hotmail.com