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.

Dental Practice Covered by this Notice

This Notice describes the privacy practices of Palm Tree Orthodontics (“Dental Practice”). “We” and “our” means the Dental Practice. “You” and “your” means our patient.

Contact Information

If you have any questions or would like additional information regarding this Notice, please contact our Privacy Official:

Email: info@ptortho.com

Our Commitment to Your Privacy

The privacy of your health information is important to us. We understand that your health information is personal, and we are committed to protecting it. This Notice explains how we may use and disclose your protected health information for treatment, payment, healthcare operations, and other legally permitted purposes.

Protected health information includes demographic and medical information that may identify you and relates to your past, present, or future physical or mental health condition and healthcare services.

We are required by law to:

• Maintain the privacy of your protected health information.
• Provide you with this Notice of our legal duties and privacy practices.
• Follow the terms of the Notice currently in effect.

Last Revision Date

This Notice was last revised on August 1, 2021.

How We May Use or Disclose Your Health Information

The following examples describe ways we may use or disclose your health information. These examples are not exhaustive, but they outline common and legally permitted uses.

Common Uses and Disclosures

• Treatment: We may use your health information to provide dental treatment or coordinate care with specialists, physicians, or other healthcare professionals.
• Payment: We may use and disclose your information to obtain payment from insurance providers or health plans.
• Healthcare Operations: Information may be used for internal operations such as quality assurance, staff training, audits, legal compliance, and business planning.
• Appointment Reminders: We may contact you by phone, text, voicemail, email, postcard, or letter regarding appointments.
• Treatment Alternatives and Related Services: We may inform you about treatment options, benefits, or services that may interest you.
• Family and Friends: We may disclose relevant information to family members or friends involved in your care or payment for your care unless you object.
• Business Associates: We may share information with trusted third-party service providers who assist with practice operations. These providers are contractually required to protect your information.

Less Common Uses and Disclosures

• Required by Law: When disclosure is mandated by federal or state law.
• Public Health Activities: Including disease prevention, reporting abuse or neglect, recalls, and public health investigations.
• Victims of Abuse or Neglect: Information may be shared with appropriate government authorities when required.
• Health Oversight Activities: For audits, inspections, investigations, or licensing purposes.
• Legal Proceedings: In response to court orders, subpoenas, or lawful legal requests.
• Law Enforcement: For investigations, identifying suspects, or reporting crimes.
• Coroners and Funeral Directors: When necessary for official duties.
• Organ and Tissue Donation: To authorized donation organizations.
• Research Purposes: When approved under applicable privacy and ethical guidelines.
• Serious Threats to Health or Safety: When necessary to prevent harm.
• Specialized Government Functions: Including military, national security, or correctional institution purposes.
• Workers’ Compensation: To comply with workers’ compensation laws and related programs.

Authorization for Other Uses and Disclosures

Any uses or disclosures not described in this Notice will only occur with your written authorization unless otherwise permitted or required by law. You may revoke your authorization in writing at any time, except where action has already been taken in reliance on that authorization.

Your Rights Regarding Your Health Information

You have certain rights regarding your protected health information. Requests to exercise these rights must be submitted in writing to our Privacy Official.

• Right to Access and Review: You may request copies of your health records in electronic or paper form.
• Right to Amend: You may request corrections to incomplete or inaccurate information.
• Right to Restrict Use and Disclosure: You may request limits on certain uses or disclosures of your information.
• Right to Confidential Communications: You may request communications through alternative methods or locations.
• Right to an Accounting of Disclosures: You may request a list of certain disclosures made during the previous six years.
• Right to a Paper Copy: You may request a printed copy of this Notice at any time.
• Right to Notification of a Security Breach: You will be notified if a breach compromises the privacy or security of your health information.

Special Protections for Certain Health Information

Federal and state laws may provide additional protections for certain information, including HIV-related information, substance abuse treatment records, mental health records, and genetic information.

Changes to This Notice

We reserve the right to update this Notice at any time. Any revisions will apply to all health information maintained by our practice. Updated versions will be posted in our office and on our website, if applicable.

Effective date of this Notice: 05/01/2020.

Filing a Privacy Complaint

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Official or with the U.S. Department of Health and Human Services, Office for Civil Rights.

We will not retaliate against you for filing a complaint.

Ensuring Your Information Remains Confidential

No mobile information will be shared with third parties or affiliates for marketing or promotional purposes. All other categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.