DRAFT — requires professional review

This is a STRUCTURE, not finished legal text. HIPAA requires specific content, and HHS publishes model notices a compliance professional adapts for the practice. Every marked gap below must be filled and the whole notice approved before publication (L1). This page must not go live until a qualified reviewer has approved the wording.

Notice of PRivacy PRactices

How protected health information about you may be used and disclosed, and how you can get access to it.

Last updated: Not yet published

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.

Reviewer: HIPAA requires this header statement verbatim and prominently displayed. Confirm formatting meets 45 CFR 164.520.

Our commitment

Beaver Lake Orthodontics is required by law to protect the privacy of your health information, to give you this notice describing our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your health information

For treatment

We use your health information to provide orthodontic care — for example, to plan treatment, and to share records with your general dentist or another specialist involved in your care.

For payment

We may use and disclose your information to bill and collect payment for treatment, including sharing it with a dental benefit plan to determine coverage.

For health care operations

We may use your information to run the practice — for example, scheduling, quality review, and training.

Appointment reminders and related services

We may contact you to remind you of an appointment, or to tell you about treatment options.

Reviewer: describe the actual reminder methods once Greyfinch is live, and address text messaging only if the number’s provider is covered by a business associate agreement (O4).

Other uses required or permitted by law

We may use or disclose your information without your authorization where the law requires or permits it — for example, for public health activities, reporting suspected abuse or neglect, health oversight, judicial proceedings, law enforcement in specified circumstances, coroners and medical examiners, serious threats to health or safety, specialized government functions, and workers’ compensation.

Reviewer: confirm this list against current federal rules and any Arkansas provisions that are more protective.

Uses that always require your written authorization

Most uses and disclosures of psychotherapy notes, uses for marketing, and any sale of your health information require your written authorization. Photographs used in advertising require a separate signed release. You may revoke an authorization in writing at any time.

Your rights

To inspect and get a copy of your health information.
To ask us to correct information you believe is wrong or incomplete.
To ask for a list of certain disclosures we have made.
To ask us to limit how we use or disclose your information.
To ask us to contact you in a specific way or at a specific address.
To ask us not to share information with a health plan when you have paid for that service in full yourself.
To get a paper copy of this notice, even if you agreed to receive it electronically.
To be notified if there is a breach of your unsecured health information.

Reviewer: state how each right is exercised — who to contact, in what form, and the response times the law requires.

Our duties

We are required to maintain the privacy of your health information, to give you notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. We reserve the right to change this notice and to make the revised notice effective for information we already hold. A current copy will always be available at this address and in our office.

Complaints

If you believe your privacy rights have been violated, you may complain to us, and you may complain to the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you in any way for filing a complaint.

Reviewer: add the current HHS Office for Civil Rights complaint address and web address.

Who to contact

Beaver Lake Orthodontics
602 N 13th Street, Rogers, AR 72756
479-633-7993

Reviewer: name the practice’s Privacy Officer and give a direct contact method. HIPAA requires a named contact.

Effective date

Reviewer: set the effective date. It cannot precede the date the practice begins treating patients.

Questions about this page

Call 479-633-7993 or email info@beaverlakeortho.com.Please don’t email medical information.