Effective date: August 1, 2026
Your rights
- Receive a paper or electronic copy of your records.
- Ask us to correct information you believe is incorrect or incomplete.
- Request confidential communications and certain restrictions.
- Receive an accounting of certain disclosures.
- Receive a paper copy of this notice and appoint a legally authorized representative.
- File a complaint without retaliation.
How we use and share information
We may use and share health information for treatment, payment, and healthcare operations, and for other purposes permitted or required by law.
Treatment and coordination with other healthcare practitioners
We may share relevant information with another dentist, dental specialist, physician, hospital, pharmacy, laboratory, imaging provider, or other healthcare practitioner involved in your treatment. This may include clinical notes, medical and dental history, X-rays, photographs, treatment plans, referral information, and other information reasonably necessary to coordinate care.
At your written request, and as permitted by law, we may provide copies of your records to another provider or person you designate.
Payment and practice operations
We may use and share information to bill for services, submit insurance or Medicaid claims, verify coverage, coordinate benefits, manage the practice, improve quality, train staff, perform audits, and work with service providers that appropriately safeguard information.
Other legally permitted disclosures
We may disclose information for public health and safety, health oversight, workers' compensation, certain law-enforcement or legal requests, disaster relief, research that satisfies legal requirements, and other purposes permitted or required by law.
Substance use disorder treatment information
If we receive information from a program covered by 42 CFR Part 2, we will use and disclose it only as permitted by applicable law and a valid consent. We will not use those records in a proceeding against you without written consent or a qualifying court order and subpoena.
Our responsibilities
We are required to maintain the privacy and security of protected health information, provide notice of reportable breaches, and follow the duties and practices described in the notice currently in effect.
Complaints and questions
Contact our Office Manager using the details below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for making a complaint.
Office Manager, Stephen Family Dentistry2037 S Buckner Blvd, Dallas, TX 75217
Telephone: (214) 398-2545
Email: office@stephenfamilydentistry.com
