HIPAA Notice of Privacy Practices

Effective Date: November 3, 2026

At Lefton Family Dentistry, protecting your personal health information is an important part of our commitment to providing quality dental care. This Notice of Privacy Practices explains how we may use and disclose your Protected Health Information (PHI), your rights regarding that information, and our responsibilities under HIPAA.

1. Our Commitment to Your Privacy

We are required by law to maintain the privacy and security of your Protected Health Information, provide you with this Notice, and follow the privacy practices described in the Notice currently in effect.

Protected Health Information includes information that identifies you and relates to your past, present, or future physical or oral health, dental treatment, or payment for healthcare services.

2. How We May Use and Disclose Your Health Information

For Treatment

We may use and share your health information to provide, coordinate, and manage your dental care. This may include sharing information with dental specialists, laboratories, and other healthcare professionals involved in your treatment.

For Payment

We may use and disclose your health information to bill and collect payment for dental services. This may include submitting insurance claims, verifying coverage, processing payments, and communicating with billing partners.

For Healthcare Operations

We may use your information for activities necessary to operate our practice, including quality assessment, staff training, licensing, administrative functions, compliance, and improving patient care.

Appointment Reminders and Treatment Alternatives

We may contact you by telephone, text message, email, or mail regarding upcoming appointments, treatment alternatives, and other health-related services, as permitted by applicable law.

Other Permitted Disclosures

We may disclose your Protected Health Information without written authorization when permitted or required by law, including:

• Public health reporting and legally required disclosures.
• Reporting suspected abuse, neglect, or domestic violence when authorized by law.
• Health oversight activities, audits, and investigations.
• Judicial or administrative proceedings and valid legal requests.
• Law enforcement purposes under circumstances permitted by law.
• Preventing or reducing a serious and imminent threat to health or safety.
• Workers’ compensation matters as authorized by law.

Uses Requiring Written Authorization

Certain uses and disclosures require your written authorization, including most uses of psychotherapy notes, certain marketing activities, sales of PHI, and other uses not otherwise permitted by law.

You may revoke your authorization in writing at any time, except to the extent that we have already acted in reliance on it.

3. Your Rights Regarding Your Health Information

As a patient of Lefton Family Dentistry, you have the following rights regarding your Protected Health Information:

• Right to Access: You may inspect and obtain a copy of your dental records, subject to certain exceptions. Reasonable, cost-based fees may apply where permitted by law.
• Right to Request Amendment: You may request corrections to information you believe is incorrect or incomplete.
• Right to an Accounting of Disclosures: You may request a list of certain disclosures made during the preceding six years.
• Right to Request Restrictions: You may ask us to limit certain uses or disclosures. We must honor qualifying restrictions on disclosures to a health plan for services paid in full out of pocket, unless disclosure is required by law.
• Right to Confidential Communications: You may request that we communicate with you using a particular method or at a specific location.
• Right to a Paper Copy: You may request a paper copy of this Notice at any time.
• Right to Breach Notification: You will be notified of a breach of unsecured PHI when notification is required by law.
• Right to a Personal Representative: A legally authorized representative may exercise applicable privacy rights on your behalf.

To exercise these rights, please contact our office using the information provided below.

4. Our Responsibilities

Lefton Family Dentistry is committed to maintaining appropriate safeguards to protect patient information. We are responsible for:

• Maintaining the privacy and security of your PHI.
• Following applicable HIPAA privacy requirements.
• Providing patients with this Notice.
• Notifying affected individuals of reportable breaches.
• Following the terms of the Notice currently in effect.
• Obtaining written authorization when required by law.

5. Changes to This Notice

We reserve the right to revise this Notice as necessary to reflect changes in applicable laws, regulations, or our privacy practices.

Any revised Notice may apply to health information we already maintain and information we receive in the future. The current Notice will be available at our office and on our website.

6. Questions and Complaints

If you have questions about this Notice or believe your privacy rights have been violated, you may contact Lefton Family Dentistry or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.

For information about filing a HIPAA complaint, please visit HHS HIPAA Complaint Information .

We will not retaliate against you for filing a complaint or exercising your privacy rights.

7. Contact Information

To submit a privacy-related request or contact our practice regarding this Notice, please use the following information:

8. Acknowledgment of Receipt

Patients may be asked to acknowledge receipt of this Notice of Privacy Practices during their first visit to Lefton Family Dentistry.

This acknowledgment confirms that the Notice was provided or made available. It does not waive any patient privacy rights.

If a patient declines to sign, we will document our good-faith effort to obtain acknowledgment as required by applicable HIPAA regulations.

Our Commitment to Patient Confidentiality

At Lefton Family Dentistry, your privacy is an important part of the trust you place in our team. We are committed to treating your personal and dental health information with professionalism, care, and respect.