HIPAA NOTICE OF PRIVACY PRACTICES
Last Revised: February 10, 2026
This NOTICE describes how your dental information may be used and disclosed and how you can get access to that information. It applies to the health information used to make decisions about your care that Machen Family Dentistry (MFD) generates or maintains.
Machen Family Dentistry (MFD) is required by law to protect the privacy of your dental information, give you notice of MFD’s legal duties and privacy practices, and follow the current notice. It will be followed by all employees and volunteers of the dental care components of MFD.
1. Uses and Disclosures of Your Health Information
The following categories describe some of the ways that MFD may use or disclose your health information without your authorization.
Treatment: MFD will use your health information to provide you with dental or medical treatment/services and for treatment activities of other health care providers. Examples: Your health information may be used by the members involved in your care. MFD maintains health information about its patients in an electronic medical record that allows MFD to share medical information for treatment purposes. This facilitates access to medical information by other health care providers who provide care to you.
Payment: MFD may use your health information for payment activities such as to determine plan coverage, to bill/collect, or to help another health care provider with payment activities. Any individuals assigned to your account will have access to all account information, including itemized services. Example: Your health information may be released to an insurance company to get pre-approval of payment for services.
Operations: MFD may use your health information for uses necessary to run its dental care business, such as to conduct quality assessment activities, train, or arrange for legal services. Example: MFD may use your health information to conduct internal audits to verify proper billing procedures.
Health Information Exchange: MFD may participate in a health information exchange (HIE), an organization in which providers exchange patient information to facilitate health care, avoid duplication of services, and reduce the likelihood of errors. By participating in HIE, MFD may share your health information with other providers who participate in the PHI or participants of other PHI’s. If you do not want your medical information in the HIE, you must request a restriction.
Business Associates: MFD may disclose your health information to other entities that provide a service to MFD or on MFD’s behalf that requires the release of your health information, such as billing service, but only if MFD has received satisfactory assurance that the other entity will protect your health information.
Individuals Involved in Your Care or Payment for Your Care: MFD may release your health information to a friend, family member, or legal guardian who is involved in your care or who helps pay for your care.
Research: MFD may use and disclose your health information to researchers for research. Your health information may be disclosed for research without your authorization if the authorization requirement has been waived or revised by a committee charged with making sure the disclosure will not pose a great risk to your privacy, or that steps are being taken to protect your health information to researchers to prepare for research under certain conditions, and to researchers who have signed an agreement promising to protect the information. Health information regarding deceased individuals can be released without authorization under certain circumstances.
2. Uses and Disclosures of Health Information Required/Permitted by Law
The following categories describe some of the ways that MFD may be allowed or required to use or disclose your health information without your authorization.
Required by Law/ Law Enforcement: MFD may use and disclose your health information if required by federal, state, or local law, such as for workers’ compensation, and if requested by law enforcement officials in response to a court order or to locate a suspect.
Public Health and Safety: MFD may use and disclose your health information to prevent a serious threat to the health and safety of you, others, or the public and for public health activities, such as to prevent injury. 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.
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.
Fundraising: We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving the communications
Food and Drug Administration (FDA) and Health Oversight Agencies: MFD may disclose health information about incidents related to food, supplements, product defects, or post-marketing surveillance to the FDA and manufacturers to enable product recalls, repairs, or replacements; and to health oversight agencies for activities authorized by law, such as audits or investigations.
Lawsuits/Disputes:
If you are involved in a lawsuit/dispute and have not waived the physician-patient privilege, MFD may disclose your health information under a court/administrative order, subpoena, or discovery request after attempting to inform you of the request.
Coroners, Medical Examiners, and Funeral Directors: MFD may release your health information to coroners, medical examiners, or funeral directors to enable them to carry out their duties.
National Security/Intelligence Activities and Protective Services: MFD may release your health information to authorized national security agencies for the protection of certain persons or to conduct special investigations.
Military/ Veterans: MFD may disclose your health information to military authorities if you are an armed forces or reserve member.
Inmates: If you are an inmate of a correctional facility or are in custody of law enforcement, MFD may release your health information to a correctional facility or law enforcement official so they may provide your health care or protect the health and safety of you or others.
3. Your rights regarding your health information
You have the rights described below in regard to the health information that MFD maintains about you. You must submit a written request to exercise any of these rights.
Right to Inspect/Copy: You have the right to inspect and get a copy of health information maintained by MFD and information used in decisions about your care.
Right to Amend: If you believe health information MFD created is inaccurate or incomplete, you may ask MFD to amend it. You must provide a reason for your request. MFD cannot delete or destroy any information already included in your records. MFD may deny your request if you ask to amend information that MFD did not create (unless the creator is not available to make the amendment); that is not part of the health information MFD maintains; that is not part of the information you are permitted by law to inspect and copy; or that is accurate and complete.
Right to Accounting of Disclosures: You have the right to ask for a free list of disclosures MFD has made for your dental health information. MFD is not required to list all disclosures, such as those you authorized.
Right to Request Restrictions: You have the right to request a restriction or limit on how MFD uses or discloses your health
information. You must be specific in your request for restrictions. You may restrict disclosure of your health information to a health plan only if the disclosure is for payment or health care operations and pertains to a health care item or service for which you pay out-of-pocket in full at the time they are provided. MFD is not required to agree to other requests. IF MFD agrees or is required to comply, MFD will comply with the requests unless the information is required to be disclosed by law or is needed in case of emergency. Example: you may want to pay cash in advance for services rather than have your insurance billed.
Right to request confidential contacts: You have the right to request that MFD contact you about dental issues in a certain way, such as by mail. You must specify how or where you wish to be contacted; MFD will try to accommodate reasonable requests.
Right to a copy of this notice: You have the right to a paper or electronic copy of this notice.
4. Changes to this Notice
MFD reserves the right to change this notice and to make the revised notice effective for health information MFD created or received about you prior to the revision, as well as to information it receives in the future. Revised notices will be posted and available at each location where medical services are provided and on MFD’s website.
5. Right to be Notified
You have the right to be notified of breaches of your unsecured health information.
6. Complaints
If you believe your privacy rights have been violated, you may file a complaint with MFD. Submit a written complaint within 180 days of when you knew or should have known of the circumstance leading to the complaint. You will not be retaliated against for filling a complaint
7. SUD Treatment Information
If we receive or maintain any information about you from a substance use disorder treatment program that is covered by 42CFR Part 2(a the Part 2 Program) through a general consent you provide to the Part 2 Program to use and disclose the Part 2 Program record for purposes of treatment, payment or health care operations, we may use and disclose your Part 2 Program record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your Part 2 Program record through specific consent you provide to us or another third party, we will use and disclose your Part 2 Program record only as expressly permitted by you in your consent as provided to us.
8. Other uses and Disclosures of PHI
Your authorization is required, with a few expectations, for disclosure of psychotherapy notes, use or disclosure of PHI for marketing, and for sale of PHI. We will also obtain your written authorization before using or disclosing your PHI for purposes other than those provided for in this Notice (or as otherwise permitted or required by law.) You may revoke authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already acted in reliance on the authorization.
9. Alternative Communication.
You have the right to request that we communicate with you about your health information by alternative means or at alternative locations. You must make your request in writing. Your request must specify the alternative means or location and provide satisfactory explanation of how payments will be handled under the alternative means or location you request. We will accommodate all reasonable requests. However, if we are unable to contact you using the ways or locations you have requested, we may contact you using the information we have.