HIPAA Patient Privacy Notice

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.

If you have any questions about this Notice please contact our Privacy Officer or any staff member in our office. 817-623-9699
Privacy Officer: Mitchell Mason Contact number: 817-623-9699
External HIPAA Privacy and Security Resource contact: David Wornica, CHPSE. Contact number: 469-342-8300 ext. 628.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out your treatment, collect payment for your care and manage the operations of this clinic. It also describes our policies concerning the use and disclosure of this information for other purposes that are permitted or required by law. It describes your rights to access and control your protected health information. “Protected Health Information” (PHI) is information about you, including demographic information that may identify you, that relates to your past, present, or future physical or mental health or condition and related health care services.

We are required by Federal law to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. You may obtain revisions to our Notice of Privacy Practices by accessing our website, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

A. Uses and Disclosures of Protected Health Information

By applying to be treated in our office, you are implying consent to the use and disclosure of your protected health information by your doctor, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to bill for your health care and to support the operation of the practice.

Uses and Disclosures Based Upon Your Implied Consent

Following are examples of the types of uses and disclosures of your protected health care information we will make, based on this implied consent. These examples are not meant to be exhaustive but to describe the types of uses and disclosures that may be made by our office.

Treatment

We may use and disclose your protected health information (PHI) to provide, coordinate, or manage your healthcare and related services. This includes sharing your information with other healthcare providers, such as specialists or laboratories, who assist in your treatment at the request of your dentist.

Our office may also use HIPAA-compliant artificial intelligence (AI) tools to support your care. These tools help review dental images (such as X-rays) and other health data to assist with diagnosis and treatment planning. AI is used to enhance, not replace, your provider’s clinical judgment. All AI-assisted findings are reviewed and approved by a licensed dentist before being used in your treatment.

Payment

Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.

Healthcare Operations

We may use or disclose, as needed, your protected health information in order to support the business activities of this office. These activities may include, but are not limited to, quality assessment activities, employee review activities and staff training.

We will share your protected health information with third party “Business Associates” that perform various activities such as billing or transcription services. Whenever an arrangement between our office and a Business Associate involves the use or disclosure of your protected health information, we will have a written agreement with that Business Associate that protects your privacy.

Uses and Disclosures With Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law.

Other Permitted and Required Uses

• Required by Law
• Public Health Activities
• Communicable Diseases
• Health Oversight
• Abuse or Neglect
• Legal Proceedings
• Law Enforcement
• Workers’ Compensation

Special Protections

Substance Use Disorder Records

• May be used for treatment, payment, and operations as permitted by law.
• Cannot be used in legal proceedings without authorization or court order.
• Other disclosures require written authorization.

Reproductive Health Information

• May be used for treatment, payment, and operations.
• Will not be used to investigate lawful reproductive care.
• Other disclosures require written authorization.

B. Your Rights

• Right to inspect and copy your protected health information
• Right to request restrictions
• Right to confidential communications
• Right to amend your records
• Right to an accounting of disclosures
• Right to obtain a paper copy of this notice

C. Complaints

You may complain to us, to the Texas Attorney General’s Office, or the Secretary of Health and Human Services, if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

This notice was published and becomes effective on February 16, 2026.