Notice of Privacy Practices

Your information. Your rights. Our responsibilities.

This Notice of Privacy Practices describes how Halex Pediatric Dentistry and Orthodontics (“Halex,” “we,” “us,” or “our”) may use and disclose your protected health information (“PHI”) and explains your rights regarding your health information.

Please review this Notice carefully. Halex Pediatric Dentistry and Orthodontics is committed to protecting the privacy and security of the health information entrusted to us by our patients and their families.

Your rights

When it comes to your health information, you have certain rights.

Get a Copy of Your Health Information

You have the right to inspect and obtain a copy of your medical and dental records and other health information that we maintain about you, subject to certain legal limitations.

You may request your records in paper or electronic form. We may charge a reasonable, cost-based fee as permitted by law.

Ask Us to Correct Your Health Information

You may request that we correct health information about you that you believe is incorrect or incomplete.

We may deny your request in certain circumstances, but if we do, we will provide you with an explanation.

Request Confidential Communications

You may ask us to contact you in a specific way or at a specific location.

For example, you may request that we contact you only by phone, email, text message, or at a particular address.

We will accommodate reasonable requests as required by applicable law.

Ask Us to Limit What We Use or Share

You may request that we limit how we use or disclose your health information for treatment, payment, or health care operations.

We are not required to agree to every request, except as required by law.

If you pay for a service or item entirely out of pocket and request that we not disclose information about that service or item to your health plan for payment or health care operations, we will honor that request unless disclosure is required by law.

Get a List of Certain Disclosures

You may request an accounting of certain disclosures of your health information made by us during the six years before the date of your request.

This accounting generally does not include disclosures made for treatment, payment, health care operations, disclosures you authorized, or certain other disclosures excluded by law.

Get a Copy of This Notice

You may request a paper copy of this Notice at any time. You may also obtain a copy electronically.

Choose Someone to Act for You

If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make decisions regarding your health information on your behalf, subject to applicable law.

For children and minors, parents, legal guardians, and other authorized representatives generally may exercise rights on behalf of the minor patient. These rights may be limited in certain circumstances by federal or state law.

Get Notified of a Breach

If a breach occurs that compromises the privacy or security of your unsecured protected health information, you have the right to be notified as required by law.

File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with Halex Pediatric Dentistry and Orthodontics or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

Your choices

For certain health information, you may tell us your preferences about what we share.

You may ask us to share information with a family member, close friend, or other person involved in your care or payment for your care.

If you are unable to tell us your preference, such as in an emergency, we may use our professional judgment to determine whether a disclosure is in your best interest.

How we may use and disclose your health information

We may use and disclose your health information without your written authorization for the purposes described below, as permitted or required by law.

For Treatment

We may use and disclose your health information to provide, coordinate, and manage your dental and orthodontic care.

For example, we may share information with dentists, orthodontists, physicians, specialists, laboratories, dental professionals, or other health care providers involved in your care.

For Payment

We may use and disclose your health information to bill and collect payment for services we provide.

For example, we may provide information to your dental or medical insurance company to obtain payment or determine coverage for services.

For Health Care Operations

We may use and disclose your health information for activities necessary to operate our practice and provide quality care.

These activities may include quality assessment and improvement, employee and provider training, credentialing, auditing, compliance activities, billing and collection activities, patient safety, and managing our practice.

Appointment Reminders

We may use your health information to contact you about appointments, including by telephone, voicemail, text message, email, patient portal, or other communication methods you have provided to us.

Treatment Alternatives and Health-Related Services

We may contact you about treatment alternatives or other health-related services that may be of interest to you.

Individuals Involved in Your Care

We may disclose relevant health information to a family member, close friend, caregiver, or other person involved in your care or payment for your care when permitted by law.

Business Associates

We may disclose health information to third-party service providers who perform services on our behalf, such as billing companies, information technology providers, electronic health record providers, laboratories, document management services, or other administrative service providers.

Our business associates are required to appropriately safeguard your health information and comply with applicable privacy requirements.

Required by Law

We may use or disclose your health information when required to do so by federal, state, or local law.

Public Health Activities

We may disclose health information for public health activities permitted by law, including preventing or controlling disease, reporting certain conditions, or notifying appropriate authorities when required.

Abuse, Neglect, or Domestic Violence

We may disclose health information to appropriate government authorities when required or permitted by law to report suspected abuse, neglect, or domestic violence.

Health Oversight Activities

We may disclose health information to governmental agencies for activities authorized by law, including audits, investigations, inspections, licensing activities, and disciplinary proceedings.

Legal Proceedings and Law Enforcement

We may disclose health information when permitted or required by law in response to court orders, subpoenas, warrants, or certain other legal or law enforcement requests.

Serious Threats to Health or Safety

We may use or disclose health information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, consistent with applicable law.

Workers’ Compensation

We may disclose health information as authorized by and necessary to comply with workers’ compensation laws and similar programs.

Organ and Tissue Donation

We may disclose health information to organizations involved in organ, eye, or tissue donation and transplantation when permitted by law.

Medical Examiners and Funeral Directors

We may disclose health information to medical examiners, coroners, and funeral directors as permitted by law.

Research

We may use or disclose health information for research purposes when permitted by law and appropriate privacy protections are in place.

Disaster Relief

We may disclose health information to organizations involved in disaster-relief efforts so that your family or other persons responsible for your care may be notified about your condition or location.

Uses and disclosures that require your written authorization

Certain uses and disclosures of your health information require your written authorization.

Generally, we will obtain your written authorization before:

• Using or disclosing psychotherapy notes, when applicable.
• Using or disclosing your health information for marketing purposes when authorization is required by law.
• Using or disclosing photographs, videos, or other images of you for marketing, promotional, educational, or social media purposes, beyond what is needed for treatment or your dental record.
• Selling your health information, except where otherwise permitted by law.

Other uses and disclosures not described in this Notice will be made only with your written authorization unless otherwise permitted or required by law.

If you provide written authorization, you may revoke it at any time in writing, except to the extent we have already relied upon the authorization.

Electronic communications

If you provide us with your telephone number, mobile phone number, or email address, we may use that information to communicate with you regarding appointments, treatment, billing, insurance, or other matters related to your care.

Electronic communications, including text messages and email, may carry privacy and security risks. You may request an alternative method of communication as permitted by law.

Minors and pediatric patients

Because Halex Pediatric Dentistry and Orthodontics provides care to children and adolescents, we recognize the importance of protecting pediatric patient information.

Parents, legal guardians, and other legally authorized representatives generally may exercise applicable HIPAA rights on behalf of a minor patient. However, federal and Virginia law may provide circumstances in which a minor may consent to certain health care services or may have privacy rights independent of a parent or guardian.

Halex will follow applicable federal and state law when determining whether a parent, guardian, or other individual may access or receive a minor patient’s health information.

Special protections for certain information

Certain types of health information may receive additional protection under federal or state law.

Halex will comply with applicable laws governing specially protected health information, including where applicable, information related to mental health, substance use disorder treatment, HIV/AIDS, genetic information, reproductive health care, and other protected information.

Nondiscrimination and language assistance

Halex Pediatric Dentistry and Orthodontics complies with applicable federal civil rights laws, including Section 1557 of the Affordable Care Act, and does not discriminate on the basis of race, color, national origin, sex, age, or disability.

We provide, free of charge and in a timely manner: language assistance services (such as qualified interpreters and information translated into other languages) to patients and families with limited English proficiency, and appropriate auxiliary aids and services (such as qualified sign language interpreters and information in alternate formats) to individuals with disabilities. To request these services, contact our Privacy Officer using the information at the end of this Notice.

If you believe Halex has failed to provide these services or has discriminated in another way on the basis of race, color, national origin, sex, age, or disability, you may file a grievance with our Privacy Officer or with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, Washington, D.C. 20201, 1-800-368-1019 (TDD: 1-800-537-7697).

Fundraising

If we conduct fundraising activities, we may use certain information to contact you regarding fundraising, as permitted by law.

You have the right to opt out of receiving fundraising communications from us.

Our responsibilities

Halex Pediatric Dentistry and Orthodontics is required by law to:

• Maintain the privacy and security of your protected health information.
• Provide you with this Notice describing our legal duties and privacy practices.
• Follow the terms of the Notice currently in effect.
• Notify you as required by law if a breach occurs that compromises the privacy or security of your protected health information.
• Provide you with a copy of this Notice upon request.
• Follow applicable federal and state privacy laws.

We will not use or disclose your health information other than as described in this Notice or as otherwise permitted or required by law unless you provide written authorization.

We reserve the right to change our privacy practices and the terms of this Notice. If we make material changes, we may update this Notice. The revised Notice will apply to all health information we maintain and will be made available as required by law.

Notice of breach

If we discover a breach of your unsecured protected health information that requires notification under applicable law, we will notify you as required by law.

Questions or privacy complaints

If you have questions about this Notice or believe your privacy rights have been violated, please contact:

Halex Pediatric Dentistry and Orthodontics
Privacy Officer: Anastasia Theodorogiannis
Phone: 757-240-5711
Email: info@hrpediatricdentistry.com
Mailing Address: 580 City Center Blvd, Ste. 2E, Newport News, VA 23606

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.