NOTICE OF PRIVACY PRACTICES

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.

Effective Date: February 12, 2026

Mint Dental Works is committed to protecting the privacy and security of your protected health information (PHI). This Notice of Privacy Practices describes how we may use and disclose your PHI, your rights regarding your PHI, and our legal duties to protect it.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information. 

We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We are required to follow the duties and privacy practices described in this Notice and provide you with a copy upon request.

We will not use or disclose your information other than as described in this Notice unless you authorize us to do so in writing. If you authorize us to use or disclose your information, you may revoke that authorization at any time in writing, except to the extent that we have already relied upon it.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your dental and health care services. This includes sharing information with other healthcare providers involved in your care.

Payment

We may use and disclose your PHI to obtain payment for services provided to you. This may include billing, insurance claims processing, eligibility verification, utilization review, and collection activities.

Health Care Operations

We may use and disclose your PHI for health care operations necessary to run our practice. Examples include quality assessment activities, employee training, licensing, accreditation, auditing, compliance programs, and business planning. 

We will make reasonable efforts to limit the use and disclosure of PHI to the minimum necessary to accomplish the intended purpose, except where otherwise permitted or required by law.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Certain uses and disclosures of your PHI require your written authorization. Except as otherwise permitted by law, we will obtain your authorization before using or disclosing your information for purposes not described in this Notice.

We will not sell your protected health information or use it for certain marketing purposes without your written authorization.

You may revoke an authorization at any time by submitting a written request, except to the extent we have already acted in reliance upon it.

SPECIAL PROTECTIONS FOR CERTAIN HEALTH INFORMATION

Some information, such as HIV-related information, genetic information, alcohol and/or substance use disorder treatment records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records.

SPECIAL PROTECTIONS FOR SUBSTANCE USE DISORDER RECORDS

Certain health information we maintain — specifically records related to substance use disorder (SUD) diagnosis, treatment, or referral — may be protected by federal law under 42 CFR Part 2 and may receive additional protections beyond those provided by HIPAA.

We will not use or disclose protected SUD records without your written consent except as expressly permitted or required by law.

Restrictions on Legal Proceedings

Protected SUD records, or testimony describing their contents, may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless:

• You provide specific written consent; or
• A court issues an order that complies with applicable federal law.

Notice of Redisclosure

Information disclosed with your consent may be subject to redisclosure by the recipient and may no longer be protected under federal privacy laws. Recipients of protected SUD records may be prohibited from further disclosure except as permitted by law or with your express written consent.

Single Consent for Treatment, Payment, and Health Care Operations

If you provide written consent for the disclosure of protected SUD records for treatment, payment, and health care operations, we may use and disclose those records as permitted by law. This consent may be revoked at any time except to the extent we have already relied upon it.

OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES

We may use or disclose your PHI without your authorization when permitted or required by law,including:

• As required by federal, state, or local law
• For public health activities
• To report abuse, neglect, or domestic violence
• For health oversight activities
• In response to court orders or legal proceedings
• To law enforcement officials when permitted by law
• To coroners, medical examiners, and funeral directors
• For approved research purposes
• To prevent a serious threat to health or safety
• For specialized government functions
• For workers' compensation purposes

YOUR RIGHTS

You have the following rights regarding your protected health information:

• The right to inspect and obtain a copy of your health information
• The right to request amendments to your health records
• The right to request restrictions on certain uses and disclosures (although we are not required to agree)
• The right to request confidential communications
• The right to receive an accounting of certain disclosures
• The right to obtain a paper copy of this Notice upon request

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice and make the revised Notice effective for all protected health information that we maintain.

Any updated Notice will be available in our office and posted on our website.

QUESTIONS OR COMPLAINTS

If you have questions about this Notice or believe your privacy rights have been violated, you may contact us using the information below.

Privacy Contact

Mint Dental Works

Phone: 503-254-1323

Email: om@mintdentalworks.com

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting the Office for Civil Rights Complaint Portal. Filing a complaint will not affect your care or treatment in any way.