Notice of Privacy Practices

Effective Date: December 2024

Our Pledge Regarding Health Information

East Lake Dental is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to notify you following a breach of unsecured PHI.

How We May Use and Disclose Your Health Information

Treatment

We may use your health information to provide, coordinate, or manage your dental care. For example, we may share information with other healthcare providers involved in your care, such as specialists or your primary care physician.

Payment

We may use and disclose your health information to bill and collect payment for services. This includes sending claims to your dental insurance company and sharing information necessary to process your claims.

Healthcare Operations

We may use your health information for our healthcare operations, including quality assessment, training, accreditation, and other administrative functions.

Other Permitted Uses

We may also use or disclose your health information:

• To contact you for appointment reminders
• To inform you about treatment alternatives or health-related benefits
• To family members or friends involved in your care (with your permission)
• As required by law
• For public health activities
• To report suspected abuse or neglect
• For health oversight activities
• In response to court orders or legal proceedings
• To coroners, funeral directors, and organ donation organizations
• For workers' compensation purposes

Uses Requiring Your Authorization

We will obtain your written authorization before using or disclosing your health information for:

• Marketing purposes
• Sale of your health information
• Most uses of psychotherapy notes (if applicable)
• Other purposes not described in this notice

You may revoke your authorization at any time in writing.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your dental records. We may charge a reasonable fee for copies.

Right to Amend

You have the right to request an amendment to your health information if you believe it is incorrect or incomplete.

Right to an Accounting of Disclosures

You have the right to request a list of disclosures we have made of your health information (excluding treatment, payment, and healthcare operations).

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information. We are not required to agree to your request unless it relates to disclosures to your health plan for services you paid for in full.

Right to Request Confidential Communications

You have the right to request that we communicate with you in a certain way or at a certain location (for example, only by mail or at a specific phone number).

Right to a Paper Copy of This Notice

You have the right to receive a paper copy of this notice upon request.

Our Responsibilities

We are required to:

• Maintain the privacy of your health information
• Provide you with this notice of our privacy practices
• Abide by the terms of this notice
• Notify you if we cannot accommodate a requested restriction
• Notify you if a breach occurs that may have compromised your health information

Changes to This Notice

We reserve the right to change this notice and make the new provisions effective for all health information we maintain. We will post a current copy in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information

For questions about this notice, to exercise your rights, or to file a complaint, contact:

• Phone: (248) 437-4119
• Email: elakedental@gmail.com
• Address: 201 S. Lafayette St., South Lyon, MI 48178