Effective Date: April, 16th, 2026
6637 West Peoria Ave, Suit D‑2
Glendale, AZ 85302
Phone: (623) 300‑2550
Email:
This document explains how your health information may be used or shared, and outlines the rights you have regarding that information. Please review it carefully.
Our Responsibilities
My Dental & Implants is obligated under the Health Insurance Portability and Accountability Act (HIPAA) to safeguard your protected health information (PHI), provide this Notice, and follow the privacy rules that apply to us. We must also inform you if a breach occurs that compromises your information.
How We May Use and Disclose Your Health Information
- Treatment
Your PHI may be used or shared so we can provide dental services, coordinate care, or consult with other professionals involved in your treatment.
Examples include:
- Clinical evaluation and treatment planning
- Sending X‑rays or records to specialists
- Communicating with dental labs or other providers
- Payment
We may use or share your information to handle billing and payment matters, including:
- Submitting claims to your insurance
- Checking eligibility and coverage
- Responding to questions from your insurer
Insurance plans may require details about your diagnosis or the procedures performed.
- Health Care Operations
We can use PHI for purposes that help us run My Dental & Implants efficiently and maintain quality care. Such activities include:
- Quality improvement and case reviews
- Staff education and evaluation
- Accreditation, licensing, or compliance activities
Other Situations Where We Are Allowed to Disclose PHI
Federal law permits or requires PHI to be disclosed without written authorization in certain situations, such as:
- Public health reporting
- Cases of suspected abuse or neglect
- Health oversight reviews or audits
- Workers’ compensation claims
- Certain law enforcement requests
- Court orders or other legal processes
- Coroner or medical examiner needs
- Situations involving safety threats
When Your Written Authorization Is Required
We will not use or release your PHI for the following unless you sign a written authorization:
- Non‑care‑related marketing
- Selling your health information
- Most uses of psychotherapy notes
- Any uses not already described in this Notice
You may withdraw your authorization at any time by submitting a written request.
Your Rights Regarding Your Health Information
- Right to Inspect or Obtain Copies
You may review or request copies of your PHI, including electronic versions. Fees may apply for printing, copying, or mailing.
- Right to Request Restrictions
You may ask us to limit how your information is used or disclosed.
We are not required to agree unless:
- You paid fully out of pocket for a service, and
- You ask us not to share that information with your insurance plan.
- Right to Choose How We Contact You
You may request that we communicate with you in a specific way, such as at a different address, phone number, or email.
Reasonable requests will be honored.
- Right to Request an Amendment
If you believe your PHI is incomplete or incorrect, you may request that we amend it.
If we deny your request, we will provide a written explanation.
- Right to an Accounting of Disclosures
You may request a record of certain disclosures we have made in the past six years, excluding those for treatment, payment, or health care operations.
- Right to a Copy of This Notice
You may request a paper copy of this Notice at any time.
Changes to This Notice
We may update or revise this Notice at any time. Any new version will be available in our office and upon request.
Questions or Complaints
If you have concerns about how your information is used, or if you want to exercise your rights, you may contact:
My Dental & Implants
6637 West Peoria Ave, Suite D‑2
Glendale, AZ 85302
Phone: (623) 300‑2550
Email:
You may also file a complaint with the U.S. Department of Health & Human Services.
We will not retaliate against you for filing a complaint.
