NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
EFFECTIVE DATE: 23rd January 2026
THIS NOTICE DESCRIBES HOW DENTAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Shan Dental (“Covered Entity,” “Practice,” “we,” “us,” “our”) is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the Health Information Technology for Economic and Clinical Health Act (“HITECH”) to maintain the privacy and security of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices.
Protected Health Information (PHI): Any individually identifiable health information, including dental records, radiographs, treatment plans, clinical notes, payment records, and any other information that identifies you or could be used to identify you.
Dental Health Information: Clinical data, including but not limited to dental examinations, radiographic images, periodontal charts, treatment histories, referral communications, and oral health assessments.
TREATMENT We may use or disclose your dental PHI to provide, coordinate, or manage your dental treatment and related services. This includes:
● Consultations with dental specialists (orthodontists, oral surgeons, periodontists, endodontists)
● Laboratory services for crowns, bridges, and prosthetic devices
● Referrals to other healthcare providers
● Emergency dental care coordination
● Continuing education activities involving de-identified case studies
PAYMENT We may use and disclose dental PHI to obtain payment for services provided, including:
● Billing and collection activities
● Insurance claim processing and adjudication
● Verification of coverage and benefits
● Utilization review and pre-authorization activities
● Medical necessity determinations
HEALTHCARE OPERATIONS We may use and disclose dental PHI for healthcare operations, including:
● Quality assessment and improvement activities
● Credentialing and peer review activities
● Training programs for dental personnel
● Compliance with regulatory requirements
● Business planning and development
● Legal and audit functions
REQUIRED BY LAW We may use or disclose your dental PHI when required by federal, state, or local law, including:
● Court orders and judicial proceedings
● Public health reporting requirements
● Communicable disease reporting
● Child abuse and neglect reporting
● Workers’ compensation claims
MARKETING COMMUNICATIONS We will not use your dental PHI for marketing purposes without your written authorization, except for:
● Face-to-face marketing communications
● Promotional gifts of nominal value
● Treatment recommendations and health education
RIGHT TO REQUEST AMENDMENTS You may request amendments to your dental PHI if you believe it is incorrect or incomplete.
● Requests must be in writing and include reasons for the amendment
● We may deny requests if the information is accurate and complete.
● You may submit a statement of disagreement if your request is denied
RIGHT TO REQUEST RESTRICTIONS You may request restrictions on uses and disclosures of your dental PHI.
● We are not required to agree to restrictions except for disclosures to health plans when you pay out-of-pocket in full.
● Restrictions must be in writing and specify the information and persons involved.
RIGHT TO REQUEST ALTERNATIVE COMMUNICATIONS You may request confidential communications by alternative means or locations.
● Requests must be reasonable and specify alternative contact methods
● We will accommodate reasonable requests without requiring explanations
RIGHT TO AN ACCOUNTING OF DISCLOSURES You may request an accounting of disclosures of your dental PHI for the six years before your request.
● The accounting will not include disclosures for treatment, payment, or healthcare operations.
● The first accounting in 12 months is free; additional requests may incur fees.
RIGHT TO NOTIFICATION OF BREACH You have the right to be notified of any breach of your unsecured dental PHI.
We will make reasonable efforts to use, disclose, and request only the minimum amount of dental PHI necessary to accomplish the intended purpose.
We reserve the right to modify this Notice and establish new provisions, which will be effective for all dental PHI we maintain. Updated notices will be posted in our office and on our website.
