Privacy Policy + HIPAA Notice of Privacy Practices
Effective Date: [Date] | Last Updated: [Date]
This notice describes how medical and dental information about you may be used and disclosed, and how you can access this information. Please review it carefully.
Our Commitment to Your Privacy
At Driftwood Dentistry, we are committed to protecting the privacy and security of your personal health information. We understand that your health information is personal, and we take our responsibility to safeguard it seriously. This Privacy Policy and HIPAA Notice of Privacy Practices describes your rights as a patient and our obligations under the Health Insurance Portability and Accountability Act (HIPAA) and applicable state law.
Who We Are
Driftwood Dentistry is a dental practice located in Ponte Vedra Beach, Florida. For purposes of this notice, "we," "us," and "our" refer to Driftwood Dentistry and all members of our workforce, including our dentists, hygienists, administrative staff, and any business associates acting on our behalf.
Contact Information: Driftwood Dentistry [Street Address] Ponte Vedra Beach, FL [ZIP] Phone: [Phone Number]
Email: [Email Address]
Your Protected Health Information (PHI)
Protected Health Information (PHI) refers to any information we create or receive about your past, present, or future physical or oral health condition; the dental care we provide to you; or payment for that care — when that information can reasonably be used to identify you. This includes information in your dental records, billing records, and any communications between you and our office.
How We Use and Disclose Your Information
We use and share your health information in the ways described below. Some uses and disclosures require your authorization; others are permitted or required by law.
Treatment: We use your PHI to provide, coordinate, and manage your dental care. This includes sharing information with other healthcare providers involved in your treatment — for example, a specialist we refer you to, an oral surgeon, or a dental laboratory fabricating a restoration for you.
Payment: We may use and disclose your PHI to bill for services and collect payment. This may include sharing information with your dental insurance company (if applicable) or a third-party financing provider to obtain reimbursement for the care we provide.
Healthcare Operations: We may use your PHI for internal operations such as quality assessment, staff training, scheduling, and practice management. We may also use de-identified information (information that cannot be traced back to you) for general business analytics.
Appointment Reminders: We may contact you by phone, text, or email to remind you of upcoming appointments or follow up after treatment. If you would prefer we use a specific method of contact or avoid certain numbers or addresses, please let us know and we will accommodate your request.
Required by Law: We are required by law to disclose your PHI in certain circumstances, including to public health authorities for disease reporting, to law enforcement under specific legal processes, in response to a valid court order or subpoena, and to comply with other applicable federal or state regulations.
Business Associates: We may share your PHI with third-party vendors and service providers ("business associates") who perform functions on our behalf, such as billing services, IT support, or dental laboratories. All business associates are required by law and by contract to protect your information in accordance with HIPAA.
Disclosures Requiring Your Authorization: For any uses or disclosures not described in this notice — including most uses of psychotherapy notes, marketing communications, or the sale of your PHI — we will ask for your written authorization. You may revoke any authorization you have given us at any time in writing, except to the extent we have already acted in reliance upon it.
Your Rights as a Patient
You have the following rights with respect to your protected health information.
Right to Access Your Records: You have the right to inspect and receive a copy of your dental and health records. Requests must be submitted in writing. We will respond within 30 days. We may charge a reasonable fee for copying and mailing records.
Right to Request Amendments: If you believe that information in your records is incorrect or incomplete, you may request that we amend it. We will review your request and respond in writing. We may deny your request if we determine the information is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request a list of certain disclosures we have made of your PHI. This right applies to disclosures made for purposes other than treatment, payment, or healthcare operations.
Right to Request Restrictions: You may request that we limit how we use or share your information. We are not required to agree to all requests, but we will accommodate reasonable restrictions when possible. We are required to agree if the request is to restrict disclosure to a health plan for services you have paid for in full out of pocket.
Right to Request Confidential Communications: You may ask us to contact you in a specific way or at a specific location — for example, to only call your cell phone, not your home number. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice: You have the right to receive a paper copy of this notice at any time, even if you have agreed to receive it electronically. Ask our front desk and we will provide one.
Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our office or directly with the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr/privacy. We will not retaliate against you for filing a complaint.
Website Privacy
Our website may collect basic information such as your name, email address, and phone number when you submit a contact form or sign up for updates. This information is used only to respond to your inquiries and communicate with you about our practice. We do not sell, rent, or trade your personal information to third parties. Our website may use cookies and analytics tools (such as Google Analytics) to understand how visitors interact with our site. This information is collected in aggregate and does not identify you personally. You may disable cookies in your browser settings at any time.
Changes to This Notice
We reserve the right to update this notice at any time. Any changes will be effective immediately upon posting to our website. The current version will always be available at our front desk and on our website. If we make material changes to how we use or disclose your PHI, we will notify you directly.
Contact Us
If you have questions about this notice or about how we handle your health information, please contact us:
Driftwood Dentistry [Street Address], Ponte Vedra Beach, FL [ZIP] Phone: [Phone Number]
Email: [Email Address]
This notice is effective as of [Date]. A copy of this notice is available at our front desk upon request.