Joint Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO THIS INFORMATION, AND YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

You have the right to a paper or electronic copy of this Notice and to discuss it with the Bright Smiles Privacy Officer using the contact information in Section 12.

1. Who This Notice Covers

This Joint Notice of Privacy Practices applies to the following Bright Smiles entities and their service locations:

• Bright Smiles Dental Center PC, dba Bright Smiles - 907 Buford Rd, Suite 100, Cumming, GA 30041 - 678-922-8282
• Apex Dental PC, dba Bright Smiles - 845 Scenic Hwy S, Suite 300, Lawrenceville, GA 30046 - 770-277-5588
• Dawsonville Smiles LLC, dba Bright Smiles - 78 Dawson Village Way N, Suite 170, Dawsonville, GA 30534 - 706-525-7127

The Bright Smiles entities covered by this Notice may coordinate patient care and conduct joint quality-assessment and improvement activities. Each entity covered by this Notice has agreed to follow its terms with respect to protected health information created or received in connection with its participation.

Information Sharing Among Bright Smiles Entities

As permitted by law, the Bright Smiles entities and providers covered by this Notice may use and share health information with one another as necessary for treatment, payment, and health care operations described in this Notice, including coordination of care and joint quality-assessment and improvement activities. This Joint Notice does not authorize uses or disclosures that are otherwise prohibited by law.

2. Your Rights

Get an Electronic or Paper Copy of Your Health Record

You can ask to see or receive an electronic or paper copy of your dental record and other health information we maintain about you. We will provide access within the time required by law and may charge a reasonable, cost-based fee when permitted.

Ask Us to Correct Your Health Record

You can ask us to correct health information you believe is incorrect or incomplete. We may deny the request in certain circumstances and will explain the reason in writing as required by law.

Request Confidential Communications

You can ask us to contact you in a specific way or at a different address. We will accommodate reasonable requests as required by law.

Ask Us to Limit What We Use or Share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We generally are not required to agree. If we agree, we will follow the restriction except as permitted by law, including when emergency treatment makes disclosure necessary. If you pay completely out of pocket for an item or service, you may ask us not to disclose that information to your health plan for payment or health care operations, and we will honor the request unless disclosure is required by law.

Get a List of Certain Disclosures

You may ask for an accounting of certain disclosures generally covering the six years before your request. Certain disclosures, including many for treatment, payment, and health care operations and other disclosures excluded by law, will not appear on the accounting. We will provide the accounting as required by law and may charge a reasonable fee for additional accountings within a 12-month period when permitted.

Get a Copy of This Notice

You may request a paper copy at any time, even if you agreed to receive it electronically. We will provide it promptly.

Choose Someone to Act for You

A person with legal authority to act for you, such as a legal guardian or an authorized personal representative, may exercise your privacy rights as permitted by law. We may verify that authority before acting.

File a Complaint

You may complain to the Bright Smiles Privacy Officer or the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

3. Your Choices

Family, Friends and Others Involved in Your Care

You may tell us whether we may share relevant information with a family member, close friend, caregiver, or another person involved in your care or payment. If you cannot tell us your preference, we may share relevant information when permitted by law and when we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

Disaster Relief

We may share relevant information with an organization assisting with disaster-relief efforts when permitted by law.

Marketing, Sale of Information and Psychotherapy Notes

We will obtain your written authorization when HIPAA requires it for marketing, for a sale of PHI, and for most uses or disclosures of psychotherapy notes if we maintain such notes. You may revoke an authorization in writing as permitted by law.

Fundraising

If we contact you for fundraising, you may tell us not to contact you again. If we maintain Part 2 records and those records would be used for fundraising, we will provide the notice and choice required by applicable Part 2 law before such communications.

4. How We Typically Use or Share Your Health Information

Treat You

We may use your health information and share it with health care professionals who are treating you. Bright Smiles providers covered by this Notice may access and share information as permitted by law when coordinating treatment across locations.

Run Our Health Care Operations

We may use and share information to operate our practices and improve care, including quality assessment and improvement, staff training, credentialing, auditing, compliance, patient-service activities, and other health care operations permitted by law. The Bright Smiles entities covered by this Notice may also conduct joint quality-assessment and improvement activities.

Bill for Your Services

We may use and share information to bill and obtain payment from dental or medical benefit plans and other responsible parties, including permitted payment activities involving the Bright Smiles entities covered by this Notice.

5. Other Ways We May Use or Share Your Health Information

We may use or disclose health information for other purposes allowed or required by law, subject to applicable conditions and any more protective federal or state law. Examples include:

• public health and safety activities, including disease prevention, product recalls, reporting adverse reactions, reporting suspected abuse or neglect, and preventing a serious threat to health or safety;
• research when applicable legal requirements are satisfied;
• compliance with federal, state, or local law, including disclosures to HHS for HIPAA compliance review;
• organ and tissue donation requests when applicable;
• coroners, medical examiners, and funeral directors when permitted by law;
• workers’ compensation;
• law-enforcement purposes allowed by law;
• health oversight activities;
• specialized government functions; and
• court or administrative orders, subpoenas, and other lawful legal process as permitted by law.

6. Other Uses and Disclosures

Uses and disclosures not described in this Notice and not otherwise permitted or required by law generally will be made only with your written authorization. You may revoke an authorization in writing, except to the extent we already acted in reliance on it or another legal exception applies.

7. Substance Use Disorder Records

If a Bright Smiles entity covered by this Notice creates, receives, or maintains substance use disorder patient records protected by 42 C.F.R. Part 2, those records receive the protections required by Part 2 in addition to applicable HIPAA protections. Such Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or the court order and subpoena required by law. Additional Part 2 consent, redisclosure, complaint, breach-notification, and fundraising protections will be followed when applicable.

8. More Protective Laws

If another federal or state law provides greater privacy protection or imposes stricter limits on a use or disclosure of particular health information, we will follow the more protective requirement when it applies.

9. Our Responsibilities

• maintain the privacy and security of PHI as required by law;
• provide this Notice describing our legal duties and privacy practices;
• follow the duties and privacy practices described in the Notice currently in effect;
• notify affected individuals following a breach of unsecured PHI when notification is required by law; and
• provide you with a copy of the Notice and information about how to exercise your rights.

10. Business Associates

We may use service providers that require access to PHI to perform functions or services for a Bright Smiles entity covered by this Notice. When HIPAA requires it, those business associates must safeguard PHI and comply with applicable requirements, including use of a Business Associate Agreement or other required safeguard.

11. Changes to This Notice

We may change this Notice and the changes may apply to PHI we already maintain. When required, a revised Notice will be available at participating Bright Smiles offices, upon request, and on the Bright Smiles website. We will retain required documentation of current and prior notices.

12. Questions, Notice Discussion, Privacy Rights or Complaints

Bright Smiles Privacy Officer
Venkatesh Srinivasan
907 Buford Rd, Suite 100
Cumming, GA 30041
Phone: (678) 941-5151
Email: info@brightsmilesga.com

You may contact the Privacy Officer to discuss this Notice, obtain a paper copy, ask how to exercise a privacy right, or make a privacy complaint. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Notice Coverage

This Joint Notice applies to Bright Smiles Dental Center PC, Apex Dental PC, and Dawsonville Smiles LLC, each dba Bright Smiles, at the service locations identified in Section 1.