Patient Rights & Legal
Notice of Privacy Practices
This notice describes how medical and dental information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Effective: July 1, 2026
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. This notice is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act.
Our Duties Regarding Your Health Information
Clayton Dental Studio is required by law to maintain the privacy of your Protected Health Information (PHI) and to provide you with this notice of our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this notice while it is in effect.
We reserve the right to change the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
How We May Use and Disclose Your Health Information
The following categories describe the ways that we may use and disclose your health information. For each category of uses or disclosures we will explain what we mean and try to give some examples.
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your dental care and any related services. For example, we may disclose your PHI to a dental specialist or other healthcare provider to whom we refer you for treatment.
Payment
We may use and disclose your PHI to obtain payment for services we provide to you. For example, we may need to give your health plan information about dental treatment you received so your health plan will pay us or reimburse you for the treatment.
Health Care Operations
We may use and disclose your PHI in connection with our healthcare operations. Health care operations include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
Appointment Reminders
We may use and disclose your PHI to contact you as a reminder that you have an appointment for treatment or medical care at our practice.
Treatment Alternatives
We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services
We may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.
Required by Law
We will disclose your PHI when required to do so by federal, state, or local law.
Public Health Activities
We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability.
Abuse, Neglect, or Domestic Violence
We may disclose your PHI to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence.
Health Oversight Activities
We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement
We may release your PHI if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime; about a death we believe may be the result of criminal conduct; about criminal conduct at our practice; and in emergency circumstances to report a crime.
Coroners, Medical Examiners, and Funeral Directors
We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.
Organ and Tissue Donation
If you are an organ donor, we may release your PHI to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Research
We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Serious Threats to Health or Safety
We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone able to help prevent the threat.
Military and Veterans
If you are a member of the armed forces, we may release your PHI as required by military command authorities.
Workers' Compensation
We may release your PHI for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Uses and Disclosures Requiring Your Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI as described in the authorization. However, we are unable to take back any disclosures we have already made with your authorization.
The following uses and disclosures will be made only with your written authorization:
- Most uses and disclosures of psychotherapy notes
- Uses and disclosures of PHI for marketing purposes
- Disclosures that constitute a sale of PHI
- Other uses and disclosures not described in this notice
Your Rights Regarding Your Health Information
You have the following rights regarding the health information we maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy your PHI that may be used to make decisions about your care. Usually, this includes medical and billing records. To inspect and copy your PHI, you must submit your request in writing to our Privacy Officer. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
Right to Amend
If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide a reason that supports your request.
Right to an Accounting of Disclosures
You have the right to request an 'accounting of disclosures.' This is a list of the disclosures we made of your PHI for purposes other than treatment, payment, and health care operations. To request this list, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years.
Right to Request Restrictions
You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request unless the request is to restrict disclosure to a health plan for payment or health care operations and the PHI pertains solely to a health care item or service for which you have paid out of pocket in full.
Right to Request Confidential Communications
You have the right to request that we communicate with you about dental matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our office or by contacting us.
Right to Notification of a Breach
You have the right to be notified in the event that we (or a Business Associate) discover a breach of your unsecured PHI. Notice of any such breach will be provided to you in accordance with applicable law.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
To file a complaint with our practice, contact our Privacy Officer using the information below. All complaints must be submitted in writing.
You will not be penalized for filing a complaint. To file a complaint with the U.S. Department of Health and Human Services, visit www.hhs.gov/hipaa/filing-a-complaint or call 1-800-368-1019 (TDD: 1-800-537-7697).
Contact Our Privacy Officer
For questions about this notice, to exercise your rights, or to file a complaint, please contact our Privacy Officer:
Clayton Dental Studio — Privacy Officer
12235 Will Clayton PKWY, Suite #4, Humble, TX 77346
This Notice of Privacy Practices is effective as of July 1, 2026.
A copy of this notice is available at our office and upon request. We are required to provide you with this notice at your first visit and upon request.
Related documents: Website Privacy Policy · Accessibility Statement
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