Notice of Privacy Practices
How we use, disclose, and protect your protected health information
Privacy Officer Contact
Name: Melodie Simon
Phone: 254-771-2515
External HIPAA Resource: David Wornica, CHPSE | 469-342-8300 ext. 628
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Protected Health Information (PHI) is information about you, including demographic information that may identify you, that relates to your past, present, or future physical or mental health or condition and related health care services.
A. Uses and Disclosures of Protected Health Information
By applying to be treated in our office, you are implying consent to the use and disclosure of your protected health information by your doctor, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you.
Uses and Disclosures Based Upon Your Implied Consent
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This includes sharing your information with other healthcare providers, such as specialists or laboratories, who assist in your treatment. Our office may also use HIPAA-compliant artificial intelligence (AI) tools to support your care by reviewing dental images and other health data to assist with diagnosis and treatment planning. All AI-assisted findings are reviewed and approved by a licensed dentist before being used in your treatment.
Payment
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
Healthcare Operations
We may use or disclose, as needed, your protected health information in order to support the business activities of this office. These activities may include quality assessment activities, employee review activities and staff training. We may contact you to remind you of your appointment, and we may call you by name in the reception area when your doctor is ready to see you.
Business Associates
We will share your protected health information with third party Business Associates that perform various activities such as billing and transcription services for the practice. We have written agreements with these associates that protect the privacy of your information.
Marketing and Communications
We may use or disclose your protected health information to provide you with information about treatment alternatives or other health-related benefits and services. We may also send you newsletters about our practice and the services we offer. You may request that these materials not be sent to you.
Uses Requiring Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization. For example, we may use your demographic information and treatment dates for fundraising activities with your written authorization. You may revoke any authorization at any time, in writing.
Permitted Uses Without Authorization
We may use or disclose your protected health information in the following situations without your consent or authorization:
- Required By Law: We may use or disclose your information as required by law, in compliance with the law and limited to the relevant requirements.
- Public Health: We may disclose information for public health activities and purposes to control disease, injury or disability.
- Communicable Diseases: We may disclose your information to a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading the disease.
- Health Oversight: We may disclose information to a health oversight agency for activities such as audits, investigations, and inspections.
- Abuse or Neglect: We may disclose your information if we believe you have been a victim of abuse, neglect or domestic violence to the appropriate governmental entity.
- Legal Proceedings: We may disclose information in response to court orders, subpoenas, discovery requests or other lawful process.
- Law Enforcement: We may disclose information for law enforcement purposes as permitted by law, including identification, location, crime victims, or medical emergencies.
- Workers' Compensation: We may disclose information to comply with workers' compensation laws and similar legally-established programs.
Special Protections
Substance Use Disorder Records
If we maintain records related to substance use disorder treatment, those records are subject to additional confidentiality protections under federal law. These records may be used and disclosed for treatment, payment, and health care operations as permitted by law. Other uses and disclosures require your written authorization or must otherwise be permitted or required by law.
Reproductive Health Information
Information related to reproductive health care may be subject to additional privacy protections under federal law. We will not use or disclose reproductive health information for the purpose of investigating or imposing liability on an individual for seeking, obtaining, providing, or facilitating lawful reproductive health care.
B. Your Rights
Right to Inspect and Copy
You may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the information. However, you may not inspect or copy psychotherapy notes or information compiled in reasonable anticipation of civil, criminal, or administrative proceedings.
Right to Request Restrictions
You may request a restriction of your protected health information by asking us not to use or disclose any part of your information. Your request must be in writing. Your provider is not required to agree to the restriction, but if we do agree, we may not violate that restriction unless it is needed to provide emergency treatment.
Right to Request Confidential Communications
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. Please make this request in writing.
Right to Request Amendment
You may have the right to request an amendment of protected health information about you. In certain cases, we may deny your request for amendment. If we deny your request, you have the right to file a statement of disagreement with us.
Right to Accounting of Disclosures
You have the right to receive an accounting of certain disclosures we have made of your protected health information for purposes other than treatment, payment or healthcare operations. This right is subject to certain exceptions, restrictions and limits.
Right to Paper Copy
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
C. Complaints
You may complain to us, to the Texas Attorney General's Office, or the Secretary of Health and Human Services, if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer at the contact information listed above. We will not retaliate against you for filing a complaint.
This notice was published and becomes effective on February 16, 2026.