Privacy Policy

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Sun Mountain Dental Care is committed to protecting the privacy and confidentiality of your Protected Health Information (PHI). PHI includes information about your past, present, or future health condition, dental care, or payment for healthcare services that can identify you.

How We May Use and Disclose Your Health Information

Treatment

We may use your health information to provide dental care and treatment. This may include sharing information with dentists, dental specialists, physicians, dental laboratories, hygienists, or other healthcare professionals involved in your care.

Example: We may send dental impressions or information to a dental laboratory to fabricate crowns, bridges, or dentures.

Payment

We may use and disclose your information to obtain payment for services we provide to you. This may include billing insurance companies, processing claims, verifying insurance eligibility, or collecting payment.

Example: We may provide information about procedures performed so your insurance provider can reimburse the treatment.

Healthcare Operations

We may use your information to operate our dental practice and ensure quality care. This includes quality assessments, staff training, licensing, auditing, accreditation, compliance reviews, and administrative functions necessary to run the practice efficiently.

Appointment Reminders and Treatment Communication

We may contact you to remind you of dental appointments or provide information about treatment alternatives, post-treatment care, or other dental health services that may benefit you.

Individuals Involved in Your Care

Unless you object, we may share relevant information with family members, guardians, or others involved in your care or payment for your care.

Public Health and Safety

We may disclose your health information for public health activities such as reporting disease, preventing or controlling health conditions, or reporting adverse events related to medical devices or medications.

Law Enforcement and Legal Proceedings

We may disclose your information when required by law, subpoena, court order, or other legal process. We may also release information to law enforcement authorities when legally required.

Health Oversight Activities

Government agencies that oversee healthcare systems, licensing, or compliance may request information to ensure healthcare providers are following regulations.

Serious Threats to Health or Safety

We may disclose your information if necessary to prevent a serious threat to your health or safety or the safety of others.

Your Rights Regarding Your Health Information

You have the following rights regarding your protected health information:

• The right to inspect and obtain copies of your dental and health records.
• The right to request corrections or amendments if you believe information is inaccurate.
• The right to request restrictions on certain uses or disclosures of your information.
• The right to request confidential communications (for example, contacting you at a specific phone number).
• The right to receive an accounting of disclosures made of your health information.
• The right to obtain a paper or electronic copy of this Notice of Privacy Practices at any time.

Our Responsibilities

Sun Mountain Dental Care is required by law to maintain the privacy of your protected health information and provide you with this notice describing our legal duties and privacy practices. We must follow the privacy practices described in this notice while it is in effect. We reserve the right to change our privacy practices and update this notice as permitted by law.

Questions or Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office:

Sun Mountain Dental Care
Privacy Officer: Office Manager
Address: 2101 E. Sun Mountain Avenue, Suite 107, Wasilla, AK 99654
Phone: (907) 357-5757

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Filing a complaint will not affect the care you receive and there will be no retaliation.

HIPAA Acknowledgement of Receipt of Privacy Practices

I acknowledge that I have received or been offered a copy of the Notice of Privacy Practices for Sun Mountain Dental Care explaining how my health information may be used and disclosed.

Patient Name (Print): _______________________________
Signature: ________________________________________
Date: _____________________________________________
Relationship to Patient (if applicable): __________________