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NOTICE OF PRIVACY PRACTICES

Dental Health Associates of Arkansas, P.A.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to provide you with this Notice which describes our privacy practices and legal duties, as well as your rights concerning your health information. We must follow the privacy practices described in this Notice while it is in effect. This Notice takes effect September 23, 2013, and will remain in effect until we replace it.

We may change our privacy practices, and/or this Notice, from time to time. If we make any material revisions to this Notice, we will provide you with a copy of the revised Notice which will specify the date on which such revised Notice becomes effective. The revised Notice will apply to all of your health information from and after the revised date. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION WITHOUT WRITTEN AUTHORIZATION

Uses and Disclosures for Treatment, Payment, and Health Care Operations. We must disclose your health information to you, as described in this Notice. We also use your health information and share it with others, in electronic or other format, to help treat your condition, coordinate payment for that treatment, and run our business operations.

The following are examples of situations where we do not need your written authorization to use your health information or share it with others:

Uses and Disclosures for the Public Need

Required by Law:

We may use or disclose your health information when we are required by law to do so.

REQUIREMENT FOR WRITTEN AUTHORIZATION

We may use your health information for treatment, payment, health care operations or other purposes described in this Notice. You may also give us written authorization to use your health information or to disclose it to anyone for any purpose. We cannot use or disclose your health information for any reason except those described in this Notice unless you give us written authorization to do so. For example, we require your written authorization for uses and disclosures of health information for marketing purposes, and disclosures that constitute a sale of your health information. Marketing is a communication about a product or service that encourages recipients of the communication to purchase or use the product or service. You may obtain a form to revoke your authorization by using the contact information listed at the end of this Notice. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect.

COMPLAINTS

If you are concerned that we may have violated your privacy rights or have any other complaints, you may complain to us using the contact information above. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. If you choose to file a complaint, we will not retaliate or take action against you for your complaint.