NOTICE OF PRIVACY PRACTICES

Crowley Family Dentistry This notice describes how medical/dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Effective Date:1.1.2026

OUR COMMITMENT TO YOUR PRIVACY

Crowley Family Dentistry is committed to protecting the privacy of your health information. We create a record of the care and services you receive at our practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by this practice.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

The following describes the ways we may use and disclose health information that identifies you (“Protected Health Information” or “PHI”). Not every use or disclosure will be listed; however, we have described all of the categories of uses and disclosures.

Uses and Disclosures for Treatment, Payment, and Health Care Operations

Treatment: We may use your PHI to provide, coordinate, or manage your dental care and related services. For example, your PHI may be shared with a dental specialist or other health care provider to whom we refer you.

Payment: We may use and disclose your PHI to obtain payment for services we provide to you. For example, we may submit claims to your dental insurance company and include information about the treatment you received.

Health Care Operations: We may use and disclose your PHI in connection with our health care operations, including quality assessment, employee review, training, licensing, and conducting or arranging for other business activities. For example, we may use your PHI to evaluate the performance of our staff in caring for you.

Appointment Reminders: We may use and disclose your PHI to contact you as a reminder that you have an appointment for treatment or dental care. We may contact you by phone, text, email, or mail.

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.

Other Permitted Uses and Disclosures

We may also use or disclose your PHI without your written authorization in the following circumstances:

As 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 such as reporting communicable diseases, injuries, or reactions to medications.
Health Oversight Activities: We may disclose your PHI to a health oversight agency for audits, investigations, inspections, and licensure purposes.
Lawsuits and Disputes: We may disclose your PHI in response to a court or administrative order, subpoena, or other lawful process.
Law Enforcement: We may release your PHI if required by law enforcement officials for specific law enforcement purposes.
Coroners, Medical Examiners, and Funeral Directors: We may release your PHI to a coroner or medical examiner to identify a deceased person or determine the cause of death.
Serious Threats to Health or Safety: We may use and disclose your PHI to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Workers’ Compensation: We may release your PHI for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.
Military and Veterans: If you are a member of the armed forces, we may release your PHI as required by military command authorities.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Other uses and disclosures of your PHI not covered by this notice or the laws that apply to us will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes, uses and disclosures of your PHI for marketing purposes, and any sale of your PHI. You may revoke an authorization in writing at any time. Upon receipt of your revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on your authorization.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding 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. To access your dental records, submit a written request to our office. We may charge a reasonable fee for the cost 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. We may deny your request under certain circumstances.

Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures” — a list of disclosures we have made of your PHI in the six years prior to the date of your request, other than disclosures made for treatment, payment, or health care operations.

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. We are not required to agree to your request, except in limited circumstances required by law.

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.

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.

Right to be Notified of a Breach: You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.

HOW TO EXERCISE YOUR RIGHTS

To exercise any of the rights described above, please submit a written request to:

Privacy Officer

Crowley Family Dentistry

204 W Main St, Crowley, TX 76036

(817) 297-1801

CHANGES TO THIS NOTICE

We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our office. The notice will contain the effective date on the first page.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer at the address listed above. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

CONTACT INFORMATION

For questions about this notice or to report a concern, please contact: