Notice of Privacy Practices
Dental Elements – Confidence Starts with a Smile!
Effective Date: February 16, 2026
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.
Our Legal Duty
We are required by law to maintain the privacy of your protected health information (PHI). We must provide you with this notice of our legal duties and privacy practices. If a breach occurs that may have compromised the privacy or security of your unsecured PHI, we will notify you in writing via first-class mail (or via email if you have agreed to electronic notice). We are required to abide by the terms of the notice currently in effect.
Uses and Disclosures of Health Information
We use and disclose your information for Treatment, Payment, and Healthcare Operations:
- Treatment: We may share info with other healthcare providers treating you.
- Payment: We use your info to bill and collect payment for services.
- Healthcare Operations: We use info for quality assessment, practitioner evaluation, and training.
Special Protections for Substance Use Disorder (SUD) Records
Some information we receive may be protected under federal law (42 CFR Part 2):
- Stricter Consent: SUD records generally require your specific written consent before we can use or disclose them for treatment, payment, or healthcare operations.
- Legal Proceedings: These records cannot be used in civil, criminal, administrative, or legislative proceedings against you without your written consent or a specific court order. A standard subpoena is not sufficient.
- Redisclosure Warning: Once we disclose your info to a third party, it may be redisclosed by the recipient and may no longer be protected by federal privacy laws.
Your Rights
- Access: You have the right to look at or get copies of your health records.
- Right to Amend: You have the right to request that we amend your health information if you believe it is incorrect or incomplete.
- Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI for the last 6 years.
- Restrictions: You may request limits on how we use or share your PHI. We must agree to a request to restrict disclosure to a health plan if you have paid for the service in full out-of-pocket.
- Fundraising: You have the right to opt-out of any fundraising communications.
Questions and Complaints
We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
If you want more information or have concerns, please contact us. You may also submit a written complaint to the U.S. Department of Health and Human Services.
Contact Information:
- Address: 1781 15th Street, Denver, CO 80202
- Phone: 303-309-4093
- Email: [email protected]
Acknowledgment of Receipt
I have received a copy of the Notice of Privacy Practices for Dental Elements. Patient Signature: ___________________________ Date: ___________________________