NOTICE OF PRIVACY PRACTICES
Chandler Dental Excellence
Effective: February 16, 2026
THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS IT.
OUR COMMITMENT
We are required by federal and Arizona law to:
• Protect the privacy of your protected health information (PHI)
• Provide this Notice describing how we may use and share PHI
• Follow the terms of this Notice while it is in effect
We may update our privacy practices at any time and the revised Notice will apply to all PHI we maintain. Updated versions will be available in our office and on our website.
HOW WE MAY USE AND SHARE YOUR INFORMATION
➤ Treatment
We may use or share PHI to care for you, coordinate services, or consult with other providers.
➤ Payment
We may share PHI with insurance plans or third parties to obtain payment for services.
➤ Health Care Operations
We may use PHI for practice management, quality review, credentialing, auditing, and customer service.
➤ Individuals Involved in Your Care
We may disclose relevant PHI to family or others you identify. You may request limitations at any time.
➤ Appointment and Service Notices
We may contact you with appointment reminders or information about care or benefits.
Tell us if you prefer not to receive voicemail or email messages.
➤ As Required or Permitted by Law
We may disclose PHI without authorization when required for:
• Public health reporting, abuse/neglect reporting, safety threats
• Oversight agencies and audits
• Court orders or law enforcement needs
• Coroners, medical examiners, organ/tissue donation
• Workers’ compensation
• Military or national security activities
➤ Business Associates
We may share PHI with vendors who assist us (billing, labs, shredding, IT). They must protect your information.
➤ Marketing, Fundraising & Sale of PHI
We will not sell your PHI. We require written authorization for marketing not related to your care or fundraising beyond contact information. You have the right to opt out of any fundraising communications before they occur. You may opt out at any time.
➤ Substance Use Disorder (SUD) Records
SUD treatment records are specially protected under 42 CFR Part 2. We may document and maintain information but will not share without written consent before disclosure.
They cannot be used in legal proceedings without your permission, unless a court orders it.
➤Reproductive Health Information
We provide special protection for your reproductive health information (e.g., contraception, pregnancy care, abortion). This data is not shared for civil, criminal, or administrative investigations unless legally required, in which case we disclose only the minimum necessary details. You may also request additional privacy or communication limits for this sensitive information.
➤Redisclosure Notice
General PHI: Once PHI is shared with others who are not covered by HIPAA or Part 2, federal law does not require them to protect your information, and it may be redisclosed.
SUD Records: Information about substance use disorder diagnosis, treatment, or referral for treatment remains protected under 42 CFR Part 2 and cannot be redisclosed by most recipients without a new consent or specific legal authority.
YOUR RIGHTS
You have the right to:
1. Inspect and request a copy of your health information.
2. Ask for corrections if information is incorrect or incomplete.
3. Request restrictions on how we use or share PHI (we may not be able to agree in all cases).
4. Require us not to bill your insurance for a service you pay for entirely out-of-pocket.
5. Receive confidential communications in a specific way (mail only, no voicemail, etc.).
6. Request an accounting of certain disclosures we have made.
7. Receive a copy of this Notice at any time.
8. Authorize or revoke permission for uses not described here.
9. Receive notification if your PHI is involved in a breach.
COMPLAINTS
To report a privacy concern, contact our office.
You may also file a complaint with:
U.S. Department of Health & Human Services — Office for Civil Rights
Phone: 1-800-368-1019
We will not retaliate against you for filing a complaint.
CONTACT: Chandler Dental Excellence Privacy Officer • 480-786-1734
You will be asked to sign a separate form acknowledging receipt of this Notice
480-786-1734