NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW CAREFULLY.

OUR LEGAL DUTIES

Martinez & West Orthodontics is required by law to maintain the privacy and security of your protected health information (“PHI”), provide notice of our privacy practices, and notify you following a breach of unsecured PHI. We must follow the practices described in this Notice while it is in effect. We reserve the right to change this Notice and will post updated versions in our office and on our website.

HOW WE USE AND DISCLOSE HEALTH INFORMATION

Treatment

We may use and disclose PHI to provide orthodontic care, including consultations, imaging, treatment planning, referrals, laboratory services, and coordination with other healthcare providers.

Payment

We may use PHI for billing, claims processing, payment collection, and insurance eligibility verification.

Healthcare Operations

We may use PHI for practice operations such as:

• Quality improvement
• Staff training
• Compliance activities
• Business management
• Credentialing and licensing

Communication with You

We may contact you using:

• Phone calls
• Voicemail
• Text messaging
• Email
• Patient portal messaging

These communications may include appointment reminders, treatment updates, financial information, or administrative notifications.

You may request alternative communication methods.

Individuals Involved in Care

We may share information with parents, guardians, or individuals involved in your care or payment unless you request otherwise, subject to applicable laws.

Digital Imaging and Records Sharing

Orthodontic treatment involves digital photographs, radiographs, and scans. These may be used for treatment, coordination with providers, or insurance documentation.

Marketing and Practice Communications

We will obtain authorization before using your PHI for marketing purposes where required by law.

Social Media and Educational Use

Patient images or testimonials will only be used with written authorization

Required by Law / Public Health / Oversight

We may disclose PHI as required by law or for permitted purposes such as public health reporting, health oversight activities, judicial proceedings, workers’ compensation, or law enforcement.

Substance Use Disorder Records (42 CFR Part 2)

If applicable, we will comply with special federal confidentiality protections.

OTHER USES AND DISCLOSURES

We will obtain written authorization for:

• Marketing uses where required
• Sale of PHI
• Psychotherapy notes
• Uses not described in this Notice

Authorization may be revoked in writing.

YOUR RIGHTS

You have the right to:

• Access Your Records
• Request copies in paper or electronic format.
• Request Amendment
• Accounting of Disclosures
• Request Restrictions
  
  • You may request limits on disclosures. We must comply with requests to restrict disclosure to a health plan if you pay in full out-of-pocket.
• Confidential Communications

Breach Notification

You will be notified if your unsecured PHI is compromised.

QUESTIONS OR COMPLAINTS

If you have questions or concerns, contact our Privacy Officer. You may also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you.

PRIVACY OFFICER CONTACT INFORMATION

Privacy Officer Name: Vicki D’Ambrosio
Phone: 513-598-9800
Email: vicki@marƟnezortho.com